Abstract
BackgroundDue to the unique anatomical location of retroperitoneal metastatic lymph nodes, current treatment options are limited. This study was designed to explore the clinical efficacy and prognostic factors of CT-guided 125I brachytherapy for the treatment of retroperitoneal metastatic lymph nodes.MethodsWe retrospectively evaluated 92 patients received 125I brachytherapy for retroperitoneal metastatic lymph nodes. A layered Cox proportional hazards model was established to filter out the independent factors affecting local tumor progression-free survival (LTPFS).ResultsThe median LTPFS was 8 months. Metastatic lymph node with uniform density (p-0.009), clear boundaries (p-0.011), regular morphology (P < 0.001), and < 3 organs at risk of metastasis (p-0.020) were associated with better LTPFS. Necrotic lymph nodes (p < 0.001), fusion (p-0.003), and invasion of vessels visible on images (p < 0.001) were associated with poor LTPFS. Puncture path through abdominal wall or paravertebral approach were also associated with better LTPFS than a hepatic approach (P < 0.05). A maximum diameter ≤ 3 cm (P-0.031) or 3–5 cm (P-0.018) were also associated with significantly better LTPFS than a maximum diameter ≥ 5 cm. The Cox proportional hazards model suggested that lymph nodes invaded the large vessels visible on images, maximum diameter and puncture path were independent risk factors for LTPFS.ConclusionCT-guided 125I brachytherapy is an optional palliative treatment modality for retroperitoneal metastatic lymph nodes, which can provide high local control without severe complications. Better preoperative planning, intraoperative implementation, better choice of puncture path, and selection of appropriate tumor size are important factors that can improve the clinical efficacy of 125I brachytherapy for retroperitoneal metastatic lymph nodes.
Highlights
Due to the unique anatomical location of retroperitoneal metastatic lymph nodes, current treatment options are limited
Retroperitoneal metastatic lymph nodes are often close to the spinal cord, gastrointestinal tract, liver, kidney, and pancreas, which have extremely low radiation tolerance
We conducted a retrospective analysis of 92 patients with retroperitoneal metastatic lymph nodes, who were treated with 125I brachytherapy from April 2008 to August 2016
Summary
Due to the unique anatomical location of retroperitoneal metastatic lymph nodes, current treatment options are limited. This study was designed to explore the clinical efficacy and prognostic factors of CT-guided 125I brachytherapy for the treatment of retroperitoneal metastatic lymph nodes. Retroperitoneal metastatic lymph nodes often cause a series of serious clinical symptoms, such as abdominal pain, bloating, jaundice, loss of appetite, and radiating pain in the lower back. These symptoms can severely affect the patients’ quality of life [4]. It is difficult to maintain high concentrations of chemotherapies in the pelvic and abdominal lymph nodes, and systemic chemotherapy has little or no treatment effect [7,8,9,10]. It is difficult to obtain better results for relatively large retroperitoneal metastatic lymph nodes. It is often difficult to decipher the risk/benefit ratio of radiation therapy [12,13,14]
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