Image-Guided Percutaneous 125I Seed Implantation as a Salvage Treatment for Recurrent Soft Tissue Sarcomas After Surgery and Radiotherapy

Abstract

Purpose: The purpose of this study was to evaluate the safety and efficacy of percutaneous 125I seed implantation using CT or ultrasound guidance in the treatment of recurrent soft tissue malignancies after surgery and radiotherapy. Materials and Methods: From February 2002 to September 2009, we treated 18 patients with recurrent soft tissue sarcomas under ultrasound or CT guidance. All 18 patients underwent evaluatation of implantation quality with CT scans. The actuarial median number of 125I seeds implanted was 35 (range, 6 to 129), and the actuarial D90 of the implanted 125I seeds ranged from 107.9 to 204.4 Gy (median, 147.1 Gy). The activity of the seeds ranged from 0.4 mCi to 0.8 mCi (median, 0.7 mCi). Followup times ranged from 4 to 78 months (median, 20 months). Results: The median local control was 41 months (95% CI, 15.9–66.1 months). The 1-, 2-, 3-, 4, and 5-year local controls were 78.8%, 78.8%, 78.8%, 26.3%, and 0%, respectively. The median survival was 32 months (95% CI, 16–48 months). The actuarial 1-, 2-, 3-, 4-and 5-year survivals were 76.6%, 61.3%, 39.4%, 39.4% and 39.4%, respectively. Seven patients (38.9%) experienced recurrence after seed implantation. Six patients (33.3%) died of distant metastases and one died of stroke. Two patients developed ulceration, 1 case caused by recurrence and another by a reaction of the skin to radiation. Conclusions: Percutaneous 125I seed implantation for recurrent soft tissue malignancies under CT or ultrasound guidance is safe and minimally invasive, and is associated with high efficacy and low morbidity. CT scan show the seed distribution in tumor after seed implant.