Abstract
PURPOSE
The High-Dose-Rate (HDR) vaginal cylinder treatment is typically designed using the
initial CT, while the subsequent implants are verified using rudimentary methods (i.e.,
visual inspection, ruler measurements, etc.) and/or X-ray imaging. We are proposing
the use of a 3D-printed individualized template that could provide simple and reproducible
vaginal cylinder insertion.
MATERIAL AND METHODS
Six patients were included in the study with prescriptions of 6 Gy/fraction for 2
to 5 fractions (total 27 treatments). The first 1 to 2 treatments were delivered without
the template and the rest with the CT-based 3D-printed templates. Cone beam CTs (CBCTs)
were acquired to verify the cylinder placement for all treatments. D2cc of the bladder and rectum are recorded on both planning CT and the following on-treatment
CBCTs.
RESULTS
By using the templates, the tip position variation on average (±1 SD) reduced from
0.8±0.5 cm to 0.6±0.4 cm, and angular difference decreased from 5.3±3.5° to 4.7±2.4°.
The pitch and yaw deviation are reduced from 0.9 ± 5.8° and 0.4±2.9° to 0.0±3.9° and
-0.2±3.0°, respectively. The deviation of D2cc to bladder from the plan reduced from 6±4% to 5±3%, and rectum from 5±2% to 4±4%.
CONCLUSION
The 3D-printed patient-specific cylinder templates could potentially improve the geometrical
reproducibility of cylinder treatments at no cost of additional imaging. The D2cc for the bladder and rectum are determined by the treatment length rather than their
respective volumes.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to BrachytherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer statistics, 2020.CA Cancer J Clin. 2020; 70: 7-30
- Pre-treatment 2D scout verification tolerances and dosimetry effects on OAR for the cylinder high dose rate brachytherapy treatment of vaginal cuff cancer.JSM Clin Oncol Res. 2013; 1: 1001
- Effects of vaginal cylinder position on dose distribution in patients with endometrial carcinoma in treatment of vaginal cuff brachytherapy.J Contemp Brachytherapy. 2017; 9: 230-235
- The influence of applicator angle on dosimetry in vaginal vault brachytherapy.BJR. 2002; 75: 234-237
- 3D Slicer as an image computing platform for the Quantitative Imaging Network.Magn Reson Imaging. 2012; 30: 1323-1341
- The EMBRACE II study: the outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies.Clin Transl Radiat Oncol. 2018; 9: 48-60
- Vaginal vault brachytherapy: the effect of varying bladder volumes on normal tissue dosimetry.Br J Radiol. 2000; 73: 864-866
- Vaginal vault brachytherapy in endometrial cancer: Verifying target coverage with image-guided applicator placement.Br J Radiol. 2013; 86 (p. 20120428-20120428)
- Individualised 3D printed vaginal template for MRI guided brachytherapy in locally advanced cervical cancer.Radiother Oncol. 2016; 118: 173-175
- Development and clinical implementation of semi-automated treatment planning including 3D printable applicator holders in complex skin brachytherapy.Med Phys. 2020; 47: 869-879
- Design and evaluation of 3D printable patient-specific applicators for gynecologic HDR brachytherapy.Med Phys. 2021; 48: 4053-4063
Article info
Publication history
Published online: October 24, 2021
Accepted:
September 19,
2021
Received in revised form:
September 13,
2021
Received:
July 1,
2021
Identification
Copyright
© 2021 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
