Clinical efficacy of CT-guided iodine-125 seed implantation for recurrent head and neck carcinoma after external beam radiotherapy

Abstract

Objective To evaluate the clinical efficacy and safety of CT-guided 125I seed implantation in the treatment of recurrent head and neck tumors after radiotherapy. Methods Clinical data of 101 patients who received CT-guided radioactive 125I seed implantation for recurrent head and neck cancer after radiotherapy from 2007 to 2015 were retrospectively analyzed. The median accumulated dose of external radiotherapy was 66 Gy and the median dose after seed implantation(D90) was 117 Gy. The local progression-free survival and overall survival were analyzed by Kaplan-Meier method. Univariate analysis was performed by log-rank test and multivariate analysis was conducted by using Cox regression model. Results The median follow-up time was 12.2 months. The 5-year local progression-free survival rate was 26.6%.The 5-year overall survival rate was 15.5%. Univariate analysis demonstrated that age, pathological type, implantation site, lesion volume, D90 and short-term efficacy were correlated with local control, and KPS score, lesion volume, D90, and short-term efficacy were associated with survival (all P<0.05). Multivariate analysis revealed that pathological type, lesion volume, D90 and short-term efficacy were independent factors related to local control (P=0.000, 0.002, 0.003 and 0.014). In terms of the adverse events, skin/mucosal ulceration was observed in 25.7% and pain occurred in 13.9% of all patients. No correlation was noted between the adverse events and dose. Conclusions CT-guided radioactive 125I seed implantation is an efficacious and safe treatment of recurrent head and neck tumors after radiotherapy. Non-squamous carcinoma, small lesion volume and high dose(D90) indicate excellent local control. Key words: Head and neck neoplasm/radioactive seed implantation; Therapeutic outcome