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Background   125 I seed implantation has been found to show good therapeutic effects on tumors. Recent studies showed that three-dimensional (3D) print template-assisted  125 I seed implantation can optimize radiation dose distribution. This study aimed to compare the dose distribution differences in  125 I seed implantation among 3D print noncoplanar template- (3DPNCT), 3D print coplanar template- (3DPCT) assisted implantation and traditional free-hand implantation.    Methods  We systematically searched the PubMed, EMbase, Cochrane Library, Wan Fang Med Online, China National Knowledge Infrastructure (CNKI) from the earliest to November 2020 without time or language restrictions. And the references of primary literature were also searched. The outcome measures were dosimetry and operation time. This meta-analysis was carried out using Stata 12.0.    Results  A total of 16 original articles were selected for inclusion. The differences of D90, D100, V90, and V100 values pre- and post-implantation with traditional free-hand implantation showed statistically significant ( p  < 0.05). The differences of D90, D100, V100, V150, V200, and D2cc of organs at risk (OAR) values pre- and post-implantation with 3D print template showed no statistically significant ( p  > 0.05). Compared with traditional free-hand implantation without any templates, 3D print template could improve postoperative D90 (Standard mean difference, SMD = 0.67, 95% confidence interval (CI) = 0.35 to 0.98,  p  < 0.001), D100 (SMD = 0.82, 95%CI = 0.40 to 1.23,  p  < 0.001), V90 (SMD = 1.48, 95%CI = 0.95 to 2.00,  p  < 0.001), V100 (SMD = 1.41, 95%CI = 0.96 to 1.86,  p  < 0.001), and reduce operation time (SMD = − 0.93, 95%CI = − 1.34 to − 0.51,  p  < 0.001). In three studies, both 3DPNCT and 3DPCT plans were designed for all patients. The prescribed dose and seed activity were same. Pooled analysis of D90, D100, V100, D2cc of OAR, number of seeds and number of needles showed no significant differences between 3DPNCT and 3DPCT groups ( p  > 0.05). However, in 3DPNCT group, V150 and V200 were increased (SMD = 0.35, 0.49; 95%CI = 0.04 to 0.67, 0.02 to 0.96;  p  = 0.028, 0.043); the number of through bone needles was reduced (SMD = − 1.03, 95%CI = − 1.43 to − 0.64,  p  < 0.001).    Conclusions  Compared with traditional free-hand implantation, 3D print template-assisted  125 I seeds implantation can optimize dose distribution and reduce the implantation time at the same time. Compared with 3D print coplanar template, 3D print noncoplanar template can increase the volume of high dose within tumor target and is more safer in the respect of puncture route.    Supplementary Information  The online version contains supplementary material available at 10.1186/s13014-021-01845-y.

Dosimetry study of three-dimensional print template for 125I implantation therapy