Virtual reality-guided simulation of brachytherapy: Two case reports

Purpose: Brachytherapy requires precise applicator placement, especially in complex cases, where standard imaging may not provide sufficient guidance. Virtual reality (VR) technology has emerged as a valuable tool for pre-simulation, enabling improved anatomical understanding and procedural planning. We reported two cases, in which VR pre-simulation was used to enhance brachytherapy planning in challenging anatomical regions. Cases description: Case 1: A 51-year-old woman with carcinoma of unknown primary and poorly differentiated adenocarcinoma had previously undergone chemotherapy and radiation therapy for a large tumor in the right common iliac region. The tumor recurred and invaded the sacrum, requiring interstitial brachytherapy due to prior radiation dose constraints. Applicator placement was challenging, necessitating collaboration with an interventional radiology (IR) physician. VR pre-simulation facilitated multi-disciplinary communication and optimized puncture, leading to a safer and more accurate procedure. Case 2: A 46-year-old man with floor of the mouth cancer was initially scheduled for total glossectomy and laryngectomy, but opted for radiotherapy after significant tumor shrinkage. To minimize radiation dose to the mandible, interstitial brachytherapy was added. Due to safety concerns regarding prolonged applicator placement, a strategy of daily insertion and removal was adopted. A custom-made mouthpiece with a single guiding applicator was prepared by a dentist, and multiple needle-type applicators were employed. VR pre-simulation enabled precise needle insertion and facilitated procedural consistency, even among radiation oncologists unfamiliar with head and neck brachytherapy. Conclusions: VR technology enhances pre-procedural planning, improve multi-disciplinary coordination, and optimize needle placement in brachytherapy for complex anatomical sites. By integrating VR into brachytherapy workflows, treatment precision and safety can be improved across various anatomical regions.