Dosimetric parameters and safety analysis of 3D-printing non-coplanar template-assisted interstitial brachytherapy for non-centrally recurrent cervical cancer

Cong Wang; Yan Cheng; Yadong Song; Jia Lei; Yiqian Li; Xia Li; Huirong Shi

doi:10.3389/fonc.2023.1174470

Dosimetric parameters and safety analysis of 3D-printing non-coplanar template-assisted interstitial brachytherapy for non-centrally recurrent cervical cancer

Front Oncol. 2023 Oct 26:13:1174470. doi: 10.3389/fonc.2023.1174470. eCollection 2023.

Authors

Cong Wang¹, Yan Cheng¹, Yadong Song¹, Jia Lei¹, Yiqian Li¹, Xia Li¹, Huirong Shi²

Affiliations

¹ Department of Gynecological Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
² Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Abstract

Introduction: The prognosis of patients with non-central recurrent cervical cancer (NRCC) remains poor, and treatment options are limited. We aimed to explore the accuracy and safety of the 3D-printed non-coplanar template (3D-PNCT)-assisted ¹⁹²Ir interstitial brachytherapy (ISBT) in the treatment of NRCC.

Material and methods: A total of 36 patients with NRCC who received 3D-PNCT-guided ¹⁹²Ir ISBT in the First Affiliated Hospital of Zhengzhou University from January 2021 to July 2022 were included in this study. There were 36 3D-PNCTs that were designed and printed. The prescribed dose was 30-36 Gy, divided into five to six times, once a week. To evaluate whether the actual parameters were consistent with the preoperative design, the dosimetric parameters of pre- and postoperative treatment plans were compared, including dose of 90% high-risk clinical target volume (HR-CTV D90), volume percentage of 100% and 150% prescribed dose V_100% and V₁₅₀%, homogeneity index (HI), conformal index (CI), external index (EI), and dose received by 2 cm³ (D2cm³) of the rectum, colon, bladder, and ileum. The safety parameters including occurrence of bleeding, infection, pain, radiation enteritis, and radiation cystitis within 3 months after operation were recorded.

Results: All patients successfully completed the treatment and achieved the goals of the preoperative plan. There was no significant difference in the accuracy (HRCTVD90, V_100%, EI, CI, and HI) and safety (D2cm³ of rectum, colon, bladder, and ileum) parameters of the postoperative plan compared with the preoperative plan (all p>0.05). Major side effects included bleeding at the puncture site (13.9%), postoperative pain (8.3%), acute radiation cystitis (13.9%), and radiation enteritis (19.4%). There were no serious perioperative complications and no grade 3-4 acute radiotherapy side effects.

Conclusion: 3D-PNCT-assisted ¹⁹²Ir ISBT can be accurately and safely applied in the treatment of patients with NRCC.

Keywords: 3D-printing; dosimetry; interstitial brachytherapy; non-centrally recurrent cervical cancer; non-coplanar template.

Grants and funding

This study was funded by the following projects: the 2022 Key Research and Development Project of Henan Province, Application of 3D printing non-coplanar template assisted interstitial brachytherapy in non-central recurrent cervical cancer, 222102310606, the 2022 Key Scientific research project of colleges and universities in Henan Province, The effect of vaginal microorganisms on the efficacy of radiotherapy for cervical squamous cell carcinoma and the related immune mechanism, 22A320059, and the Zhengzhou University Undergraduate Teaching reform project in 2021, The exploration and research of Seminar teaching method combined with TBL model in gynecological clinical teaching, 2021ZZUJGLX197.