Clinical application value of template-assisted CT-guided radioactive seed implantation for pancreatic carcinoma

Abstract

Objective To investigate the clinical value of coplanar template-assisted CT guided radioactive seeds implantation in the treatment of pancreatic carcinoma. Methods A total of 22 advanced pancreatic carcinoma patients underwent CT guided radioactive seeds implantation were retrospectively analyzed. Ten patients were treated with coplanar template-assisted with an average age of (65±10) years (48 to 77 years). Tweleve patients were treated without coplanar template assist with an average age of (68±13) years (47 to 84 years). The preoperative planning designs and postoperative dosimetry verifications were performed for all patients. The dose related parameters including D90, MPD, V100, V150 and V200 were compared between pre and post operation by t test. The operating time were also evaluated between the two groups. Results Overall the 22 patients were treated successfully without serious surgery-related complications. An average of 26 seeds were implanted in the coplanar template assisted implantation group, and 23 seeds were implanted in the non template-assisted implantation group. Preoperative V100 in coplanar template group and non template group were (94.45±1.32) % and (93.27±1.37) % separately. Postoperative V100 in both groups were (89.31±2.58) % and (85.25±4.35) % separately. Postoperative D90 in both groups were (147.32±7.12) Gy and (149.25±4.86) Gy separately. Postoperative V150 in both groups were (57.83±7.74) % and (63.97±7.75) % separately. Preoperative D90 in both groups were (152.41±6.78) Gy and (153.30±7.79) Gy separately. Preoperative V150 in both groups were (58.61±14.11) % and (62.45±6.49) % separately. Postoperative MPD in both groups were (87.64±10.60) Gy and (87.12±7.66) Gy separately. Postoperative V200 in both groups were (34.12±7.67) %, (39.42±7.18) % separately. Preoperative MPD in both groups were (82.12±7.81) Gy and (83.43±4.86) Gy separately. Preoperative V200 in both groups were (29.04±10.64) %, (36.11±7.22) % separately. Compared with preoperative plans, the mean value of D90 and V100 decreased while the mean value of MPD and V200 increased in postoperative verifications in both coplanar template assist CT guided radioactive seeds implantation group and non template-assisted group. However, there was no significant difference between pre and post operation except for V100 (P<0.05). The operating time of coplanar template assist group and non template-assisted group were (44.3±12.4) min and (60.0±12.8) min respectively. The difference of operating time between two groups were statistically significant (P<0.05). Conclusion Compared with the treatment without template assist, coplanar template-assisted brachytherapy could be more accurate in preoperative plans optimization, and shorten the operation time and improve the patients' tolerance. Key words: Pancreatic neoplasms; Brachytherapy; Iodine radioisotopes; Tomography, spiral computed