Rane Sanika, Hanania Alexander, Arango Elisa, Kumar Krithika, Payne Lauren, Dittmar Susannah, Gomber Gaurav, Ugarte Vincent, Ludwig Michelle
Radiation Oncology, Baylor College of Medicine, Houston, USA.
Radiation Oncology, Dell Medical School, The University of Texas at Austin, Austin, USA.
Cureus. 2023 Jun 29;15(6):e41162. doi: 10.7759/cureus.41162. eCollection 2023 Jun.
The purpose of this report is to design, develop, and evaluate a cost-effective applicator for interstitial brachytherapy (ISBT) to minimize patient morbidity and facilitate access to curative radiation treatment for gynecologic cancers, especially in low-resource settings. A computer-aided design and prototype were developed of a proposed applicator that incorporates 44 slotted channels to gently guide needles, with or without a tandem, through the vaginal canal, effectively eliminating the need for transcutaneous needle insertions typically employed during ISBT of advanced gynecologic cancer and thus reducing the risk of vaginal laceration and bladder or rectal injury. The tested prototype was developed using AutoCAD software (Autodesk, San Francisco, CA) and 3D printed in Accura Xtreme Gray material using stereolithography. Small-scale iterative tests using a gelatin phantom were conducted on this prototype to confirm the efficacy of the applicator through inter-operator usability, needle stability, and needle arrangement. A promising prototype was developed aimed at addressing key issues with traditional perineum-based templates to facilitate ISBT, including being able to cover bulky tumors with parametrial extension reliably, decrease the risk of tissue or organ injury, and treat women with a prior hysterectomy. Results of preclinical testing demonstrated that the applicator met its purpose, suggesting that it may facilitate ISBT without the morbidity typically associated with the procedure, especially by addressing concerns associated with implementing the procedure in low-resource settings. The applicator shows substantial promise in the treatment of advanced gynecologic cancer. While further testing remains necessary to confirm its translatability to the clinical setting, the applicator appears capable of meeting its design objectives, representing its potential for improving upon current methods.
本报告的目的是设计、开发并评估一种用于间质近距离放射治疗（ISBT）的具有成本效益的施源器，以尽量减少患者的发病率，并便于为妇科癌症患者提供根治性放射治疗，尤其是在资源匮乏地区。针对一种提议的施源器进行了计算机辅助设计并制作了原型，该施源器包含44个带槽通道，可轻柔地引导带或不带串联装置的针穿过阴道管，有效消除了晚期妇科癌症ISBT过程中通常采用的经皮针插入操作，从而降低了阴道撕裂以及膀胱或直肠损伤的风险。测试原型是使用AutoCAD软件（Autodesk，加利福尼亚州旧金山）开发的，并使用立体光刻技术以Accura Xtreme Gray材料进行3D打印。使用明胶模型对该原型进行了小规模迭代测试，以通过操作员间的可用性、针的稳定性和针的排列来确认施源器的有效性。开发了一个有前景的原型，旨在解决传统会阴模板在促进ISBT方面的关键问题，包括能够可靠地覆盖有宫旁组织浸润的巨大肿瘤、降低组织或器官损伤的风险以及治疗有子宫切除史的女性。临床前测试结果表明该施源器达到了预期目的，这表明它可能有助于ISBT，且不会出现该手术通常伴随的发病率，特别是通过解决在资源匮乏地区实施该手术相关的问题。该施源器在晚期妇科癌症的治疗中显示出巨大潜力。虽然仍需进一步测试以确认其在临床环境中的可转化性，但该施源器似乎能够实现其设计目标，展现了其改进现有方法的潜力。
