A Novel Three-Dimension Printed Individualized Curved-Needle-Based Interstitial Brachytherapy for Re-Irradiation in Uterine Fundus-Involving Recurrent Cervical Cancer: A Case Report.

BACKGROUND

Re-irradiation in recurrent cervical cancer presents significant therapeutic challenges, particularly in those with a short interval since prior treatment. Brachytherapy is an ideal re-irradiation method, but regular intracavitary brachytherapy combined with interstitial brachytherapy (ISBT) is restricted by some challenging tumor anatomical locations, which can be optimized through a three-dimensional (3D)-printed curved-needle ISBT system.

CASE PRESENTATION: A 41-year-old woman diagnosed with cervical mucinous adenocarcinoma developed central pelvic relapse, with tumor extension to the uterine fundus, within two years after completing standard concurrent chemoradiotherapy (CCRT). The patient subsequently received 3D-printed individualized curved-needle-based, MRI-guided adaptive ISBT, in combination with external beam radiotherapy (EBRT) and chemotherapy. This comprehensive treatment approach achieved 45 months of overall survival (OS), 37 months of local control (LC) and progression-free survival (PFS) with grade 3 proctitis and grade 3 cystitis and no fistulation or perforation.

CONCLUSIONS

The 3D-printed individualized curved-needle ISBT is a re-irradiation option that provides satisfactory LC and prolonged survival with acceptable adverse effects for recurrent tumors located in the distal uterine fundus in cervical cancer. This technique is particularly valuable when intracavitary and traditional interstitial applicators are unsuitable due to the unique location of the tumor.