3D printing in brachytherapy: A systematic review of gynecological applications

Benjamin P Fahimian; Wu Liu; Lawrie Skinner; Amy S Yu; Tiffany Phillips; Jennifer M Steers; John DeMarco; Benedick A Fraass; Mitchell Kamrava

doi:10.1016/j.brachy.2023.02.002

3D printing in brachytherapy: A systematic review of gynecological applications

Brachytherapy. 2023 Jul-Aug;22(4):446-460. doi: 10.1016/j.brachy.2023.02.002. Epub 2023 Apr 4.

Authors

Benjamin P Fahimian¹, Wu Liu², Lawrie Skinner², Amy S Yu², Tiffany Phillips³, Jennifer M Steers³, John DeMarco³, Benedick A Fraass³, Mitchell Kamrava³

Affiliations

¹ Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: benjamin.fahimian@cshs.org.
² Department of Radiation Oncology, Stanford University, Stanford, CA.
³ Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA.

PMID: 37024350
DOI: 10.1016/j.brachy.2023.02.002

Abstract

Purpose: To provide a systematic review of the applications of 3D printing in gynecological brachytherapy.

Methods: Peer-reviewed articles relating to additive manufacturing (3D printing) from the 34 million plus biomedical citations in National Center for Biotechnology Information (NCBI/PubMed), and 53 million records in Web of Science (Clarivate) were queried for 3D printing applications. The results were narrowed sequentially to, (1) all literature in 3D printing with final publications prior to July 2022 (in English, and excluding books, proceedings, and reviews), and then to applications in, (2) radiotherapy, (3) brachytherapy, (4) gynecological brachytherapy. Brachytherapy applications were reviewed and grouped by disease site, with gynecological applications additionally grouped by study type, methodology, delivery modality, and device type.

Results: From 47,541 3D printing citations, 96 publications met the inclusion criteria for brachytherapy, with gynecological clinical applications compromising the highest percentage (32%), followed by skin and surface (19%), and head and neck (9%). The distribution of delivery modalities was 58% for HDR (Ir-192), 35% for LDR (I-125), and 7% for other modalities. In gynecological brachytherapy, studies included design of patient specific applicators and templates, novel applicator designs, applicator additions, quality assurance and dosimetry devices, anthropomorphic gynecological applicators, and in-human clinical trials. Plots of year-to-year growth demonstrate a rapid nonlinear trend since 2014 due to the improving accessibility of low-cost 3D printers. Based on these publications, considerations for clinical use are provided.

Conclusions: 3D printing has emerged as an important clinical technology enabling customized applicator and template designs, representing a major advancement in the methodology for implantation and delivery in gynecological brachytherapy.

Keywords: 3D printing; Additive manufacturing; Brachytherapy; Cervical; Endometrial; Gynecological; HDR; LDR.

Publication types

Systematic Review
Review

MeSH terms

Brachytherapy* / methods
Humans
Iodine Radioisotopes*
Printing, Three-Dimensional
Radiotherapy Dosage

Substances

Iodine-125
Iodine Radioisotopes