Department of Oncology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou 545005, Guangxi, China.
Department of Oncology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou 545005, Guangxi, China.
Brachytherapy. 2024 Nov-Dec;23(6):641-647. doi: 10.1016/j.brachy.2024.06.004. Epub 2024 Aug 24.
This study was conducted to compare the differences between 3D-printed multichannel non-co-planar vaginal applicators and single-channel vaginal applicators in cervical cancer patients with positive or close surgical margins.
Between January 2015 and June 2023, 104 cervical cancer patients who underwent radical surgery with positive or close surgical margins were enrolled to receive concurrent intensity-modulated chemoradiotherapy combined with 3D-printed multichannel non-co-planar vaginal applicators (3D-printed group, 41 patients) or single-channel vaginal applicators (single-channel group, 63 patients) guided brachytherapy. The dosimetric parameters, 5-year local control (LC), progression-free survival (PFS), overall survival (OS) of two groups were retrospectively analyzed.
The high-risk clinical target volume (D90, D100) and high-dose volume fraction (V150) in 3D-printed group were significantly higher than those in single-channel group (p < 0.05), and the homogeneity index (HI) and conformal index (COIN) were equally better in 3D-printed group. In 3D-printed group, the D2cc, D1cc, and D0.1cc of the bladder and rectum were significantly lower than those of the single-channel group (p < 0.05). The 3D-printed group had significantly superior 5-year LC (70.0% vs. 51.3%, p = 0.041) and PFS (63.0% vs. 44.2%, p = 0.045), but OS were not significantly different between treatment groups (75.4% vs. 59.7%, p = 0.112). The incidence of radiation enteritis and cystitis was lower in the 3D-printed group than in the single-channel group, but no statistical difference was noted.
The 3D-printed multichannel non-co-planar vaginal insertion applicators show the advantage of target dose, improve the LC and PFS in patients with positive or close surgical margins after cervical cancer surgery. Thus, the popularization of this method and its application may be of value.
本研究旨在比较 3D 打印多通道非共面阴道施源器和单通道阴道施源器在宫颈癌术后切缘阳性或临近的患者中的差异。
2015 年 1 月至 2023 年 6 月，纳入 104 例宫颈癌根治术后切缘阳性或临近的患者，接受调强适形放化疗联合 3D 打印多通道非共面阴道施源器（3D 打印组，41 例）或单通道阴道施源器（单通道组，63 例）引导近距离放疗。回顾性分析两组患者的剂量学参数、5 年局部控制率（LC）、无进展生存率（PFS）和总生存率（OS）。
3D 打印组的高危临床靶区（D90、D100）和高剂量体积分数（V150）显著高于单通道组（p<0.05），而 3D 打印组的适形指数（HI）和均匀性指数（COIN）更好。在 3D 打印组中，膀胱和直肠的 D2cc、D1cc 和 D0.1cc 显著低于单通道组（p<0.05）。3D 打印组 5 年 LC（70.0% vs. 51.3%，p=0.041）和 PFS（63.0% vs. 44.2%，p=0.045）明显更高，而两组 OS 无显著差异（75.4% vs. 59.7%，p=0.112）。3D 打印组放射性肠炎和膀胱炎的发生率低于单通道组，但无统计学差异。
3D 打印多通道非共面阴道施源器在宫颈癌术后切缘阳性或临近的患者中显示出靶区剂量的优势，提高了患者的 LC 和 PFS。因此，这种方法的推广及其应用可能具有价值。
