Clinical applications of custom-made vaginal cylinders constructed using three-dimensional printing technology

Purpose Three-dimensional (3D) printing technology allows physicians to rapidly create customized devices for patients. We report our initial clinical experience using this technology to create custom applicators for vaginal brachytherapy. Material and methods Three brachytherapy patients with unique clinical needs were identified as likely to benefit from a customized vaginal applicator. Patient 1 underwent intracavitary vaginal cuff brachytherapy after hysterectomy and chemotherapy for stage IA papillary serous endometrial cancer using a custom printed 2.75 cm diameter segmented vaginal cylinder with a central channel. Patient 2 underwent interstitial brachytherapy for a vaginal cuff recurrence of endometrial cancer after prior hysterectomy, whole pelvis radiotherapy, and brachytherapy boost. We printed a 2 cm diameter vaginal cylinder with one central and six peripheral catheter channels to fit a narrow vaginal canal. Patient 3 underwent interstitial brachytherapy boost for stage IIIA vulvar cancer with vaginal extension. For more secure applicator fit within a wide vaginal canal, we printed a 3.5 cm diameter solid cylinder with one central tandem channel and ten peripheral catheter channels. The applicators were printed in a biocompatible, sterilizable thermoplastic. Results Patient 1 received 31.5 Gy to the surface in three fractions over two weeks. Patient 2 received 36 Gy to the CTV in six fractions over two implants one week apart, with interstitial hyperthermia once per implant. Patient 3 received 18 Gy in three fractions over one implant after 45 Gy external beam radiotherapy. Brachytherapy was tolerated well with no grade 3 or higher toxicity and no local recurrences. Conclusions We established a workflow to rapidly manufacture and implement customized vaginal applicators that can be sterilized and are made of biocompatible material, resulting in high-quality brachytherapy for patients whose anatomy is not ideally suited for standard, commercially available applicators.

[1]  T Fannin,et al.  Medical rapid prototyping and 3D CT in the manufacture of custom made cranial titanium plates. , 1999, Journal of medical engineering & technology.

[2]  C. Haie-meder,et al.  Technical aspects and perspectives of the vaginal mold applicator for brachytherapy of gynecologic malignancies. , 2010, Brachytherapy.

[3]  Jozef Novak-Marcincin,et al.  Experimental Testing of Materials Used in Fused Deposition Modeling Rapid Prototyping Technology , 2013 .

[4]  P. Cornes,et al.  Brachytherapy in endometrial cancer: quantification of air gaps around a vaginal cylinder. , 2008, Brachytherapy.

[5]  Adir Cohen,et al.  Mandibular reconstruction using stereolithographic 3-dimensional printing modeling technology. , 2009, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[6]  P. Grigsby,et al.  Dosimetric effects of air pockets around high-dose rate brachytherapy vaginal cylinders. , 2010, International journal of radiation oncology, biology, physics.

[7]  P A Webb,et al.  A review of rapid prototyping (RP) techniques in the medical and biomedical sector , 2000, Journal of medical engineering & technology.

[8]  L. Cheung,et al.  The usefulness of stereomodels in maxillofacial surgical management. , 2007, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[9]  Ken Goldberg,et al.  Evaluation of PC‐ISO for customized, 3D printed, gynecologic 192Ir HDR brachytherapy applicators , 2015, Journal of applied clinical medical physics.

[10]  Richard Moore,et al.  Assessment of a virtual functional prototyping process for the rapid manufacture of passive-dynamic ankle-foot orthoses. , 2013, Journal of biomechanical engineering.

[11]  P. Grigsby,et al.  A new method of anatomically conformal vaginal cuff HDR brachytherapy. , 2010, Gynecologic oncology.

[12]  J. Winder,et al.  Medical rapid prototyping technologies: state of the art and current limitations for application in oral and maxillofacial surgery. , 2005, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[13]  Harry Easton,et al.  Customized vaginal vault brachytherapy with computed tomography imaging-derived applicator prototyping. , 2015, Brachytherapy.

[14]  J. Pouliot,et al.  A dosimetric evaluation of using a single treatment plan for multiple treatment fractions within a given applicator insertion in gynecologic brachytherapy. , 2013, Brachytherapy.

[15]  J. Y. Choi,et al.  Analysis of errors in medical rapid prototyping models. , 2002, International journal of oral and maxillofacial surgery.

[16]  Amit Kumar Singh,et al.  A review paper on rapid prototyping and rapid tooling techniques for fabrication of prosthetic socket , 2013 .

[17]  Marcos Anchieta,et al.  Rapid Prototyping Applied to Maxillofacial Surgery , 2011 .

[18]  B. Hargreaves,et al.  Fabrication of Custom-Shaped Grafts for Cartilage Regeneration , 2010, The International journal of artificial organs.

[19]  R. Kudo,et al.  [Gynecologic malignancies]. , 1997, Tanpakushitsu kakusan koso. Protein, nucleic acid, enzyme.