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.