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Clinical outcomes using a 3D printed tandem-needle-template and the EMBRACE-II planning aims for image guided adaptive brachytherapy in locally advanced cervical cancer.
Cobussen, Anne; Petric, Primoz; Wulff, Christian Nielsen; Buus, Simon; Spejlborg, Harald; Nielsen, Søren Kynde; Traberg, Anders; Meisner, Bjarne; Hokland, Steffen; Lindegaard, Jacob Christian.
Afiliação
  • Cobussen A; Department of Oncology, Aarhus University Hospital, Denmark.
  • Petric P; Department of Radiation Oncology, MAASTRO clinic, the Netherlands.
  • Wulff CN; Department of Oncology, Aarhus University Hospital, Denmark.
  • Buus S; Department of Radiation Oncology, Zürich University Hospital, Switzerland.
  • Spejlborg H; Department of Oncology, Aarhus University Hospital, Denmark.
  • Nielsen SK; Department of Oncology, Aarhus University Hospital, Denmark.
  • Traberg A; Department of Oncology, Aarhus University Hospital, Denmark.
  • Meisner B; Department of Oncology, Aarhus University Hospital, Denmark.
  • Hokland S; Department of Oncology, Aarhus University Hospital, Denmark.
  • Lindegaard JC; Department of Oncology, Aarhus University Hospital, Denmark.
Acta Oncol ; 62(11): 1470-1478, 2023 Nov.
Article em En | MEDLINE | ID: mdl-37594195
ABSTRACT

BACKGROUND:

Extensive local disease or narrow vagina may compromise brachytherapy (BT) in patients with cervical cancer. This is the first study to analyze long-term outcomes of using 3D printed vaginal tandem-needle templates (3DP TNT) for transvaginal insertion of needles in parallel (P) or parallel and oblique (P&O) direction to the tandem. MATERIAL AND

METHODS:

All patients treated with BT using 3DP TNT from 2015-2020 were included. Decision to use a 3DP TNT and preplanning were made after 4-5 weeks of external beam radiotherapy, based on gynecological examination and MRI with a tandem-ring applicator in situ. The TNT was 3D-printed in house consisting of a circular template with P&O holes for guidance of plastic needles and a shaft fitting the uterine tandem. Thus, the radioactive source was never in direct contact with the 3DP TNT. The TNT was 3D printed in a standard or personalized configuration. Planning aims were based on the Embrace II protocol.

RESULTS:

101 patients (median age of 63 years) were included 49 with P needles only and 52 with P&O needles. Personalized TNT was used in 19 patients in the P&O group. Performance status (WHO) was > 0 in 48%. FIGO2018 stage III-IV was present in 77%. T-score at diagnosis and BT was 9.1 and 6.3 respectively, with a significantly higher T-score in the P&O compared to P group. The mean high-risk CTV D90 was 93 Gy with no significant difference between the two groups. Three-year local control rates were 85%, 95%, 75% for the overall, P- and P&O group respectively and 68%, 80% and 56% for cancer specific survival. Grade ≥3 treatment related complications were observed in 10 (10%) patients.

CONCLUSIONS:

3DP TNT for BT in cervical cancer provides successful management of very extensive local disease and/or unfavorable anatomy with the possibility for treatment individualization.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Braquiterapia / Neoplasias do Colo do Útero Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Braquiterapia / Neoplasias do Colo do Útero Idioma: En Ano de publicação: 2023 Tipo de documento: Article