| Objective:The aim of this study is to compare the dosimetric,short-term efficacy and adverse effects between 3D-printed template-guided and conventional interstitial brachytherapy,and to explore the prospect of using individualized templates in brachytherapy for cervical cancer.Methods:We retrospectively analyzed the clinical data of 39 patients with cervical cancer who underwent interstitial brachytherapy at the Radiotherapy Department of the Second Hospital of Jilin University between January 2018 and September 2021,all with extensive invasion,poor-response after external irradiation,large eccentric masses or recurrent disease.The patients were divided into template and free-hand groups according to the treatment modality.The repeatability was assessed by comparing the dosimetric characteristics of the pre-plan with the actual plan;general implementation such as the number and route of inserted and intraoperative complications were recorded and compared between the template group and the freehand group;the dosimetric characteristics,recent efficacy and differences in adverse effects were compared between the template group and the free-hand group.Results:A total of 39 patients were included in this study,18 in the template group and 21 in the free-hand group.The median age in the former was54 years（31-80 years）and was 54 years（36-68 years）in another group.There were no significant deviations from the actual planned target-volume between the pre-plan and the actual plan.As far as high-risk clinical target volume（HR-CTV）D90,the actual plan was higher than the pre-plan with mean values of 10.84 and 9.81Gy（p=0.007）,respectively,with higher conformability（p=0.319）but lower homogeneity（p=0.745）;the mean D2cc values of bladder and rectal of actual plan were higher（p=0.193 and 0.177）,and the sigmoid dose was lower（p=0.576）.All 39patients completed 189 treatments totally and 18 templates were designed.In the template group,848 interstitial needles were used,547（64.50%）and 301（35.50%）were applied from vaginal and perineum respectively.In the free-hand group,852 needles were used,825（96.83%）and 27（3.17%）were applied vaginally and perineally respectively.A total of 3not-used needles were used in 189 treatments,1（0.12%）in the template group and 2（0.23%）in the free-hand group;a total of 6 needles penetrated the uterus,2（0.24%）in the template group and 4（0.47%）in the free-hand group.Dosimetrically,the mean HR-CTV D90 and D98values were 10.84 and 8.49 Gy in the template group and 10.20 and 8.09Gy in the free-hand group,respectively（p=0.005,0.035）;there was also a trend for D100 to be higher than in the free-hand group（p=0.246）;the dose distribution was more concentrated in the template group,with higher V100,V150 and V200 than in the freehand group（p=0.009,0.01 and 0.064）;and the mean value of the conformability index was slightly higher in the template group（p=0.096）,but the uniformity index was lower（p=0.032）.D2cc in the bladder was higher in the template group,with mean values of10.06 and 9.38 Gy（p=0.086）,respectively,and mean D2cc values of rectum and sigmoid were slightly lower（p=0.976,0.192）in the sigmoid,respectively.In terms of efficacy and complications,before and after treatment,3 months after the end of treatment and 6 months after the end of treatment,the clinical remission rates were 50%,94.4%and 81.2%with 3,0 and 2 cases of grade≥3 complications in the template group and52.4%,90.4%and 85.7%in the freehand group（p=0.882,0.736 and0.616）and 2,1 and 7 cases of grade≥3 complications in the freehand group（p=0.291,0.104,0.768）.Conclusion:The 3D printed individualized template-guided interstitial brachytherapy is completed well in treatment of cervical cancer,satisfying the pre-planning design requirements.It is a feasible modality with reasonable plan distribution,similar efficacy and adverse effects compared to free-hand modality,which is conducive to the popularization of interstitial brachytherapy. |
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