Article Text
Abstract
Introduction Adjuvant radiotherapy following definitive surgery for intermediate and high-intermediate risk endometrial cancers provides significant reduction in local recurrence. Vaginal brachytherapy is used as monotherapy for intermediate risk malignancies and may be used in conjunction with external beam radiotherapy if there is cervical stromal involvement. Delivery of prescribed dose critically depends on close apposition of the applicator to the vaginal mucosa. While in many cases a cylindrical applicator may suffice, if the vault topography is irregular, close apposition may not be possible. We are conducting a feasibility study to develop an efficient and robust clinical workflow for a personalised 3D-printed vaginal applicator generated from a simulation CT.
Methods Patients identified at the Northern Sydney Cancer Centre Gynaeoncology multidisciplinary tumour board requiring intracavitary vaginal brachytherapy are eligible. Eligible and consenting patients are CT simulated using a standard fixed diameter cylinder followed by a CT simulation with a gel or alginate distended vaginal cavity. A model for the custom applicator is generated and sent for 3D printing. Brachytherapy plans are produced for both the cylinder and custom applicator and patients are treated using the best tolerated technique and dosimetrically superior plan. Patient reported quality of life outcomes and clinician reported outcomes are collected as well as dosimetric data. Clinical follow up extends to 5 years.
Current Trial Status The trial is open and we are actively recruiting patients with a target of 10 patients. To date four patients have been screened, one patient is for clinical assessment and one patient is in the planning stage for treatment.