Abstract
Radioactive iodine-125 (I-125) is the most widely used radioactive sealed source for interstitial permanent brachytherapy (BT). BT has the exceptional ability to deliver extremely high doses that external beam radiotherapy (EBRT) could never achieve within treated lesions, with the added benefit that doses drop off rapidly outside the target lesion by minimizing the exposure of uninvolved surrounding normal tissue. Spurred by multiple biological and technological advances, BT application has experienced substantial alteration over the past few decades. The procedure of I-125 radioactive seed implantation evolved from ultrasound guidance to computed tomography guidance. Compellingly, the creative introduction of 3D-printed individual templates, BT treatment planning systems, and artificial intelligence navigator systems remarkably increased the accuracy of I-125 BT and individualized I-125 ablative radiotherapy. Of note, utilizing I-125 to treat carcinoma in hollow cavity organs was enabled by the utility of self-expandable metal stents (SEMSs). Initially, I-125 BT was only used in the treatment of rare tumors. However, an increasing number of clinical trials upheld the efficacy and safety of I-125 BT in almost all tumors. Therefore, this study aims to summarize the recent advances of I-125 BT in cancer therapy, which cover experimental research to clinical investigations, including the development of novel techniques. This review also raises unanswered questions that may prompt future clinical trials and experimental work.
Highlights
As one of the main techniques for the delivery of radiotherapy, brachytherapy (BT) is the implantation of radioactive sources into patients’ bodies through intraluminal or interstitial applicators
Several clinical studies, which created novel intraoperative built custom-linked seeds for the treatment of prostate cancer, were able to demonstrate a lower risk of seed migration, more stable dose distribution, and increased no biochemical evidence of disease in stranded seeds compared to loose seeds, with slightly longer operation time in the stranded-seeds group [10, 31, 32]
A clinical trial (n = 81) evaluating the efficacy of I-125 BT in locally recurrent nasopharyngeal cancer (NPC) when compared with external beam re-radiotherapy reported a higher median local tumor progression-free survival (PFS) (LTPFS; 21 vs. 17 months, p = 0.015), without meaningfully impacting overall survival (OS) [85]
Summary
As one of the main techniques for the delivery of radiotherapy, brachytherapy (BT) is the implantation of radioactive sources into patients’ bodies through intraluminal or interstitial applicators. BT is performed by permanent seed implants [ as low-dose rate (LDR) or high-dose rate (HDR)] after loading techniques [6]. Both have served as auxiliary BT boosts to complement EBRT for better local control (LC) [7]. Several clinical studies, which created novel intraoperative built custom-linked seeds for the treatment of prostate cancer, were able to demonstrate a lower risk of seed migration, more stable dose distribution, and increased no biochemical evidence of disease in stranded seeds compared to loose seeds, with slightly longer operation time in the stranded-seeds group [10, 31, 32]. Palliative treatment for hepatic and pulmonary oligometastasis with local recurrence
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