Expert consensus workshop report: Guideline for three-dimensional printing template-assisted computed tomography-guided¹²⁵I seeds interstitial implantation brachytherapy

Abstract

Radioactive 125I seeds (RIS) interstitial implantation brachytherapy has been a first-line treatment for early-stage cancer of the prostate gland. However, its poor accuracy and homogeneity has limited its indication and hampered its popularization for a long time. Intriguingly, scholars based in China introduced computed tomography (CT)-guided technology to improve the accuracy and homogeneity of RIS implantation and broadened the indications. Then, they creatively designed and introduced three-dimensional printing coplanar template (3D-PCT) and 3D printing noncoplanar template (3D-PNCT) into the practice of RIS implantation. Use of such templates makes RIS implantation more precise and efficacious and aids preoperative planning, real-time dose optimization, and postoperative planning. However, studies on the standard workflow for 3D-PT-assisted CT-guided RIS implantation have not been published. Therefore, the China Northern Radioactive Seeds Brachytherapy Group organized multidisciplinary experts to formulate the guideline for this emerging treatment modality. This guideline aims at standardizing 3D-PT-assisted CT-guided RIS implantation procedures and criteria for selecting treatment candidates and assessing outcomes and for preventing and managing postoperative complications.

Efficacy and dosimetry analysis of image-guided radioactive 125I seed implantation as salvage treatment for pelvic recurrent cervical cancer after external beam radiotherapy

“…In line with previous reports, the tumor volume, dose and recurrent sites might influence the effect [212324]. Encouragingly, with the improvement of technology, we were the first brachytherapy center to incorporate 3-dimensional printing template into RIS implantation, in order to increase the accuracy of treatment [252627]. Furthermore, the combination with multiple modern image technologies helped us to define the tumor margin more precisely, which might overcome the problems of target area delineation and dose coverage.…”

Comparative study for CT-guided 125 I seed implantation assisted by 3D printing coplanar and non-coplanar template in peripheral lung cancer

“…All procedures were conducted according to the international guideline [3]. Two days before the operation, patients obtained a CT-scan (Brilliance Bigbore CT, Philips Co., Ltd.) to locate the lesions, using a slice thickness of 5 mm.…”

“…Guided by the 3DPT, preoperative planning can be accurately realized in surgery [2]. Currently, 3DPT is divided into two types: 3D-printing non-coplanar template (3DPNCT), characterized by individualization, and non-coplanarity of the needle path and 3D-printing coplanar template (3DPCT), characterized by all needles path in the same direction [3] (Figure 1). In the present study, we compared the application of 3DPNCT and 3DPCT, which included designing the radioactive seed implantation plan for a thoracic tumor, and further analyzed the differences at the planning step to provide theoretical support for choosing a more reliable implantation technology and a more optimal strategy.…”

Iodine-125 seed implantation treatment of lung metastases <2.5 cm using a 5-ml syringe as a guide

“…[28] Computed tomography fluoroscopy-guided percutaneous Iodine-125 seed implantation has been studied, but it is advisable to apply this approach cautiously for small lesions < 2.5 cm. [29] Novel 3D-printing template technologies can be used to guide the puncture and solve the problems of the continuous respiration-associated movements of the lungs, [30,31] but it requires printing systems, CAD software, and the ability/experience to use them.…”