{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T12:15:27Z","timestamp":1774354527069,"version":"3.50.1"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Conventional freehand three-dimensional interstitial brachytherapy (F-3DIB) for locally advanced cervical cancer (LACC) is limited by suboptimal dose distribution and operator dependency. This study aimed to evaluate the long-term survival and safety benefits of 3D-printed template-guided interstitial brachytherapy (3D-PTIB).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective single-center cohort study included 300 patients with FIGO IIB-IVA LACC who underwent brachytherapy between January 2021 and June 2022. The median follow-up time was 36.2 months (range: 34-41). Follow-up data were collected between January 2024 and June 2025, ensuring adequate follow-up for survival assessment. Patients were divided into 3D-PTIB and F-3DIB groups. Propensity score matching was used to balance baseline characteristics, resulting in a matched cohort of 240 patients. The outcomes assessed included 3-year overall survival (OS), progression-free survival (PFS), local control (LC), dosimetric parameters, and late toxicities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The 3D-PTIB group exhibited significantly better 3-year OS (76.7% vs. 66.2%, HR = 0.69, p = 0.02) and LC (90.0% vs. 78.3%, HR = 0.47, p = 0.01) than the F-3DIB group. A trend toward improved 3-year PFS was also observed (70.8% vs. 62.3%, HR = 0.73, p = 0.05). Notably, the 3D-PTIB group achieved an 11.7% absolute improvement in local control (90.0% vs. 78.3%). A\n                      <jats:italic>post hoc<\/jats:italic>\n                      power analysis indicated that the study had approximately 80% power (\u03b1 = 0.05, two-sided) to detect the observed hazard ratio of 0.69 for OS in the matched cohort. Dosimetric advantages included a significantly greater HR-CTV D90 (87.5 \u00b1 3.2 Gy vs. 82.1 \u00b1 4.8 Gy, p &amp;lt; 0.001) and reduced rectal D2 cc (64.5 \u00b1 5.1 Gy vs. 72.3 \u00b1 6.7 Gy, p &amp;lt; 0.001). Clinically, the incidence of \u2265 grade 3 radiation proctitis was significantly lower in the 3D-PTIB group (4.2% vs. 11.7%, p = 0.008).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>3D-printed template-guided interstitial brachytherapy significantly improves intermediate- to long-term survival and reduces late toxicity in LACC patients, particularly high-risk patients with a tumor diameter &amp;gt; 4 cm or parametrial invasion, highlighting its potential as a superior alternative to conventional freehand interstitial brachytherapy.<\/jats:p>\n                  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