Organ sparing treatment for penile cancer using a 3D-printed high-dose-rate brachytherapy applicator

We present a case study of the treatment of localized squamous cell carcinoma on the glans penis with a custom-fabricated high-dose-rate (HDR) brachytherapy applicator. A cylindrically shaped applicator was fabricated with eight embedded channels suitable for standard plastic brachytherapy catheters...

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Published in:	Brachytherapy Vol. 22; no. 5; pp. 580 - 585
Main Authors:	Lee, Hugh H.C., Chiu, Tsuicheng D., Hrycushko, Brian, Xiong, Zhenyu, Hudak, Steve, Woldu, Solomon, Mauck, Ryan, Corwin, Terry, Meng, Xiaosong, Margulis, Vitaly, Desai, Neil, Folkert, Michael R., Garant, Aurelie
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-09-2023
Subjects:	3D printed applicator Custom bolus HDR brachytherapy Penile cancer Plesiotherapy SCC Penile cancer CTV PLA Plesiotherapy 3D printed applicator HDR DVH SLA FDM HDR brachytherapy Custom bolus
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Abstract	We present a case study of the treatment of localized squamous cell carcinoma on the glans penis with a custom-fabricated high-dose-rate (HDR) brachytherapy applicator. A cylindrically shaped applicator was fabricated with eight embedded channels suitable for standard plastic brachytherapy catheters. An additional custom silicone bolus/sleeve was designed to be used with the 3D-printed applicator to provide an additional offset from the source to skin to reduce the surface dose and for patient comfort. The patient (recurrent cT1a penile cancer) underwent CT simulation, and the brachytherapy plan was created with a nominal prescription dose of 40 Gy in 10 fractions given bidaily to the surface, and 35 Gy at 5 mm depth. Dose coverage to the clinical target volume was 94% (D90). Most fractions were treated with only 5-10 min of setup time. Follow up visits up to 1 year showed no evidence of disease with no significant changes in urinary and sexual function and limited cosmetic detriment to the patient. Patient-specific organ-sparing HDR plesiotherapy using 3D printing technology can provide reliable and reproducible patient setup and may be effective in achieving disease control for superficial penile cancer, although preserving patient quality of life.
AbstractList	PURPOSEWe present a case study of the treatment of localized squamous cell carcinoma on the glans penis with a custom-fabricated high-dose-rate (HDR) brachytherapy applicator.METHODS AND MATERIALSA cylindrically shaped applicator was fabricated with eight embedded channels suitable for standard plastic brachytherapy catheters. An additional custom silicone bolus/sleeve was designed to be used with the 3D-printed applicator to provide an additional offset from the source to skin to reduce the surface dose and for patient comfort.RESULTSThe patient (recurrent cT1a penile cancer) underwent CT simulation, and the brachytherapy plan was created with a nominal prescription dose of 40 Gy in 10 fractions given bidaily to the surface, and 35 Gy at 5 mm depth. Dose coverage to the clinical target volume was 94% (D90). Most fractions were treated with only 5-10 min of setup time. Follow up visits up to 1 year showed no evidence of disease with no significant changes in urinary and sexual function and limited cosmetic detriment to the patient.CONCLUSIONSPatient-specific organ-sparing HDR plesiotherapy using 3D printing technology can provide reliable and reproducible patient setup and may be effective in achieving disease control for superficial penile cancer, although preserving patient quality of life. We present a case study of the treatment of localized squamous cell carcinoma on the glans penis with a custom-fabricated high-dose-rate (HDR) brachytherapy applicator. A cylindrically shaped applicator was fabricated with eight embedded channels suitable for standard plastic brachytherapy catheters. An additional custom silicone bolus/sleeve was designed to be used with the 3D-printed applicator to provide an additional offset from the source to skin to reduce the surface dose and for patient comfort. The patient (recurrent cT1a penile cancer) underwent CT simulation, and the brachytherapy plan was created with a nominal prescription dose of 40 Gy in 10 fractions given bidaily to the surface, and 35 Gy at 5 mm depth. Dose coverage to the clinical target volume was 94% (D90). Most fractions were treated with only 5-10 min of setup time. Follow up visits up to 1 year showed no evidence of disease with no significant changes in urinary and sexual function and limited cosmetic detriment to the patient. Patient-specific organ-sparing HDR plesiotherapy using 3D printing technology can provide reliable and reproducible patient setup and may be effective in achieving disease control for superficial penile cancer, although preserving patient quality of life.
Author	Lee, Hugh H.C. Corwin, Terry Meng, Xiaosong Mauck, Ryan Hrycushko, Brian Margulis, Vitaly Garant, Aurelie Chiu, Tsuicheng D. Woldu, Solomon Hudak, Steve Desai, Neil Xiong, Zhenyu Folkert, Michael R.
Author_xml	– sequence: 1 givenname: Hugh H.C. orcidid: 0000-0003-1325-1530 surname: Lee fullname: Lee, Hugh H.C. organization: Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX – sequence: 2 givenname: Tsuicheng D. surname: Chiu fullname: Chiu, Tsuicheng D. email: Tsuicheng.Chiu@UTSouthwestern.edu organization: Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX – sequence: 3 givenname: Brian surname: Hrycushko fullname: Hrycushko, Brian organization: Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX – sequence: 4 givenname: Zhenyu surname: Xiong fullname: Xiong, Zhenyu organization: Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX – sequence: 5 givenname: Steve surname: Hudak fullname: Hudak, Steve organization: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX – sequence: 6 givenname: Solomon surname: Woldu fullname: Woldu, Solomon organization: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX – sequence: 7 givenname: Ryan orcidid: 0000-0001-6385-5397 surname: Mauck fullname: Mauck, Ryan organization: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX – sequence: 8 givenname: Terry surname: Corwin fullname: Corwin, Terry organization: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX – sequence: 9 givenname: Xiaosong orcidid: 0000-0003-1120-7691 surname: Meng fullname: Meng, Xiaosong organization: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX – sequence: 10 givenname: Vitaly surname: Margulis fullname: Margulis, Vitaly organization: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX – sequence: 11 givenname: Neil orcidid: 0000-0002-6287-3427 surname: Desai fullname: Desai, Neil organization: Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX – sequence: 12 givenname: Michael R. orcidid: 0000-0002-2886-0956 surname: Folkert fullname: Folkert, Michael R. organization: Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX – sequence: 13 givenname: Aurelie orcidid: 0000-0003-3835-0906 surname: Garant fullname: Garant, Aurelie organization: Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
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SubjectTerms	3D printed applicator Custom bolus HDR brachytherapy Penile cancer Plesiotherapy
Title	Organ sparing treatment for penile cancer using a 3D-printed high-dose-rate brachytherapy applicator
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