Three-dimensional-printed template-assisted image-guided brachytherapy for cervical cancer: Technology, dosimetry, and clinical implementation.

PURPOSE: Three-dimensional (3D)-printed templates have emerged as practical tools to reduce geometric uncertainty and workflow variability in free-hand intracavitary/interstitial (IC/IS) brachytherapy for cervical cancer. This narrative review aimed to summarize contemporary evidence on 3D-printed templates and applicators, focusing on technology, dosimetry, clinical outcomes, and practical implementation within modern image-guided brachytherapy programs.

MATERIAL AND

METHODS

A narrative literature review with structured search and evidence mapping elements was performed using PubMed and PubMed Central to identify clinical, dosimetric, and technical studies reporting on 3D-printed templates or applicators for cervical or gynecologic brachytherapy between January 2020 and April 2026. The final search was updated on April 28, 2026. Search terms combined cervical cancer, brachytherapy, and 3D printing concepts. Human studies describing device design, imaging and planning approaches, dosimetry, clinical outcomes, or workflow metrics were included, while reference lists of key articles and guidelines were screened to capture influential pre-3D printing mould and hybrid IC/IS series. Data from eligible reports were summarized in structured tables and synthesized qualitatively by theme.

RESULTS

Current evidence suggests that 3D-printed templates and applicators can improve the reproducibility of intracavitary/interstitial implantation, and facilitate individualized high-dose-rate or low-dose-rate brachytherapy in anatomically complex primary and recurrent cervical cancer. The reported studies generally showed improved high-risk clinical target volume coverage, higher D90/D98 values, better conformity, and similar or reduced organ at risk doses, compared with standard applicators or free-hand techniques. Emerging clinical series, including early reports on AI-assisted and curved needle template approaches, indicate favorable local control with acceptable severe toxicity, although most available data remain retrospective, single-center, or heterogeneous.

CONCLUSIONS

Three-dimensional-printed template-assisted brachytherapy represents a clinically relevant strategy for improving implantation reproducibility and supporting individualized image-guided brachytherapy in cervical cancer. Although promising, evidence is still evolving. Wider adoption will require prospective multi-institutional validation, standardized manufacturing and sterilization pathways, robust template-specific quality assurance, and pragmatic implementation models suitable for different clinical settings.