Characterization of combined intracavitary/interstitial brachytherapy including oblique needles in locally advanced cervix cancer

Şerban, M; Fokdal, Lars; Nielsen, S.K.; Hokland, Steffen; Hansen, Aviaja Anna; Spejlborg, Harald; Rylander, S.; Petrič, Primož; Lindegaard, Jacob Christian; Tanderup, Kari

doi:10.1016/j.brachy.2021.03.019

Cited by 11 publications

(6 citation statements)

References 39 publications

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“…The idea of utilizing the patient-specific vaginal space for generating personalized 3D templates or molds for interstitial gynecologic brachytherapy is powerful, but not new [ 22 , 27 , 28 ]. Our proposal, however, improves upon this idea by utilizing the DMBT tandem to the mix by intensity modulating the vicinity of the cervical canal that is within the dosimetric reach from the tandem and uses optimally positioned needles to complement the technology by covering regions of the target unreachable by the tandem.…”

Section: Discussionmentioning

confidence: 99%

“…In our example patient case for 3D printing and the five cases for retrospective planning analysis, we manually reoptimized the needle positions based on the geometric locations of the anatomy of the target and the OARs, and our understanding of the dosimetric capabilities and limits of the DMBT tandem, but of course, it is in our long-term interest to develop an optimization algorithm suitable for this task for a more seamless implementation of the overall proposed workflow. In fact, this is an area of active research in general [ 28 , 29 , 30 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

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A Novel Workflow with a Customizable 3D Printed Vaginal Template and a Direction Modulated Brachytherapy (DMBT) Tandem Applicator for Adaptive Interstitial Brachytherapy of the Cervix

Sohn

Polizzi

Richeson

et al. 2022

JCM

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A novel clinical workflow utilizing a direction modulated brachytherapy (DMBT) tandem applicator in combination with a patient-specific, 3D printed vaginal needle-track template for an advanced image-guided adaptive interstitial brachytherapy of the cervix. The proposed workflow has three main steps: (1) pre-treatment MRI, (2) an initial optimization of the needle positions based on the DMBT tandem positioning and patient anatomy, and a subsequent inverse optimization using the combined DMBT tandem and needles, and (3) rapid 3D printing. We retrospectively re-planned five patient cases for two scenarios; one plan with the DMBT tandem (T) and ovoids (O) with the original needle (ND) positions (DMBT + O + ND) and another with the DMBT T&O and spatially reoptimized needles (OptN) positions (DMBT + O + OptN). All retrospectively reoptimized plans have been compared to the original plan (OP) as well. The accuracy of 3D printing was verified through the image registration between the planning CT and the CT of the 3D-printed template. The average difference in D2cc for the bladder, rectum, and sigmoid between the OPs and DMBT + O + OptNs were −8.03 ± 4.04%, −18.67 ± 5.07%, and −26.53 ± 4.85%, respectively. In addition, these average differences between the DMBT + O + ND and DMBT + O + OptNs were −2.55 ± 1.87%, −10.70 ± 3.45%, and −22.03 ± 6.01%, respectively. The benefits could be significant for the patients in terms of target coverage and normal tissue sparing and increase the optimality over free-hand needle positioning.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Novel Workflow with a Customizable 3D Printed Vaginal Template and a Direction Modulated Brachytherapy (DMBT) Tandem Applicator for Adaptive Interstitial Brachytherapy of the Cervix

Sohn

Polizzi

Richeson

et al. 2022

JCM

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“…IS needles are secured to the applicator using guiding tubes (GT), and an insertion tool can be used to accurately control needle depths making IC/IS techniques accessible to more practitioners. Combined IC/IS with the use of oblique needles has been reported to improve dose coverage in distal parametrial tissues relative to using straight needles only [ 23 , 24 ]. A comprehensive review of brachytherapy applicators for cervical cancer was provided in a study from Mourya et al .…”

Section: Purposementioning

confidence: 99%

The Montreal split ring applicator: Towards highly adaptive gynecological brachytherapy using 3D-printed biocompatible patient-specific interstitial caps

Kamio,

Roy,

Morgan

et al. 2023

jcb

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Purpose The addition of interstitial (IS) needles to intra-cavitary (IC) brachytherapy applicators is associated with improved outcomes in locally advanced cervical cancers involving parametrial tumor extensions. The purpose of this work was to validate a clinical workflow involving 3D-printed caps for a commercial IC split ring applicator that enable using IS needle trajectories tailored to each treatment. Material and methods A dedicated software module was developed in this work allowing users to design patient-specific IS caps without knowledge of computer-aided design (CAD) software. This software module was integrated to 3D Brachy, a commercial software developed by Adaptiiv Medical Technologies Inc. For validation of the workflow, CAD models of ground truth caps with five IS needle trajectories were designed with Fusion 360™, 3D-printed, assembled with a split ring applicator, and CT-scanned with radio-opaque markers. 3D Brachy was then applied to generate a replica based on trajectories reconstructed from the radio-opaque markers. A comparison between ground truth and replicated IS needle trajectories was done using intersection points with planes at the level of the cervix (z = 0 cm) and a representative needle depth (z = 3 cm). Results Prototypes of interstitial caps 3D-printed in both BioMed Amber and BioMed Clear SLA resins were tested to be functional both pre- and post-sterilization for IS needles with obliquity angles ≤ 45°. Distance-to-agreement at z = 0 cm and 3 cm as well as deviations in pitch and yaw angles of the five IS needle trajectories were found to have mean values of 3.3 ±2.1 mm, 7.3 ±2.0 mm, 2.9° ±2.3°, and 7.0° ±7.0°, respectively. Conclusions The clinical workflow for image-guided adaptive cervical cancer brachytherapy using the Montreal split ring applicator was validated.

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“…They also analysed the loading patterns in different parts of the applicator and reported that almost half (44%) of the dwell time was shifted to the interstitial needles, with tandem and ring dwell times accounting for 31% and 25% of the total dwell time, respectively. In this way, the dose was moved into the tumour, while the dose to the unaffected vagina was reduced and the total TRAK (total reference air kerma) remained roughly unchanged [ 81 ].…”

Section: Clinical Evidencementioning

confidence: 99%

The Use of 3D Printing Technology in Gynaecological Brachytherapy—A Narrative Review

Segedin,

Kobav,

Zobec Logar

2023

Cancers

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Radiation therapy, including image-guided adaptive brachytherapy based on magnetic resonance imaging, is the standard of care in locally advanced cervical and vaginal cancer and part of the treatment in other primary and recurrent gynaecological tumours. Tumour control probability increases with dose and brachytherapy is the optimal technique to increase the dose to the target volume while maintaining dose constraints to organs at risk. The use of interstitial needles is now one of the quality indicators for cervical cancer brachytherapy and needles should optimally be used in ≥60% of patients. Commercially available applicators sometimes cannot be used because of anatomical barriers or do not allow adequate target volume coverage due to tumour size or topography. Over the last five to ten years, 3D printing has been increasingly used for manufacturing of customised applicators in brachytherapy, with gynaecological tumours being the most common indication. We present the rationale, techniques and current clinical evidence for the use of 3D-printed applicators in gynaecological brachytherapy.

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Characterization of combined intracavitary/interstitial brachytherapy including oblique needles in locally advanced cervix cancer

Cited by 11 publications

References 39 publications

A Novel Workflow with a Customizable 3D Printed Vaginal Template and a Direction Modulated Brachytherapy (DMBT) Tandem Applicator for Adaptive Interstitial Brachytherapy of the Cervix

A Novel Workflow with a Customizable 3D Printed Vaginal Template and a Direction Modulated Brachytherapy (DMBT) Tandem Applicator for Adaptive Interstitial Brachytherapy of the Cervix

The Montreal split ring applicator: Towards highly adaptive gynecological brachytherapy using 3D-printed biocompatible patient-specific interstitial caps

The Use of 3D Printing Technology in Gynaecological Brachytherapy—A Narrative Review

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