KEY POINTS
- This retrospective, single-center feasibility study evaluated computed tomography datasets from 20 patients with cervical cancer treated using three-dimensional printed template-guided interstitial or combined intracavitary–interstitial brachytherapy.
- The greedy algorithm-based framework generated collision-free, non-coplanar needle trajectories using geometric influence radii of 12, 15, and 18 mm, followed by dwell-time optimization and dosimetric assessment against manual plans.
- Final algorithm-selected plans achieved high-risk clinical target volume coverage of 91.96% ± 1.24%, compared with 92.62% ± 1.51% for manual planning (p=0.024); all selected plans remained above the predefined 90%clinical threshold.
- Mean needle use decreased from 5.40 ± 0.94 to 4.25 ± 0.55 per patient (p<0.001), with fewer needles required in 16 of 20 patients.
- Mean total workflow time was 8.2 ± 1.4 minutes, compared with 2–3 hours for manual trajectory planning. Rectal, bladder, and sigmoid D2cc values did not differ significantly between approaches.
CLINICAL TAKEAWAY
This semi-automated framework could substantially reduce planning time and the number of interstitial needles while maintaining clinically acceptable target coverage and organ-at-risk doses. However, the evidence is technical and preliminary: validation was retrospective, involved only 20 patients, and did not assess physical insertion accuracy, procedural complications, or clinical outcomes.