Clinical outcomes of using 3D-printed applicators for high-dose-rate brachytherapy in gynecological malignancy.

IF 1.1 4区医学 Q4 ONCOLOGY Journal of Contemporary Brachytherapy Pub Date : 2024-12-01 Epub Date: 2024-12-31 DOI:10.5114/jcb.2024.146670

Wiwatchai Sittiwong, Pittaya Dankulchai, Utumporn Puangragsa, Tissana Prasartseree, Pongpop Tuntapakul, Chanida Sathitwatthanawirot, Janiya Kittikornchaichan, Sansanee Kongkum, Niyada Piputpanukul, Kantarat Rojanapan

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Abstract

Purpose: To investigate the clinical outcomes and toxicities of using 3D-printed applicators for image-guided adaptive brachytherapy (IGABT) in gynecological cancer patients.

Material and methods: Fourteen patients with gynecological cancers, both primary and recurrent, treated with in-house 3D-printed applicators between 2021 and 2022 were included in the study, and their data were retrospectively reviewed. Timing and patterns of response to treatment were recorded. Kaplan-Meier estimates at 2 years post-treatment were analyzed to obtain local relapse-free survival (LRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) rates. Actuarial rates of genitourinary (GU), gastrointestinal (GI), and skin and mucosal toxicities were also reported.

Results: The median follow-up time for all patients was 27 (IQR: 15.4-32.5) months. Among the primary cases, 2 patients had cervical cancer and 3 had extra-mammary Paget's disease of the vulva. For the recurrent cases, all patients had vaginal relapses. The most common primary cancers were cervical cancer (44.4%) and ovarian cancer (33.3%). At 3 months post-treatment, 13 patients (92.9%) achieved a complete response (CR), and 1 patient (7.1%) showed a partial response (PR). The 2-year rates of LRFS, DMFS, PFS, and OS for primary/recurrent cases were 100%/74.07%, 100%/88.9%, 100%/64.8%, and 100%/88.9%, respectively. The actuarial rates of ≥ grade 2 acute GU and GI toxicities were 7.1% for both groups. For late GU and GI toxicities, the actuarial rates were 14.3% and 21.4%, respectively. In terms of skin and mucosal toxicities, 4 patients (28.6%) developed acute grade 3 toxicity, and 1 patient (7.1%) experienced persistent grade 3 vaginal toxicity.

Conclusions: IGABT treatment using 3D-printed applicators for HDR brachytherapy in challenging cases due to incompatibility of the standard applicators with the patient's anatomy or highly advance disease, has demonstrated encouraging outcomes and acceptable toxicity profiles.

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目的：探讨在妇科癌症患者中使用3D打印涂抹器进行图像引导自适应近距离放射治疗（IGABT）的临床效果和毒性：研究纳入了14名妇科癌症患者，包括原发性和复发性癌症患者，他们在2021年至2022年期间接受了内部3D打印涂抹器治疗，研究人员对他们的数据进行了回顾性审查。研究记录了治疗反应的时间和模式。对治疗后 2 年的卡普兰-梅耶估计值进行分析，以获得无局部复发生存率（LRFS）、无远处转移生存率（DMFS）、无进展生存率（PFS）和总生存率（OS）。此外，还报告了泌尿生殖系统（GU）、胃肠道（GI）以及皮肤和粘膜毒性的精算率：所有患者的中位随访时间为 27 个月（IQR：15.4-32.5）。在原发病例中，2 名患者患有宫颈癌，3 名患者患有乳腺外阴帕吉特氏病。在复发病例中，所有患者都有阴道复发。最常见的原发性癌症是宫颈癌（44.4%）和卵巢癌（33.3%）。治疗后3个月，13名患者（92.9%）获得了完全应答（CR），1名患者（7.1%）获得了部分应答（PR）。初治/复发病例的2年LRFS、DMFS、PFS和OS率分别为100%/74.07%、100%/88.9%、100%/64.8%和100%/88.9%。两组急性胃肠道毒性≥2级的精算率均为7.1%。晚期胃肠道和消化道毒性的精算率分别为14.3%和21.4%。在皮肤和粘膜毒性方面，4名患者（28.6%）出现急性3级毒性，1名患者（7.1%）出现持续性3级阴道毒性：使用三维打印涂抹器进行IGABT治疗，用于因标准涂抹器与患者解剖结构不相容或疾病高度进展而具有挑战性的病例的HDR近距离放射治疗，取得了令人鼓舞的疗效和可接受的毒性概况。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Contemporary Brachytherapy ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

2.40

自引率

14.30%

发文量

审稿时长

16 weeks

期刊介绍： The “Journal of Contemporary Brachytherapy” is an international and multidisciplinary journal that will publish papers of original research as well as reviews of articles. Main subjects of the journal include: clinical brachytherapy, combined modality treatment, advances in radiobiology, hyperthermia and tumour biology, as well as physical aspects relevant to brachytherapy, particularly in the field of imaging, dosimetry and radiation therapy planning. Original contributions will include experimental studies of combined modality treatment, tumor sensitization and normal tissue protection, molecular radiation biology, and clinical investigations of cancer treatment in brachytherapy. Another field of interest will be the educational part of the journal.