Efficacy and clinical prognostic factors of image-guided 125I seed implantation for locally recurrent soft tissue sarcoma

Abstract

Objective To evaluate the outcomes and prognostic factors of image-guided 125I seed implantation for locally recurrent soft tissue sarcoma(RSTS). Methods A total of 60 patients with RSTS who received image-guided 125I seed implantation in Peking University Third Hospital, from September 2002 to December 2015, were retrospectively analyzed. The enrollment criteria: KPS > 60 points, refused or could not tolerate surgery or radiotherapy, the expecting survival time >3 months, relapsed after multiple treatment of soft tissue sarcoma, and underwent CT or ultrasound guided 125I seed implantation treatment. In all, the median activity of seeds was 25.9×106 Bq (range, 11.1×106-29.6×106 Bq), median number of implanted seeds was 58 (range, 3-133), and the median D90 was 120 Gy (range, 36.50-460.97 Gy). The local progression-free survival (LPFS) and overall survival (OS) were calculated using the Kaplan-Meier method . The log-rank test and Cox regression model were used for the univariate and multivariate analyses. Results The median follow-up was 18.75 months (range, 1-146). The median OS was 18.5 months (95% CI 13.1-23.9). The 1-, 3- and 5-year OS rate were 63.3%, 33.0% and 29.5%, respectively. The 1-, 3- and 5-year LPFS rate were 72.5%, 63.7% and 59.7%, respectively. The general rate of pain relieving was 100% (6/6). 8.3% (5/60) presented grade Ⅳ skin toxicity. No fatal complications ocurred. The univariate analysis suggested that tumor size, tumor volume, KPS score, D90 were prognostic factors of OS and LPFS. The multivariate analysis demonstrated that previous chemotherapy history and distant metastases were independent prognostic factors of survival. Conclusions Image-guided 125I seed implantation for recurrent soft tissue sarcoma is a safe treatment option with high efficacy and low morbidity. Tumor size and D90 were the prognostic factors of OS and LPFS. Key words: Recurrence; Soft tissue sarcoma; 125I seed implantation; Prognosis