Department of Radiation Oncology, Stanford University, Stanford, California.
Department of Radiation Oncology, Stanford University, Stanford, California.
Int J Radiat Oncol Biol Phys. 2022 Sep 1;114(1):111-119. doi: 10.1016/j.ijrobp.2022.05.027. Epub 2022 May 30.
In cervical cancer brachytherapy, adding interstitial needles to intracavitary applicators can enhance dosimetry by improving target coverage while limiting normal tissue dose. However, its use is limited to a subset of practitioners with appropriate technical skill. We designed tandem anchored radially guiding interstitial templates (TARGITs) with a 3-dimensional (3D) printing workflow to optimize needle placement and facilitate greater ease-of-use of intracavitary/interstitial (IC/IS) technique. This study compared dosimetry and procedure characteristics between tandem and ovoid (T&O) implants using TARGIT technique versus non-TARGIT technique.
This single-institution retrospective cohort study included patients undergoing T&O brachytherapy as part of definitive radiation treatment for cervical cancer between February 2017 and January 2021. TARGIT technique was implemented from November 2019 onwards; all prior procedures involved non-TARGIT technique using a no needle or freehand needle approach. Target coverage, dose to organs at risk, and procedure times were evaluated and compared between TARGIT technique and non-TARGIT technique.
The cohort included 70 patients with cervical cancer who underwent 302 T&O procedures: 68 (23%) with TARGIT technique and 234 (77%) with non-TARGIT technique, which included 133 no needle and 101 freehand needle implants. TARGIT implants involved longer average procedure times (+6.3 minutes, P < .0001). TARGIT implants achieved a higher mean high-risk clinical target volume V100% than non-TARGIT implants (+4.4%, P = .001), including for large tumors 30 cm or greater (+8.1%, P = .002). Average D90 was 4.6 Gy higher and average D98 was 3.2 Gy higher for TARGIT technique compared with non-TARGIT technique (P = .006 and P = .02). Total treatment doses to rectum, bowel, and bladder were not significantly different for TARGIT versus non-TARGIT technique.
The 3D-printed TARGIT approach to T&O brachytherapy achieved greater tumor coverage while sparing normal tissues, particularly for large tumor volumes, with only a slight increase in average procedure time. TARGIT represents a creative technological solution for increasing accessibility of advanced IC/IS brachytherapy technique for cervical cancer definitive radiation treatment.
在宫颈癌近距离放射治疗中，腔内施源器中添加间质针可以通过提高靶区覆盖率，同时限制正常组织剂量，来增强剂量学。然而，它的使用仅限于具有适当技术技能的少数从业者。我们设计了串联锚定的放射状引导间质模板（TARGIT），采用三维（3D）打印工作流程来优化针的放置，并使腔内/间质（IC/IS）技术更易于使用。本研究比较了 TARGIT 技术与非 TARGIT 技术用于串联和卵圆（T&O）植入物的剂量学和程序特征。
这是一项单机构回顾性队列研究，纳入了 2017 年 2 月至 2021 年 1 月期间接受 T&O 近距离放射治疗作为宫颈癌根治性放射治疗一部分的患者。TARGIT 技术于 2019 年 11 月开始实施；所有之前的手术均采用无针或徒手针方法进行非 TARGIT 技术。评估并比较了 TARGIT 技术和非 TARGIT 技术之间的靶区覆盖率、危及器官剂量和手术时间。
该队列包括 70 例宫颈癌患者，共进行了 302 次 T&O 手术：68 例（23%）采用 TARGIT 技术，234 例（77%）采用非 TARGIT 技术，其中包括 133 例无针和 101 例徒手针植入。TARGIT 植入术平均手术时间较长（+6.3 分钟，P<0.0001）。TARGIT 植入物的高风险临床靶区体积 V100% 比非 TARGIT 植入物高（+4.4%，P=0.001），包括 30cm 或更大的大肿瘤（+8.1%，P=0.002）。与非 TARGIT 技术相比，TARGIT 技术的平均 D90 高 4.6Gy，平均 D98 高 3.2Gy（P=0.006 和 P=0.02）。直肠、肠和膀胱的总治疗剂量在 TARGIT 与非 TARGIT 技术之间无显著差异。
3D 打印的 TARGIT 方法用于 T&O 近距离放射治疗，在不影响正常组织的情况下实现了更大的肿瘤覆盖，特别是对于大肿瘤体积，平均手术时间仅略有增加。TARGIT 代表了一种创新的技术解决方案，可提高先进的 IC/IS 近距离放射治疗技术用于宫颈癌根治性放射治疗的可及性。
