Comparison of Planning between 3D-Printing Non-Coplanar Template and 3D-Printing Coplanar Template-Assisted Radioactive Seed Implantation As Re-Irradiation for Pelvic Wall Recurrent Gynecological Malignant Tumors

Abstract

Purpose/Objective(s): 3D-printing non-coplanar template (3D-PNCT) and 3D-printing coplanar template (3D-PCT) have different characteristics. It is unclear which one is more suitable to guide radioactive seeds implantation as re-irradiation for pelvic wall recurrent gynecological malignant tumor. So we compared the difference of preoperative planning parameters between the two templates, and the difference of planning parameters between preoperative planning and postoperative planning, to guide the clinical application. Materials/Methods: From January 2016 to March 2018, 33 patients with pelvic wall recurrent gynecological malignant tumor were treated with 125 I radioactive seeds implantation assisted by 3D-printing template and in our department. The age was 50 (32-71) years. The lesion volume was 40.0 (4.6-332.4) cc. All patients underwent 3D-PNCT and 3D-PCT preoperative planning. The prescription dose and seed activity of the two plannings for one patient were the same, and the D 90 of target remained similar. Ten patients assisted by 3D-PCT or the other ten patients assisted by 3D-PNCT were selected and compared with the parameters between preoperative planning and postoperative planning. The parameters included the number of needles and seeds, D 90 , D 100 , V 100 , V 150 , V 200 , external index (EI) and conformal index (CI). The comparison of the parameters was based on the Wilcoxon test. Results: In 37 cases of preoperative planning comparison, D 90 , D 100 , V 100 , EI and CI were similar between the 3D-PNCT group and 3D-PCT group (P > 0.05). The number of needles through intestine and bone in 3D-PNCT group was less than that in 3D-PCT group (0 (0-13), 0 (0-25), Z Z-2.941, P < 0.05; 0 (0-3), 0 (0-25), Z Z-2.232, P < 0.05). Both in the two groups, the number of needles through the intestine in the upper pelvic region with supine position was more than that in the middle and lower pelvic region (3D-PNCT: ZZ3.583, 3.937, P<0.01; 3D-PCT: ZZ3.625, 4.205, P<0.01). The differences of the planning parameters before and after operation were compared in patients actually used 3D-PNCT or 3D-PCT, respectively. With 3D-PCT, the seeds number of postoperative planning (48.7AE23.3) were more than that of preoperative planning (45.7AE21.5) (ZZ-2.255, P<0.05), but the dosimetric parameters of GTV showed no significant difference (P>0.05). With 3D-PNCT, there was no statistical difference between preoperative planning and postoperative planning on seed implantation and dosimetry parameters (P>0.05). Conclusion: For patients with gynecological malignancies with pelvic recurrence, both of the two preoperative planning could achieve prescription dose, but 3D-PNCT was more safe. The postoperative planning of 3D-PNCT and 3D-PNCT can achieve the dose parameters of preoperative planning in guiding 125 I radioactive seed implantation. But 3D-PNCT can more accurately meet the preoperative planning, and 3D-PCT needs to optimize the number of seeds during the operation.

Individualized Medicine Using 3D Printing Technology in Gynecology: A Scoping Review

“…13 Our scoping review has highlighted that patient speci c 3D printed brachytherapy devices have been the most commonly studied individualized 3D printed model in gynecology in the literature to date. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] The 3D printed models produced and studied were mainly personalized vaginal brachytherapy cylinder applicators and or interstitial brachytherapy needle templates in a population of patients with gynecologic malignanies including primary vaginal cancer, locally advanced or recurrent cervical or endometrial cancer. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] In addition, some studies created 3D printed devices that could be personalized and used in combination with standardized applicators or templates.…”

“…[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] The 3D printed models produced and studied were mainly personalized vaginal brachytherapy cylinder applicators and or interstitial brachytherapy needle templates in a population of patients with gynecologic malignanies including primary vaginal cancer, locally advanced or recurrent cervical or endometrial cancer. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] In addition, some studies created 3D printed devices that could be personalized and used in combination with standardized applicators or templates. 30 31 Some of the larger cohort studies provided clinically relevant results supporting the utility of individualized 3D printed devices for use in brachytherapy treatment of gynecological malignancies.…”