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3D-printed brachytherapy in patients with cervical cancer: improving efficacy and safety outcomes

Radiation Oncology volume 19, Article number: 152 (2024) Cite this article

Abstract

Objective

This study aims to evaluate the efficacy and safety of 3D printing technology in brachytherapy for cervical cancer, comparing its outcomes with conventional free hand implantation brachytherapy.

Methods

A total of 50 cervical cancer patients treated at the First Affiliated Hospital of Gannan Medical College from January 2019 to July 2023 were included in this study. Patients were divided into two groups: 25 patients received intensity-modulated radiotherapy (IMRT) combined with 3D-printed brachytherapy, and 25 patients underwent IMRT combined with free hand brachytherapy implantation. Key indicators analyzed included short-term therapeutic effects, survival outcomes, operation times, the number of CT scans, the number of needles inserted, dosimetric parameters, and complications.

Results

The use of 3D-printed brachytherapy significantly improved the safety of radiation therapy operations, especially for large tumors (≥ 30 mm), by providing more precise dose distribution and reducing the radiation doses received by critical organs such as the bladder and rectum. Compared to the artificial implant group (88% prevalence), the 3D-printed brachytherapy group showed a significantly lower incidence of radiation enteritis (29.2% prevalence, p < 0.001). There were no significant differences in other complications between the two groups. For instance, the incidence of radiation cystitis was relatively high in the 3D-printed brachytherapy group (79.2% prevalence) compared to the artificial implant group (64% prevalence, p = 0.240). The median follow-up period in this study was 22.5 months [IQR 18–29]. Among the 49 patients included, 43 had cervical squamous carcinoma and 6 had cervical adenocarcinoma. Short-term therapeutic response rates were comparable, with no significant difference in overall survival observed between the two groups.

Conclusion

3D-printed brachytherapy offers a more effective and safer therapeutic option for patients with cervical cancer, particularly for those with large tumors or complex anatomical structures.

Introduction

Cervical cancer is one of the common malignancies in gynecology [1, 2]. In recent years, the incidence of cervical cancer in China has been on the rise, and the average age of onset is gradually decreasing, showing a trend towards affecting younger women [3, 4]. Surgery, radiotherapy, and chemotherapy are the primary treatment modalities for cervical cancer [5]. Brachytherapy, an essential component of radiotherapeutic management for cervical cancer, encompasses two main types: interstitial and intracavitary radiation treatments [6]. Interstitial radiation therapy involves the insertion of radiation sources directly into the tumor tissue [7], while intracavitary radiation treatment refers to the placement of fully sealed radiation sources into natural body cavities, such as the vagina or uterus [8]. For patients with large cervical masses or parametrial invasion, satisfactory dose distribution is often unachievable due to limitations posed by the applicators [9].

The precision and customization afforded by 3D printing technology promise to overcome these challenges [10]. The advent of 3D printing technology in medicine has opened new avenues for enhancing the efficacy and safety of brachytherapy, particularly in cervical cancer treatment [11, 12]. The use of 3D-printed applicators for intracavitary brachytherapy (ICBT) and interstitial brachytherapy (ISBT) in cervical cancer treatment represents a significant advancement [13]. Customized 3D-printed applicators are designed to conform to individual patient anatomy, allowing for more accurate placement of radiation sources and, consequently, more effective dose delivery to the tumor while sparing adjacent healthy tissues [13, 14]. This tailored approach is particularly beneficial for treating tumors with complex geometries or those located in challenging positions. Furthermore, the utilization of 3D-printed non-coplanar templates (3D-PNCT) in ISBT facilitates precise needle placement, ensuring high-precision treatment and minimizing risks to nearby critical structures [14, 15]. This method not only enhances the therapeutic efficacy but also significantly reduces the risk of complications associated with inaccurate needle positioning.

The purpose of this study is to investigate the impact of 3D-printed brachytherapy on the efficacy and safety of radiation therapy in cervical cancer patients. We aim to compare the outcomes of patients undergoing 3D-printed brachytherapy with those receiving traditional free hand implantation brachytherapy. Key indicators to be analyzed include short-term therapeutic effects, recurrence rates, operation times, the number of CT scans, the number of needles inserted, dosimetric parameters, and complications [16]. The primary endpoints of our study are local control rate and survival status, assessed up to the day of the last follow-up. Secondary endpoints include the incidence of complications. Our goal is to determine whether 3D-printed individualized models can offer a more effective and safer therapeutic option for patients with cervical cancer, especially for those with large tumors or complex anatomical structures. By evaluating the advantages and limitations of 3D printing technology in brachytherapy, we hope to provide valuable insights into its potential role in improving treatment outcomes and reducing complications in cervical cancer management.

Materials and methods

Study design and participants

This retrospective study compared 50 cervical cancer patients treated at the First Affiliated Hospital of Gannan Medical College in Ganzhou City, Jiangxi Province, from January 2019 to July 2023. Inclusion criteria: (1) proven cervical cancer with measurable lesions; (2) inoperable or unwilling to undergo surgery; (3) staged according to FIGO criteria, including patients with stage IIA and beyond; (4) aged 20–80 years old, not combined with other tumors; (5) complete and reliable clinical information and follow-up data. Exclusion criteria: (1) Receiving other anti-tumour treatments before simultaneous radiotherapy, including radical surgery and palliative reduction surgery; (2) Combined with other tumours; (3) Concurrent with other serious diseases requiring immediate treatment, such as severe cardiopulmonary dysfunction, acute infections, and haematological system diseases; (4) Coagulation defects, haemorrhagic diseases, infection at the implantation site, or a tendency to haemorrhage; (5) Pregnant or breastfeeding patients; (6) Patients who refuse to participate, or who have personality or mental disorders, or who are incapable of civil behaviour or have limited civil behaviour capacity. Patients were staged according to the 2018 FIGO edition, with MRI used to determine each patient’s staging. A total of 25 patients underwent intensity-modulated radiotherapy (IMRT) combined with free hand brachytherapy implantation, and 25 patients underwent IMRT combined with 3D-printed brachytherapy. All patients received concurrent weekly cisplatin sensitization therapy during the treatment period.

Patients were informed about the indications and potential side effects of 3D-printed template-assisted brachytherapy. Informed consent for radiation and brachytherapy was obtained from all patients prior to treatment. The general data of both groups were comparable.

Brachytherapy materials and equipment

Both groups of patients underwent afterloading brachytherapy in our hospital. The brand of Brachytherapy Aferloader used in our hospital: Varian, radiation source: Iridium-192 (192Ir), HDR Brachytherapy Aferloader, model: Gamma Medplus ix, treatment system: Varian Brachytherapy, doctor. The tube is inserted into the uterine cavity, the cervix is then visually inspected under the gynaecological dilator, and the implantation needle is inserted into the interstitium of the cervix parallel to the cervix around the opening of the cervix, and then the applicator is fixed in place with a gauze tamponade and the gynaecological dilator is withdrawn. The number, direction and depth of insertion are determined empirically by the surgeon. After insertion, the patient is transferred to the CT room using a transport bed for CT localisation: the image is reconstructed with a 2.5 mm layer thickness scan and transferred to the Varian back-loaded planning system, and then, once the target area has been outlined, the plan is designed and the treatment is carried out on the Varian brachytherapy system. CT Scanner: Large-aperture CT simulator, scanning conditions at 120KV and 150 mA, with a slice thickness of 2.5 mm. 3D-PIT: Produced by a 3D photopolymerization rapid prototyping machine, using EC-compliant medical photopolymer resin, with a precision of 0.1 mm. Brachytherapy Implantation Needles: Interstitial implantation needles, 192Ir brachytherapy source.

Brachytherapy procedure

All patients in this study first received external pelvic irradiation radiotherapy at a dose of 45 Gy/25 fractions, and patients with a positive lymph node diagnosis were locally reloaded to 60 Gy, with patients receiving a prescribed dose of 2.4 Gy/fx 25 fractions. After completion of the external irradiation, patients began to receive CT-guided IC/ISBT, with patients receiving a prescribed dose of 6 Gy/fx 5–6 fractions, The total EQD2 for external irradiation of the CTV plus postloading radiotherapy was > 85 Gy.

The operator reviews the patient’s MRI images prior to brachytherapy to ensure accuracy. The patient is then placed on a gynecological examination bed, which is suitable for transfer, and positioned in the lithotomy position. The operator performs a thorough gynaecological examination of the patient prior to insertion of the implantation, which is standardised and documented by using the revised proportional clinical chart recommended by the European Society for Therapeutic Radiotherapy (GEC-ESTRO), which measures the thickness, width, height and paraphysical infiltration of the lesion. The thickness, width and height of the lesion, as well as the infiltration in the parietal area will be measured for the physician’s reference when inserting the applicator and outlining the target area.

During the operation, gynaecological disinfection was strictly carried out, sterile cavernous towel was laid and urinary catheter was left in place. A gynaecological dilator was inserted into the vagina to expose the cervical os and the posterior fornix and disinfected, and the cervical canal was explored with a uterine probe. According to the results of the exploration, a suitable curvature and length of the uterine tube (which is also the applicator) was selected and implanted into the cervical canal.

Procedure and imaging localization of IC/IS brachytherapy

The physician first inserts a uterine tube into the uterine cavity, then visually inspects the cervix under a gynecologic dilator and inserts the insertion needles parallel to the uterine tube into the interstitial space of the cervix around the cervical os, then inserts a gauze tamponade to hold the applicator in place, and removes the gynecologic dilator. In this procedure, the number, direction and depth of insertion are determined empirically by the physician. After insertion, the patient is moved to the CT room using a transfer bed for CT localization: the image is reconstructed with a 2.5 mm layer thickness scan and transferred to the KL-HDR-C postloading planning system, and then the target area is outlined, and then the plan is designed and treated on the KL-brachy 6.3.0.9 radiotherapy planning system (Fig. 1A-B).

Fig. 1
figure 1

A: Target Area Outlining and Treatment Planning for Unarmed IC/ISBT; B: Unarmed IC/ISBT Backloaded Radiotherapy Program Dose Curves

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3D IC/IS BT: modeling and pre-planning process

After implanting the uterine tube into the uterine cavity, the surgeon fills the vagina sufficiently with gauze so that the gauze fills the vagina, avoids the creation of an air gap, and molds to fit the patient’s skin at the mons veneris. The patient is then moved to the CT room for a CT localization scan using a transfer bed, and a posterior loading CT image is taken in order to create a 3D individualized vaginal mold. Tumor target area, critical organ target area and vaginal anatomy were reconstructed on the CT localization image, virtual setup of insertion and implantation needles, including the number of insertion and implantation needles, location, depth of entry into the cervical tissues, and needle spacing required between 0.5 and 2 cm, with the goal of maximum coverage of the target area, and the construction of the individualized cylindrical vaginal mold based on the patient’s vaginal image. After finalizing the modeling, the 3D individualized vaginal mold is printed using PLA as the material and sterilized and sealed, waiting for use (Fig. 2A-C). This process takes 2 days.

Fig. 2
figure 2

A: Individualized vaginal plugs are created and printed in the first scanned CT image. B: Individualized vaginal plugs made according to pre-planned objects. C: Parameters such as number, position, number, depth and direction of needle passes are defined in the preplanning

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For the 3DP-IC/IS BT technique, after the uterine tube is implanted, the gynecologic dilator is removed, and a sterile, pre-designed, 3D-printed individualized vaginal mold is introduced. This mold, which includes apertures for both the uterine tube and implantation needles, is inserted into the vagina along the uterine tube. Needles are then implanted sequentially according to predefined lengths and paths. The mold is fixed externally with adhesive tape, and the patient undergoes the same CT scanning and target delineation process using the KL-HDR-C system. The treatment plan is subsequently carried out with the KL-brachy 6.3.0.9 radiotherapy planning system (Fig. 3A-B).

Fig. 3
figure 3

A: 3D-IC/ISBT target area outlining and treatment plan development; B: 3D-IC/ISBT Backloaded Radiotherapy Program Dose Curves

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Regardless of the mode of operation, the patient was given a clean enema to empty the bowels before the operation, and the bladder was emptied of urine with a catheter and refilled with 100 ml of saline through the catheter before each CT localization scan. Consistency of each treatment was achieved by these methods.

Evaluation indicators

Data on the number of implantation needles, operation time, CT scans, complications, short-term therapeutic effects, recurrence rates, and relevant dosimetric parameters were collected and recorded. Dosimetric parameters included D90 (the dose received by 90% of the high-risk clinical target volume, CTV HR, as defined by GEC ESTRO recommendations), D95, D98, and V90 (volume percentage of the target area covered by 90% of the prescribed dose). Additionally, D1cc and D2cc, as recommended by the ICRU 89 report, refer to the doses received by 1 and 2 cubic centimeters of tissue, respectively. Doses received by critical organs (bladder, rectum, and sigmoid) were also recorded. The study adhered to the ICRU 89 report guidelines in the evaluation of these dosimetric parameters [17].

Assessment of short-term efficacy and toxic side effects

The short-term therapeutic effect was evaluated according to the WHO solid tumor response criteria: Complete Response (CR), defined as the total disappearance of all target lesions; Partial Response (PR), defined as at least a 30% decrease in the sum of the diameters of target lesions; and Stable Disease (SD), where tumor shrinkage is less than PR or growth does not meet the criteria for Progressive Disease (PD). The Overall Response Rate (ORR) was calculated by combining CR and PR.

Toxic side effects were graded according to the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer (RTOG/EORTC) standards [18].

Patient follow-up

Follow-up began at the end of antitumor therapy and continued for three years, involving outpatient or inpatient reviews and telephone interviews. In the first year, follow-up was conducted every 3 months, and starting from the second year, it was conducted every 6 months. The follow-up rate was 95%, with 3 cases lost to follow-up.

Statistical analysis

All statistical analyses were conducted using SPSS 21.0 (IBM). Continuous variables with a normal distribution were expressed as mean ± standard deviation (SD), and intergroup age differences were assessed using independent samples t-tests. Categorical variables were presented as frequencies (percentages) and were assessed using the chi-squared (χ2) test; Fisher’s exact test was employed when the case number was below 40. A P-value threshold of < 0.05 was considered statistically significant. Response outcomes, including Complete Response (CR) and Partial Response (PR), were also analyzed using the chi-squared (χ²) test. Overall Survival (OS) was estimated using the Kaplan-Meier method, and differences between groups were assessed using the log-rank test. A P-value threshold of < 0.05 was considered statistically significant.

Results

Patient baseline characteristics

A total of 49 patients were analyzed in the study. The mean age of patients was 56.33 ± 9.92 years in the 3D printing-BT and 56.16 ± 8.98 years in the Freehand implant-BT, with no significant difference observed (P = 0.949). Similarly, there were no significant differences in height (154.78 ± 5.33 cm vs. 153.71 ± 6.56 cm, P = 0.542) and weight (53.88 ± 9.09 kg vs. 53.81 ± 9.16 kg, P = 0.981) between the two groups (Table 1).

Table 1 Comparison of baseline characteristics between IMRT combined with 3D postloading radiotherapy group and IMRT combined with freehand insertion afterloading radiotherapy group
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In terms of clinical diagnosis, the distribution of tumor staging was also similar across both groups. The percentage of patients with FIGO stage I, II, III, and IVA tumors in the 3D printing-BT was 4.2%, 37.5%, 29.2%, and 29.2%, respectively, compared to 4.0%, 52.0%, 40.0%, and 4.0% in the Freehand implant-BT. The differences in tumor staging distribution were not statistically significant (P = 0.119). These results indicate that there was no selection bias in the patient population.

Median follow-up of your cohort

Increased brachytherapy safety with 3D printing

A total of 252 treatments were performed, with 24 patients in the IMRT combined with 3D-printed brachytherapy group undergoing 125 treatments. In this group, a total of 443 implantation needles were used, averaging 3.5 needles per treatment, and an average of one CT scan was performed per procedure. The complication rate was 5.6% (7 cases). In contrast, 25 patients in the IMRT combined with free hand insertion brachytherapy group underwent 127 treatments. A total of 255 implantation needles were used in this group, averaging 2 needles per treatment, and an average of 1.2 CT scans were performed per procedure. The complication rate was higher at 11.0% (14 cases) (Table 2).

The coverage of the clinical target volume (CTV) was limited by the constraints on the bladder and rectum (D1cc and D2cc) in the IMRT combined with free hand insertion brachytherapy group, resulting in a lower CTV coverage compared to the IMRT combined with 3D-printed brachytherapy group. Moreover, the doses received by the bladder and rectum were lower in the 3D-printed brachytherapy group than in the free hand insertion group (Table 2).

Table 2 Comparison of radiotherapy operation between IMRT combined with 3D postloading radiotherapy group and IMRT combined with freehand insertion postloading radiotherapy group
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Enhanced safety of 3D-printed brachytherapy in large tumors

The application of 3D-printed brachytherapy significantly improved the safety of radiation therapy operations for large tumors (≥ 30 mm) compared to smaller tumors (Tables 3 and 4). In the group receiving 3D-printed brachytherapy for large tumors, CTV D90 is set at 60 Gy for all patients. the mean doses for CTV-D95, CTV-D98, and CTV-D100 were 53.08 Gy, 46.91 Gy, and 33.92 Gy, respectively, demonstrating higher accuracy in targeting the tumor area. The dose-volume ratios (CTV-v100, CTV-v150, and CTV-v200) were also superior in the 3D printing-BT, indicating better preservation of the target volume while minimizing exposure to surrounding tissues.

Table 3 Comparison of effective target areas and organ damage in radiotherapy for small tumours
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Table 4 Comparison of effective target areas and organ damage in radiotherapy for large tumours
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Furthermore, the organ-damaging doses (bladder irradiation dose D1CC and D2CC, rectal irradiation dose D1CC and D2CC) were significantly lower in the 3D printed-BT, highlighting the enhanced safety profile of 3D-printed brachytherapy in large tumors. These results underscore the importance of 3D-printed brachytherapy in improving the therapeutic outcomes of radiation therapy for patients with large cervical tumors.

Additionally, it is important to note that the 3D-printed BT approach typically involves the use of more needles compared to the free-hand procedure. This increased use of needles allows for more precise dose distribution and better targeting of the tumor, while minimizing exposure to surrounding healthy tissues. This aspect of 3D-printed BT contributes to its trend towards improved safety results and lower doses to organs at risk (OAR) when compared to free-hand BT.

Lower complication rates with 3D printing in brachytherapy

The incidence of radiation-induced cystitis and proctitis was evaluated using the RTOG/EORTC grading standards [19]. In the 3D printing-BT, 70.8% of patients had no radiation enteritis, compared to 12.0% in the Freehand implant-BT (P < 0.001). Acute and combined acute and chronic radiation enteritis were significantly less frequent in the 3D group compared to the freehand group (Table 5).

The complication rate was 5.6% for 3-printed and 11% for freehand implant. There were no significant differences between the two groups in terms of radiation cystitis, rectovaginal fistula, abdominal infection, vesicovaginal fistula, and intestinal obstruction (Table 5).

Table 5 Comparison of radiotherapy complication rates between the IMRT combined with 3D postloading radiotherapy group and IMRT combined with freehand insertion postloading radiotherapy group
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Short-term efficacy and survival outcomes of 3D-printed brachytherapy in cervical Cancer patients

In the group receiving intensity-modulated radiation therapy (IMRT) combined with 3D-printed brachytherapy, the proportions of patients achieving CR and PR were equal (50% vs. 50%). In contrast, in the group receiving IMRT combined with freehand insertion brachytherapy, the proportion of patients achieving CR was slightly lower than that of patients achieving PR (48% vs. 52%) (Fig. 4). In terms of survival outcomes, The median follow-up period in this study was 22.5 months [IQR 18–29], and overall, there were no significant differences in the therapeutic responses between the two groups, indicating that both treatment modalities provide comparable outcomes in terms of clinical response. Kaplan-Meier analysis revealed no significant difference in overall survival between the two groups of patients (P > 0.05) (Fig. 5). This indicates that while 3D-printed brachytherapy may enhance the immediate therapeutic response, it does not significantly impact the overall survival of cervical cancer patients when compared to traditional brachytherapy techniques.

Fig. 4
figure 4

Short-Term Efficacy of 3D-Printed Brachytherapy in Cervical Cancer Patients

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Fig. 5
figure 5

Survival Outcomes of 3D-Printed Brachytherapy in Cervical Cancer Patients

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Discussion

In this study, we evaluated the efficacy and safety of 3D-printed brachytherapy in patients with cervical cancer, comparing it to conventional free-hand implantation brachytherapy. Our results demonstrate that 3D-printed brachytherapy significantly improves the safety of radiation therapy, particularly for large tumors, by providing more precise dose distribution and reducing radiation doses to critical organs. Furthermore, 3D-printed brachytherapy significantly reduced the incidence of radiation enteritis in cervical cancer patients compared to the traditional free-hand insertion technique, highlighting its enhanced safety profile. Despite these improvements in safety and precision, short-term therapeutic response rates and overall survival outcomes were comparable between the two groups, indicating that 3D-printed brachytherapy offers a more effective and safer therapeutic option without compromising treatment efficacy.

Brachytherapy is an indispensable part of cervical cancer radiotherapy. Studies have shown that the absence of brachytherapy significantly reduces the effectiveness of cervical cancer radiotherapy [20]. The advent of 3D-printed brachytherapy represents a significant leap forward in the treatment of cervical cancer [21]. The comparison between 3D-printed brachytherapy and traditional free hand implantation techniques highlights several key differences that underscore the advantages of the former [22]. Traditional free hand brachytherapy, while effective, often suffers from limitations such as less precise dose distribution. This imprecision can result from the variability in applicator placement and the inability to tailor the applicators to individual patient anatomy [23]. Consequently, there is a higher risk of delivering suboptimal radiation doses to the tumor or excessive doses to surrounding healthy tissues, leading to increased complication rates. This innovative approach leverages the precision and customization capabilities of 3D printing technology, enabling the creation of patient-specific applicators that ensure more accurate placement of radiation sources [12, 24, 25]. This tailored approach is particularly beneficial for treating tumors with complex geometries or those located in anatomically challenging positions [11, 26, 27]. By facilitating precise targeting of the tumor, 3D-printed brachytherapy enhances the effectiveness of dose delivery while minimizing exposure to adjacent healthy tissues [15, 28]. This not only improves the therapeutic efficacy but also significantly reduces the risk of collateral damage and associated complications [29, 30]. The ability to customize applicators to each patient’s unique anatomy ensures optimal adaptation to individual tumor characteristics, maximizing the potential for successful treatment outcomes.

The implementation of 3D-printed brachytherapy in cervical cancer treatment has shown a significant impact on both the safety and efficacy of radiation therapy [7, 29, 31,32,33]. Our study results suggest a potential reduction in complication rates, particularly in the incidence of radiation enteritis, a common and often debilitating side effect of pelvic radiation therapy [29]. This reduction can be attributed to the precise dose distribution achieved through 3D-printed applicators, which allows for targeted radiation delivery to the tumor while minimizing exposure to surrounding healthy tissues. Furthermore, the enhanced dose distribution is especially evident in the treatment of large tumors (≥ 30 mm), where traditional brachytherapy techniques often struggle to achieve optimal coverage without exceeding safe dose limits to adjacent organs [34, 35]. The 3D-printed brachytherapy group demonstrated superior dosimetric parameters, such as CTV-D95, CTV-D98, and CTV-D100 [36], indicating more accurate targeting and coverage of the tumor volume. This precise dose delivery not only improves treatment outcomes, but also somewhat reduces the risk of complications associated with radiation therapy.

Our study, despite demonstrating the potential of 3D-printed brachytherapy in cervical cancer treatment, has limitations such as a small sample size and a short-term follow-up period, which may affect the generalizability of the findings. Additionally, the study focused primarily on safety and efficacy outcomes, with less emphasis on long-term survival and quality of life metrics. We acknowledge that many other variables, such as patient demographics, tumor characteristics, and concurrent treatments, may influence the outcomes and play a significant role in the overall effectiveness of the treatment. Therefore, a more comprehensive statistical analysis is necessary to account for these variables and draw more definitive conclusions. We further recognize the importance of addressing these limitations in future research. Larger-scale studies with longer follow-up periods are needed to assess the impact of 3D-printed brachytherapy on overall survival, disease-free survival, and long-term quality of life. Additionally, exploring the integration of 3D-printed brachytherapy with other treatment modalities, such as chemotherapy, immunotherapy, and targeted therapy, is crucial to evaluate potential synergistic effects and optimize treatment regimens. By incorporating these factors into future analyses, we can better understand the full scope of 3D-printed brachytherapy’s benefits and limitations.

Conclusion

In summary, the use of 3D-printed brachytherapy in cervical cancer patients improved the safety outcomes by minimizing the radiation doses received by the bladder and rectum, thereby enhancing the overall efficacy and safety of the treatment. 3D-printed brachytherapy significantly enhances the safety and precision of radiation therapy for cervical cancer, particularly in patients with large tumors or complex anatomical structures. By reducing the incidence of radiation enteritis and minimizing damage to critical organs, this innovative approach offers a promising advancement in the treatment of cervical cancer. In an era focused on precision treatment of tumors, the true benefits of 3D-printed brachytherapy will only become evident when applied to a population that genuinely requires it. Future research should focus on expanding sample sizes and conducting prospective controlled studies across diverse tumor parameters, with the expectation of yielding more rigorous and effective outcomes.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

IMRT:

Intensity-Modulated Radiotherapy

CR:

Complete Response

PR:

Partial Response

SD:

Stable Disease

PD:

Progressive Disease

ORR:

Overall Response Rate

RTOG:

Radiation Therapy Oncology Group

EORTC:

European Organization for Research and Treatment of Cancer

ROC:

Receiver Operating Characteristic Curve

AUC:

Area Under the Curve

CI:

Confidence Interval

ICBT:

Intracavitary Brachytherapy

ISBT:

Interstitial Brachytherapy

3D-PNCT:

3D-Printed Non-Coplanar Templates

ABS:

American Brachytherapy Society

3D-PIT:

3D Photopolymerization Imaging Technology

CT:

Computed Tomography

FIGO:

International Federation of Gynecology and Obstetrics

OS:

Overall Survival

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Acknowledgements

The authors acknowledge all the clinical and research staff from the research centers.

Funding

This work was supported in part of The Basic Research Fund, First Affiliated Hospital of Gannan Medical University (QD095), Jiangxi Provincial Health Commission Science and Technology Program (SKJP220236677).

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Author notes

  1. Zenghong Lu and Gangfeng Zhu authors contributed equally to this work.

Authors and Affiliations

  1. Department of Oncology, The First Affiliated Hospital, Gannan Medical University, Ganzhou, 341000, Jiangxi Province, China

    Zenghong Lu, Zhengang Qiu, Hailiang Guo, Yi Xiang & Yili Wang

  2. First Clinical Medical College, Gannan Medical University, Ganzhou, 341000, Jiangxi Province, China

    Gangfeng Zhu, Junyan Li, Liangjian Zheng, Cixiang Chen & Jie Che

  3. Radiotherapy Center, The First Affiliated Hospital, Gannan Medical University, Ganzhou, China

    Hailiang Guo

Authors
  1. Zenghong Lu
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  4. Hailiang Guo
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Contributions

ZH.L. : Managed data collection and arrangement; GF.Z. : Performed the statistical analyses; ZG.Q. and HL.Guo. : Reviewed and made significant revisions to the initial draft; JY. L. : Engaged in the clinical practices associated with this study; LJ. Z. : Provided technical support throughout the research process; CX. C. : Were responsible for primary data collection; J.C : Took the lead in writing the manuscript; Y.X. and YL. W. : Oversaw the overall direction and planning of the project and designed the research topic. All the authors have read and approved the final version of the manuscript.

Corresponding authors

Correspondence to Jie Che, Yi Xiang or Yili Wang.

Ethics declarations

Human ethics and consent to participate declarations

The study was approved by the Ethics Review Board of The First Affiliated Hospital of Gannan Medical University (Ganzhou, China). Written informed consent was obtained from all subjects before the study.

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Not applicable.

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The authors declare no competing interests.

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Lu, Z., Zhu, G., Qiu, Z. et al. 3D-printed brachytherapy in patients with cervical cancer: improving efficacy and safety outcomes. Radiat Oncol 19, 152 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13014-024-02536-0

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13014-024-02536-0

Keywords

Radiation Oncology

ISSN: 1748-717X

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