Patient-specific 3D-printed templates enabled efficient brachytherapy for complex cervical cancer

KEY POINTS

• The retrospective real-world cohort included 120 consecutive patients with FIGO 2018 stage IB3–IVA cervical cancer treated between March 2023 and March 2025. Eighty-five percent had stage IIIA–IVA disease, median tumour size was 5.4 cm, and 36.7% had tumours larger than 6 cm.
• All patients received definitive pelvic IMRT or VMAT to 45–50.4 Gy in 25–28 fractions, generally with weekly cisplatin at 40 mg/m², followed by patient-specific template-guided hybrid intracavitary/interstitial HDR brachytherapy.
• Templates translated CT/MRI-based preplanning into individualized catheter entry points, directions, and depths. Flexible plastic catheters and curved or oblique channels were used when straight trajectories could not safely reach lateral, parametrial, vaginal, or anatomically constrained disease.
• Across 555 template-guided fractions, patients received a median of five brachytherapy fractions. Median applicator-and-catheter placement time was 4.21 minutes, with 7.25 implanted channels per fraction; no source-pathway obstruction or clinically significant applicator displacement occurred.
• Median HR-CTV volume was 55.9 cm³, and cumulative HR-CTV D90 was 92.9 Gy EQD2. Median D2cm³ values were 72.5 Gy for rectum, 76.2 Gy for bladder, 64.9 Gy for sigmoid colon, and 63.0 Gy for bowel.
• Minor insertion-related bleeding occurred in 10.8%, and major bleeding in 1.7%. Late grade ≥3 gastrointestinal and genitourinary toxicity occurred in 2.5% and 1.7%, respectively, with no grade 4–5 toxicity or treatment-related death.
• At a median follow-up of 20.1 months, estimated three-year local and regional recurrence-free survival were 94.3% and 98.0%. Three-year overall and progression-free survival were 77.9% and 76.8%, but these later estimates were based on relatively few patients remaining at risk.

CLINICAL TAKEAWAY

SOURCE

Cancers