eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
Current Issue Archive Supplements Articles in Press Journal Information Aims and Scope Editorial Office Editorial Board Register as Author Register as Reviewer Instructions for Authors Abstracting and indexing Subscription Advertising Information Links
SCImago Journal & Country Rank

Interview with Professor Janusz Skowronek
ABS 2015
vol. 10
Original paper

Inversely designed, 3D-printed personalized template-guided interstitial brachytherapy for vaginal tumors

Shuhei Sekii, Kayoko Tsujino, Kengo Kosaka, Satoshi Yamaguchi, Hikaru Kubota, Yoko Matsumoto, Yosuke Ota, Ryohei Sasaki, Toshinori Soejima

J Contemp Brachytherapy 2018; 10, 5: 470–477
Online publish date: 2018/10/09
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
In this paper, we report cases of two patients with vaginal tumor who underwent interstitial brachytherapy (ISBT), using three-dimensional (3D)-printed personalized templates designed inversely from computed tomography (CT) or magnetic resonance (MR) images.

Material and methods
Patient 1 presenting with vaginal vault recurrence was planned to receive whole pelvis external beam radiotherapy (EBRT) followed by ISBT. The tumor invaded the paracolpium; thus, we planned to administer ISBT to include the tumor and vaginal membrane. A template was designed with holes for plastic needle applicator insertion considering the appropriate direction based on pre-treatment medical images. Patient 2 presenting with vaginal cancer was scheduled to receive EBRT and ISBT because of a paracolpium invasion. Before ISBT, MR imaging was performed with vaginal cylinder inserted in the patient’s vagina. By measuring the length of the tumor manually and projecting the tumor orthogonally to a plane parallel to the bottom surface of the cylinder applicator, a template was designed. Computer-aided design software was used for planning both templates. Polycarbonate/acrylonitrile-butadiene-styrene resin was selected as material of the templates.

Patient 1 received 4-fraction ISBT one week apart. A mean of 10 applicators were inserted through the holes of the template in an average of 9 minutes (range, 5-15 minutes). All applicators were inserted toward the planned directions. Median minimum dose covering 90% (D90%) of the clinical target volume (CTV) was 634 cGy. Patient 2 underwent three-fraction irradiation twice daily at 6-hour interval. All applicators were inserted through the inside of the template. The median D90% of the CTV was 703 cGy. No grade 3 or higher toxicity were found in both series.

3D-printed templates designed using medical images are useful, especially for ISBT of vaginal tumors. Further verification of clinical indications, design of templates, and manufacturing process are needed.


3D-printing, brachytherapy, vaginal tumor

Lukowiak M, Jezierska K, Boehlke M et al. Utilization of a 3D printer to fabricate boluses used for electron therapy of skin lesions of the eye canthi. J Appl Clin Med Phys 2017; 18: 76-81.
Kairn T, Crowe SB, Markwell T. Use of 3D Printed materials as tissue-equivalent phantoms. In: Jaffray DA (ed.). World Congress on Medical Physics and Biomedical Engineering, June 7-12, 2015, Toronto, Canada. Springer International Publishing, Cham 2015: 728-731.
Harris BD, Nilsson S, Poole CM. A feasibility study for using ABS plastic and a low-cost 3D printer for patient-specific brachytherapy mould design. Australas Phys Eng Sci Med 2015; 38: 399-412.
Huang MW, Zhang JG, Zheng L et al. Accuracy evaluation of a 3D-printed individual template for needle guidance in head and neck brachytherapy. J Radiat Res 2016; 57: 662-667.
Jones EL, Tonino Baldion A, Thomas C et al. Introduction of novel 3D-printed superficial applicators for high-dose-rate skin brachytherapy. Brachytherapy 2017; 16: 409-414.
Arenas M, Sabater S, Sintas A et al. Individualized 3D scanning and printing for non-melanoma skin cancer brachytherapy: a financial study for its integration into clinical workflow. J Contemp Brachytherapy 2017; 9: 270-276.
Sethi R, Cunha A, Mellis K et al. Clinical applications of custom-made vaginal cylinders constructed using three-dimensional printing technology. J Contemp Brachytherapy 2016; 8: 208-214.
Sohn J-I, Lim ST, Park SH et al. Effect of a reactive-type flame retardant on rheological and mechanical properties of PC/ABS blends. J Mater Sci 2003; 38: 1485-1491.
Wiebe E, Easton H, Thomas G et al. Customized vaginal vault brachytherapy with computed tomography imaging-derived applicator prototyping. Brachytherapy 2015; 14: 380-384.
Beadle BM, Jhingran A, Salehpour M et al. Cervix regression and motion during the course of external beam chemoradiation for cervical cancer. Int J Radiat Oncol Biol Phys 2009; 73: 235-241.
Rash D, Hagar Y, Cui J et al. Interfraction motion of the vaginal apex during postoperative intensity modulated radiation therapy: are we missing the target? Int J Gynecol Cancer 2013; 23: 385-392.
Cunha JA, Mellis K, Sethi R et al. Evaluation of PC-ISO for customized, 3D Printed, gynecologic 192-Ir HDR brachytherapy applicators. J Appl Clin Med Phys 2015; 16: 5168.
Craft DF, Kry SF, Balter P et al. Material matters: Analysis of density uncertainty in 3D printing and its consequences for radiation oncology. Med Phys 2018; 45: 1614-1621.
Quick links
© 2019 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe