Intensity-Modulated Interventional Radiotherapy (Modern Brachytherapy) Using 3D-Printed Applicators with Multilayer Geometry and High-Density Shielding Materials for the NMSC Treatment

Background/Objectives: This study investigates the dosimetric impact of a 3D-printed applicator integrating multilayer catheter geometry and high-density shielding, designed for contact interventional radiotherapy (IRT) in non-melanoma skin cancer (NMSC) treatment. The aim is to assess its potential to enhance target coverage and reduce doses in organs at risk (OARs). Methods: A virtual prototype of a multilayer applicator was designed using 3D modeling software and realized through fused deposition modeling. Dosimetric simulations were performed using both TG-43 and TG-186 formalisms on CT scans of a water-equivalent phantom. A five-catheter array was reconstructed, and lead-cadmium-based alloy shielding of varying thicknesses (3–15 mm) was contoured. CTVs of 5 mm and 8 mm thickness were analyzed along with a neighboring OAR. Dosimetric endpoints included V95%, V100%, V150% (CTV), D2cc (OAR), and therapeutic window (TW). Results: Compared to TG-43, the TG-186 algorithm yielded lower OAR doses while maintaining comparable CTV coverage. Progressive increase in shielding thickness led to improved V95% and V100% values and a notable reduction in OAR dose, with an optimal trade-off observed between 6 and 9 mm of shielding. The TW remained above 7 mm across all configurations, supporting its use in lesions thicker than conventional guidelines recommend. Conclusions: The integration of multilayer catheter geometry with high-density shielding in a customizable 3D-printed applicator enables enhanced dose modulation and OAR sparing in superficial IRT. This approach represents a step toward personalized brachytherapy, aligning with the broader movement in radiation oncology toward patient-specific solutions, adaptive planning, and precision medicine. Future directions should include prototyping and mechanical testing of the applicator, experimental dosimetric validation in phantoms, and pilot clinical feasibility studies to translate these promising in silico results into clinical practice.