Freehand Needle Hybrid Brachytherapy in Complex Gynecological Cancers

Hybrid intracavitary-interstitial brachytherapy improves local control in complex gynecologic malignancies. However, access to advanced applicators remains limited in resource-constrained settings. We present a case series of three patients with challenging anatomical and disease characteristics in whom personalized hybrid brachytherapy was performed using freehand interstitial needle placement. All patients received standard chemoradiation followed by CT-guided brachytherapy. Due to inadequate coverage with conventional applicators, individualized freehand needle placement was performed and stabilized using locally available materials. Adequate dosimetric coverage of the high-risk clinical target volume was achieved in all cases while respecting organ-at-risk constraints. Two patients demonstrated a complete response on follow-up imaging, while one showed excellent clinical response. This report highlights a practical, cost-effective alternative when advanced templates are unavailable and underscores the importance of innovation in resource-limited environments.