125I Particle Implantation Research Articles

Analysis of risk factors for pneumothorax after particle implantation in the treatment of advanced lung cancer after surgery and establishment of a nomogram prediction model.

To analyze the risk factors for pneumothorax after particle implantation in the treatment of advanced lung cancer and to construct and validate a nomogram prediction model. A retrospective analysis was conducted on 148 patients who underwent 125I particle implantation for advanced lung cancer at the *** from December 2022 to December 2023. Potential risk factors were identified using univariate logistic regression analysis, followed by a multivariate logistic regression analysis to evaluate the predictive factors for pneumothorax. Interaction effects between variables were studied and incorporated into the model construction. ROC curves and nomograms were generated for visualization. Calibration analysis was performed, and the corresponding net benefit was calculated to adjust the predictive model. Among the 148 patients, 58 (39.19%) experienced pneumothorax, with a mean age of 62.5 (55.25, 70) years. Multivariate analysis showed that the angle between the puncture needle and the pleura < 50° (P = 0.002, OR: 3.908, CI: 1.621-9.422), preoperative CT suggesting emphysema (P = 0.002, OR: 3.798, CI: 1.600-9.016), atelectasis (P = 0.009, OR: 3.156, CI: 1.331-7.481), and lesion located in the left lung fissure (P = 0.008, OR: 4.675, CI: 14.683) were independent risk factors for pneumothorax after particle implantation in the treatment of advanced lung cancer. Preoperative CT suggesting lesions in the left lung fissure or suggesting emphysema had a significant impact in the nomogram, with probabilities of pneumothorax occurrence at 40% and 38%, respectively. The predictive AUC for the above four risk factors for pneumothorax after particle implantation in the treatment of lung adenocarcinoma was 0.837 (95% CI: 0.767-0.908). When the Youden index was 0.59, the sensitivity was 85.56%, specificity was 74.13%, accuracy was 81.01%, positive predictive value was 83.69%, and negative predictive value was 76.78%. The angle between the puncture needle and the pleura < 50°, preoperative CT suggesting emphysema, atelectasis, and lesion located in the left lung fissure are independent risk factors for pneumothorax after particle implantation in the treatment of advanced lung cancer. Preoperative planning of the puncture path should avoid lung bullae, interlobar fissures, areas of severe emphysema, and atelectasis.

Application of radioactive iodine-125 microparticles in hepatocellular carcinoma with portal vein embolus.

Radioactive iodine-125 (125I) microparticle therapy is a new type of internal radiation therapy that has shown unique advantages in the treatment of malignant tumors, especially hepatocellular carcinoma. Patients with hepatocellular carcinoma frequently experience portal vein embolism, which exacerbates the difficulty and complexity of treatment. 125I particles, used in local radiotherapy, can directly act on tumor tissue and reduce damage to surrounding healthy tissue. Through retrospective analysis, this study discussed the efficacy and safety of radioactive 125I particles in portal vein embolization patients with hepatocellular carcinoma in order to provide more powerful evidence supporting clinical treatment. To investigate the effect of transcatheter arterial chemoembolization combined with portal vein 125I particle implantation in the treatment of primary liver cancer patients with portal vein tumor thrombus and its influence on liver function. The clinical data of 96 patients with primary liver cancer combined with portal vein tumor thrombus admitted to our hospital between January 2020 and December 2023 were retrospectively analyzed. Fifty-two patients received treatment with transcatheter arterial chemoembolization and implantation of 125I particles in the portal vein (combination group), while 44 patients received treatment with transcatheter arterial chemoembolization alone (control group). The therapeutic effects on tumor lesions, primary liver cancer, and portal vein tumor embolisms were compared between the two groups. Changes in relevant laboratory indexes before and after treatment were evaluated. The t test was used to compare the measurement data between the two groups, and the χ 2 test was used to compare the counting data between groups. The tumor lesion response rate in the combination group (59.62% vs 38.64%) and the response rate of patients with primary liver cancer complicated with portal vein tumor thrombus (80.77% vs 59.09%) were significantly greater than those in the control group (χ 2 = 4.196, 5.421; P = 0.041, 0.020). At 8 wk after surgery, the serum alpha-fetoprotein, portal vein main diameter, and platelet of the combined group were significantly lower than those of the control group, and the serum alanine aminotransferase, aspartate aminotransferase, and total bilirubin were significantly greater than those of the control group (t = 3.891, 3.291, 2.330, 3.729, 3.582, 4.126; P < 0.05). The serum aspartate aminotransferase, alanine aminotransferase, and total bilirubin levels of the two groups were significantly greater than those of the same group 8 wk after surgery (P < 0.05), and the peripheral blood platelet, alpha-fetoprotein, and main portal vein diameter were significantly less than those of the same group before surgery (P < 0.05). In patients with primary liver cancer and a thrombus in the portal vein, transcatheter arterial chemoembolization plus portal vein 125I implantation is more effective than transcatheter arterial chemoembolization alone. However, during treatment it is crucial to pay attention to liver function injury caused by transcatheter arterial chemoembolization.

CT-guided Percutaneous Microwave Ablation Combined with Local Radiotherapy or Chemotherapy of Malignant Pulmonary Tumors.

The study aimed to investigate the clinical efficacy of CT-guided microwave ablation (MWA) combined with 125I seed implantation or bronchial arterial infusion (BAI) chemotherapy in the treatment of malignant pulmonary tumors. A total of 56 patients who underwent MWA, MWA combined with 125I particle implantation, or MWA combined with BAI chemotherapy for advanced lung cancer or metastatic lung cancer from January 2015 to June 2021 in Guangdong Provincial People's Hospital were enrolled. Among them, 21 patients were treated with MWA (MWA), 18 with MWA combined with 125I seed implantation (MWA+125I), and 17 with MWA combined with BAI chemotherapy (MWA+BAI). The short-term outcomes, complications, Eastern Cooperative Oncology Group (ECOG) performance score (Zubrod-ECOG-WHO, ZPS), survival, and factors related to survival were compared between the three groups. The response rate of the MWA group (9.52%) was significantly lower than that of the MWA+125I group (50.00%) and MWA+BAI chemotherapy group (47.06%), and the differences were statistically significant (p < 0.05). The incidence of complications in the MWA, MWA+125I, and MWA+BAI chemotherapy groups was 47.62%, 55.56%, and 52.94%, respectively, with no significant difference (p > 0.05). Three months after the treatment, the ZPS of the MWA+125I and MWA+BAI chemotherapy groups was significantly lower than before treatment and significantly lower than that of the MWA group in the same period; the differences were statistically significant (p < 0.05). The median survival time of the MWA+125I group was 18 (9.983, 26.017) months and that of the MWA+BAI chemotherapy group was 21 (0.465, 41.535) months, both of which were higher than that of the MWA group [11 (6.686, 15.314) months]; the differences were statistically significant (p < 0.05). Cox regression analysis was performed on the factors related to survival and revealed treatment mode as a protective factor [HR = 0.433, 95% CI = (0.191, 0.984), p = 0.046]. Other factors, such as gender, age, and tumor size, did not independently affect survival. CT-guided MWA combined with 125I seed implantation and MWA combined with BAI chemotherapy are safe and effective for the treatment of advanced lung cancer and metastatic lung cancer, and can control tumor progression and prolong survival time.

Clinical efficacy analysis of radioactive 125I particle implantation for the treatment of pelvic local recurrence of cervical cancer after radiotherapy.

To explore the efficacy of CT-guided iodine-125 (125I) radioactive particle implantation for the treatment of pelvic local recurrence of cervical cancer after radiotherapy. To analyze clinical data of 46 patients with pelvic local recurrence of cervical cancer after radiotherapy, who underwent 125I particle implantation, post-operative follow-up using Kaplan-Meier method to calculate the rate of local control, and observation of complications. Univariate and multi-factorial analyses were performed with log-rank test and Cox regression statistical method to observe changes in serum SCC-Ag and CEA levels. A total of 57 lesions in 46 patients had a short-term local control rate of 87.72% (50/57) and effective rate of 68.42% (39/57). As of the end of follow-up, the median local progression-free survival time of 46 patients was 12.2 (range, 3.5-32) months, the median overall survival time was 16.3 (range, 3.5-40) months, with 1-year and 2-year OS of 63.04% and 41.30%. Univariate and multi-factorial analyses suggested that local recurrent mass size and recurrence site were the main factors affecting survival. Loco-regional progression-free survival (LPFS) time was 15.5 and 11.25 months in cases with recurrent mass diameter < 3 cm and ≥ 3 cm, respectively (χ2 = 10.83, p = 0.001 < 0.05). In patients with pelvic wall recurrence and central recurrence, the time to LPFS was 15.80 and 10.00 months, respectively (χ2 = 8.833, p = 0.0030 < 0.05). Tumor markers serum SCC-Ag and CEA decreased to different degrees after treatment, and the difference was statistically significant. The median LPFS in the SCC-Ag ≤ 3.5 ng/ml group was significantly higher than that in the SCC-Ag > 3.5 ng/ml group (χ2 = 4.241, p = 0.036 < 0.05). No serious post-operative complications were observed. CT-guided 125I seed implantation has significant short-term efficacy in the treatment of pelvic local recurrence of cervical cancer after radiotherapy. It can improve the effective rate in patients with initial clinical stage II, especially in those with locally recurrent masses < 3 cm and in those with a recurrence in the pelvic wall.

Percutaneous transhepatic cholangial drainage combined with intra-tumoral iodine-125 seeds implantation and chemotherapy for locally progressive pancreatic head cancer with obstructive jaundice.

To investigate the clinical efficacy of percutaneous transhepatic cholangial drainage (PTCD) combined with intra-tumoral iodine-125 (125I) particle implantation and chemotherapy in the treatment of locally advanced pancreatic head cancer (LAPHC) with obstructive jaundice. Twenty-one patients with LAPHC with obstructive jaundice were selected, and routine examination before surgery to determine location of obstruction and degree of bile duct dilatation was performed. All 21 patients underwent PTCD first, and usual examinations, including liver and kidney function, were re-examined after operation. When the liver function recovered significantly, patients were treated with seed implantation and systemic chemotherapy after surgery. Clinical efficacy and complications of 21 patients were observed, and changes in survival time and serum level of tumor markers were analyzed. After combined treatment, there were 3 cases of complete response (CR), 12 cases of partial response (PR), 3 cases of stable disease (SD), and 3 cases of progressive disease (PD) in 21 patients. The overall effective rate was 71.43%, and the local control rate was 85.71%. The pain relief was statistically significant one month after treatment, compared with that before treatment (VAS scores: 6.76 ±2.25 vs. 3.25 ±1.92, p < 0.001), and the rate of pain relief was 71.43% (15/21). In all patients, jaundice, abdominal pain, and abdominal distension improved to different degrees after surgery, and the skin pruritus disappeared. Bilirubin and transaminase improved to varying degrees 3 days, 1 week, and 4 weeks after treatment (p < 0.05). Cancer antigen 199 (CA-199), carcinoembryonic antigen (CEA), and cancer antigen 125 (CA-125) after combination therapy, achieved statistically significant differences (t = 9.525, 10.378, 3.262, respectively, p < 0.05). The overall survival time of 21 patients was 11.6 months, ranging from 3.9 to 22.6 months. For LAPHC patients with obstructive jaundice, PTCD combined with particle implantation and chemotherapy is clinically effective in improving the quality of life and prolonging survival.

Comparison of the postoperative pain change and spinal stenosis rate between percutaneous vertebroplasty combined with radiofrequency ablation and with 125I particle implantation in the treatment of metastatic spinal cord compression: A retrospective study

Background contextMetastatic spinal cord compression (MSCC) seriously affects the survival rate. ObjectiveThe therapeutic effects of two treatment strategies for MSCC: percutaneous vertebroplasty (PVP) combined with radiofrequency ablation (RFA) and PVP combined with 125I particle implantation, were compared. Study designRetrospective study. Patient sample40 patients with MSCC were divided into two groups: 19 cases in the RFA group and 21 cases in the 125I group. MethodAll patients were accessed to determine the differences in pain, which was evaluated using the visual analog scale (VAS) at 1 week, 1 month, and 3 months after the operation, and spinal stenosis rates (SSRs), which were measured at 1 and 3 months after the operation, between the two groups. ResultsThe VAS scores and SSRs at baseline were comparable between the RFA group and the 125I group (7.19 ​± ​2.07 vs 7.42 ​± ​1.95, 37.7% ​± ​11.2% vs 41.1% ​± ​11.4%). The VAS scores and SSRs at 1 month and 3 months after the operation were significantly reduced in both groups, compared with those at baseline. The VAS scores and SSRs in the 125I group were lower than those in the RFA group at 3 months after the operation (1.09 ​± ​0.97 vs 1.75 ​± ​1.06 p ​= ​0.048 and 12.3% ​± ​6.4% vs 18.1% ​± ​10.1% p ​= ​0.034), while the VAS scores at 1 week after the operation in the RFA group were lower than those in the 125I group (4.39 ​± ​1.34 vs 5.05 ​± ​1.82 p ​= ​0.049). ConclusionPVP combined with RFA has a slight advantage in relieving pain in the short term, while PVP combined with 125I particle implantation may have a better effect in the relieving pain and decreasing the SSRs at 3 months after the operation.

Radioactive Particle Implantation Combined with Chemotherapy for Treatment of Pancreatic Adenocarcinoma.

HomeRadiology: Imaging CancerVol. 3, No. 5 PreviousNext Research HighlightsFree AccessRadioactive Particle Implantation Combined with Chemotherapy for Treatment of Pancreatic AdenocarcinomaFrancesca RigiroliFrancesca RigiroliFrancesca RigiroliPublished Online:Sep 17 2021https://doi.org/10.1148/rycan.2021219020MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Take-Away Points■ Major Focus: To determine the efficacy of iodine 125 (125I) radioactive particle implantation plus regional arterial chemotherapy perfusion versus regional arterial chemotherapy perfusion therapy alone for treatment of patients with advanced pancreatic ductal adenocarcinoma.■ Key Result: This retrospective study showed significantly improved survival and overall clinical benefit of 125I radioactive particle implantation plus regional arterial chemotherapy.■ Impact: This preliminary study supports further evaluation of combined 125I radioactive particle implantation plus regional arterial chemotherapy to improve outcomes in advanced stage pancreatic ductal adenocarcinoma.Pancreatic ductal adenocarcinoma is often diagnosed at an advanced stage of disease, causing an extremely low survival rate at 1 year. While regional arterial infusion chemotherapy, obtained through catheterization of gastroduodenal, superior mesenteric, or splenic arteries, increases regional drug concentrations, responses remain low. Recent studies suggest that combining this therapy with 125I radioactive particle implantation improves inhibition of tumor growth and pain management.This retrospective study compared patients treated with 125I radioactive particle implantation plus arterial infusion chemotherapy (n = 11) versus those treated only with arterial infusion chemotherapy (n = 12). Treatment with combined 125I radioactive particle implantation plus regional arterial chemotherapy significantly improved radiologic response to therapy (73% vs 42%, P < .05) and 6-month and 9-month survival (91.7% and 50% vs 63.6% and 18.2%, respectively; P < .05) as compared with regional arterial chemotherapy alone. Combined therapy also reduced pain and improved overall quality of life to a greater extent.This study describing benefits of a “double” interventional radiologic approach suggests that development of upgraded materials and novel interventional techniques can improve treatment outcomes in pancreatic ductal adenocarcinoma. Several limits may affect the applicability of this approach, including the retrospective nature, small sample size, and preliminary application only to patients with advanced-stage disease. A future prospective study is needed to confirm these results.Highlighted ArticleYang L, Li C, Wang Z, et al. The clinical efficacy of computed tomography-guided 125I particle implantation combined with arterial infusion chemotherapy in the treatment of pancreatic cancer. J Cancer Res Ther 2021;17(3):720–725. doi: doi.org/10.4103/jcrt.jcrt_563_20Highlighted Article1. Yang L, Li C, Wang Z, et al. The clinical efficacy of computed tomography-guided 125I particle implantation combined with arterial infusion chemotherapy in the treatment of pancreatic cancer. J Cancer Res Ther 2021;17(3):720–725.doi: doi.org/10.4103/jcrt.jcrt_563_20 Crossref, Medline, Google ScholarArticle HistoryPublished online: Sept 17 2021 FiguresReferencesRelatedDetailsRecommended Articles Tumor-Vessel Relationships in Pancreatic Ductal Adenocarcinoma at Multidetector CT: Different Classification Systems and Their Influence on Treatment PlanningRadioGraphics2016Volume: 37Issue: 1pp. 93-112Preoperative CT Classification of the Resectability of Pancreatic Cancer: Interobserver AgreementRadiology2019Volume: 293Issue: 2pp. 343-349CT Radiomic Features of Superior Mesenteric Artery Involvement in Pancreatic Ductal Adenocarcinoma: A Pilot StudyRadiology2021Volume: 301Issue: 3pp. 610-622Pancreatic Adenocarcinoma Staging in the Era of Preoperative Chemotherapy and Radiation TherapyRadiology2018Volume: 287Issue: 2pp. 374-390Imaging-based Risk Scores for Treatment Selection in Early Pancreatic Cancer: A Step Forward for Tailored TreatmentRadiology2020Volume: 296Issue: 3pp. 552-553See More RSNA Education Exhibits Pancreatic Cancer: Early Detection, Diagnosis and StagingDigital Posters2020Beyond Surgical Resectability: Pearls and Pitfalls in Preoperative Imaging for PancreatoduodenectomyDigital Posters2020Missed Imaging Findings of Pancreatic Ductal Adenocarcinoma: Lessons Learned from Difficult Cases  Digital Posters2020 RSNA Case Collection Superior Mesenteric Artery SyndromeRSNA Case Collection2021Primary pancreatic lymphoma RSNA Case Collection2020Flipped hepatic Artery Infusion Pump ReservoirRSNA Case Collection2022 Vol. 3, No. 5 Metrics Altmetric Score PDF download

125I Intracavitary Irradiation Combined with 125I Seeds Implantation for Treatment of Locally Advanced Pancreatic Head Cancer: A Retrospective Analysis of 67 Cases.

BackgroundPancreatic cancer is an aggressive malignant tumor of the digestive system and the fourth leading cause of tumor-related death. Intracavitary 125I seed irradiation has been recently developed as a therapy for locally advanced pancreatic head carcinoma. However, there are still many limitations, and more investigations are needed in order to optimize this new treatment method.MethodsSixty-seven patients were included in our study; 41 cases treated by SEMS-CL-125I intracavular irradiation (SEMS-CL-125I group) and 26 cases treated by SEMS-CL-125I intracavular irradiation combined with 125I particle implantation in the tumor body (the combined group). Among the 67 patients, 43 were males and 24 were females, with an average age of 69.64±8.84 years. Tumor site size was determined based on the MRI or CT imaging scans, and the number and radius of 125I particle placement were calculated according to a specific formula. 125I particles were inserted into the tumor with a radius of 1.5 cm and a row spacing of 1 cm. The main postoperative biochemical indexes, imaging analysis, postoperative analgesia degree, median survival time and rate of complications were compared between the two groups.ResultsJaundice and liver function improved in both groups after treatment for 6 months. The combined group did better. Kaplan–Meier analysis showed that patients in the combined group had a significantly better overall survival than those in the SEMS-CL-125I group. Patients in the combined group had less complications than those in the SEMS-CL-125I group (23.1% vs 34.1%), and the postoperative pain status of the combined group was improved (26.8% vs 53.8%).ConclusionCompared with the SEMS-CL-125I intracavular irradiation alone, the combination of 125I seed implantation with solid tumor 125I seed implantation had a better therapeutic effect in LAPHC patients, with improved biochemical indicators, survival prognosis, pain relief, and fewer complications.

Therapeutic effects and prognostic factors of 125I brachytherapy for pelvic recurrence after early cervical cancer surgery

To investigate the efficacy of 125I seed implantation in the treatment regimen of pelvic recurrence after early cervical cancer surgery and to analyse prognostic factors. To evaluate efficacy and analyse prognostic factors of 125I seed implantation for pelvic recurrence after early cervical cancer surgery. A prospective study was conducted on 62 patients who experienced pelvic recurrence after early cervical cancer surgery between August 2005 and September 2015. The 62 patients were treated and assessed in 2 groups (n = 30). All 62 patients were randomized into two groups that received two different treatment regimens: the treatment group (n = 30), which received 125I particle implantation therapy, and the control group (n = 32), which received whole-pelvic irradiation using the anteroposterior/posteroanterior field and cisplatin-based concurrent chemoradiation therapy. The efficacy/efficiency of 125I seed implantation and prognostic factors were analysed by logistic regression. Overall survival was determined by Kaplan–Meier analysis. Multivariate analysis results were obtained by the Cox proportional hazards regression model. The effective control rates at 1, 3, 6 and 12 months were 76.7%, 80.0%, 83.3%, and 86.7% in the 125I particle implantation group. The total effective control rates at 1, 3, 6 and 12 months were 65.6%, 65.5%, 62.5%, and 71.9% in the chemoradiotherapy group. Significant differences were observed between the two groups. The overall survival rates at 1, 2, 3, 4, and 5 years and the median overall were 96.7%, 93.3%, 86.7%, 71.9%, 65.6% and 4.34 years, respectively, in the 125I seed implantation group and 81.3%, 71.9%, 62.5%, 56.3%, 53.1% and 3.59 years, respectively, in the control group. There were statistically significant differences in survival rates depending on the diameter of the largest recurrent pelvic tumour (χ2 = 6.611, P = 0.010). The multivariate analysis showed that the survival rates were related to the diameter of the largest recurrent pelvic tumour (χ2 = 4.538, P = 0.033). 125I implantation is an effective, safe, and promising method for the treatment of pelvic recurrence after early cervical cancer surgery. The diameter of the recurrent pelvic tumour was identified as a significant independent prognostic factor in patients who received 125I implantation.

CT-guided percutaneous implantation of 125I particles in treatment of early lung cancer.

BackgroundTo analyze the efficacy of computed tomography (CT)-guided implantation of 125I radioactive particles in treatment of early lung cancer.MethodsSix patients were analyzed, including 4 squamous cell carcinoma, 1 adenocarcinoma, and 1 small cell lung cancer. TPS software was used to calculate the therapeutic dose amount of particles implanted, and the spacing and distribution of seeds in the target area and adjacent tissues. Under the guidance of CT, 20–55 particles were implanted at each site, with the total number of radioactive particles being 226, the particle spacing being 0.5–1.0 cm, and the implantation being performed in accordance with the principle of uniform implantation. The patients were each followed up with repeated pulmonary CT scans at 1, 3, 6, 12, 18, 24, 30 and 36 months after the procedure. In accordance with the response evaluation criteria in solid tumors (RECIST), the following definitions for responses were used: complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD).ResultsThere were 2 CRs and 4 PRs one month after procedure; six patients were followed up 3 months after procedure, including 2 CRs and 4 PRs; one patient was lost in follow-up, and 5 patients were followed up 6 months after procedure, including 3 CRs and 2 PRs; five patients were followed up 12 months after procedure, including 3 CRs, 1 PR and 1 PD. The single PD patient was again given CT-guided implantation of 125I radioactive particles for the treatment of recurrent lesions. The pulmonary CT was repeated 6 months after procedure, and the response was evaluated as SD. Four patients were followed up 18 months after procedure, including 3 CRs and 1 PR; one patient was lost in follow-up and 3 patients were followed up 24 months after the procedure with the response being evaluated as CR for all of them; one patient was followed up 36 months after procedure, and the response was evaluated as PD. During the follow-up, no serious complications occurred in any of the patients.ConclusionsThe preliminary clinical observation showed that 125I radioactive particle implantation was a safe, reliable and effective therapeutic method for early lung cancer.

Evaluation of radioactive 125I seed implantation for the treatment of refractory malignant tumours based on a CT-guided 3D template-assisted technique: efficacy and safety

BackgroundTo observe the medium- and long-term clinical efficacy and safety of radioactive 125I seed implantation for refractory malignant tumours based on CT-guided 3D template-assisted technique.MethodsTwenty-five patients with refractory malignant tumours who underwent radioactive 125I seed implantation based on CT-guided 3D template-assisted technique were selected. The post-operative adverse reactions were recorded. The number of puncture needles and particles used in the operation, dosimetric parameters, post-operative physical strength scores, and tumour response were statistically analysed. The overall survival time and survival rate were calculated, and the effect and prognosis were assessed.Results125I seed implantation was successful in all patients without serious complications. The average number of implanted puncture needles was 17 (19.12 ± 13.00), and the median number of particles was 52 (55.12 ± 32.97). D90 in the post-operative clinical target volume (CTV) (93.24 ± 15.70 Gy) was slightly lower than that in the pre-operative CTV (93.92 ± 17.60 Gy; P > 0.05). The D90 in the post-operative planning target volume (PTV) (142.16 ± 22.25 Gy) was lower than the pre-operative PTV (145.32 ± 23.48 Gy; P > 0.05). The tumour responses at 6 months post-operatively: complete remission (CR), 20% (5/25); partial remission (PR), 48% (12/25); stable disease (SD), 24% (6/25); progressive disease (PD), 8% (2/25); CR + PR, 68% (17/25); and local control rate, 92% (23/25). The 6-, 12-, and 24-month survival rates were 100, 88, and 52%, respectively. The post-operative physical strength score (Karnofsky performance score, KPS) exhibited a gradual trend towards recovery, which rose to the highest value 12 months after implantation and then decreased slightly, but the average score was still > 90 points. There was one intra-operative pneumothorax, and two patients with superficial malignant tumours developed skin ulcerations. Multivariate analysis of prognosis showed that tumour sites and types were independent risk factors affecting survival. The number of needles and particles and template types were not the factors.Conclusions3D template combined with CT-guided radioactive 125I seed implantation can improve the rational distribution of radiation dose in the tumour target area because accurate radioactive 125I particle implantation was achieved. This technique has fewer complications and can further extend the overall survival and improve the quality of life.Trial registrationRegistration number: ChiCTR2000034566 2020/7/10 0:00:00Retrospectively registered.

Efficacy of Gefitinib Combined with 125I Radioactive Particles in the Treatment of Transplanted Lung Cancer Tumors in Nude Mice

To investigate the efficacy of gefitinib combined with iodine-125 (125I) radioactive particles in the treatment of transplanted tumors of the lung cancer cell line A549 in nude mice. Twenty-four nude mice were inoculated with A549-luc human lung adenocarcinoma cells stably expressing luciferase. The tumor size was approximately 8-10mm after 20days. The mice were randomly divided into four groups: a control group (n = 6), an 125I particles group (n = 6), a gefitinib group (n = 6) and a gefitinib combined 125I particles implantation group (n = 6). Tumor growth was observed, and changes in tumor size were continuously measured. Bioluminescence imaging was used to detect the bioluminescence activity of human lung adenocarcinoma A549-luc cells containing the luciferase reporter gene in vivo. After 35days, the nude mice were sacrificed, and a tumor growth curve was drawn. Before treatment, the tumor volumes of the four groups were not significantly different. The tumor volume difference was statistically significant in the four groups (control group, 125I radioactive particles, gefitinib group and combined drug group) at 5weeks after treatment (F = 10.305, P < 0.05). The tumor size in the gefitinib combined with 125I particles group was significantly smaller than that in the gefitinib, 125I particles and control groups and significantly smaller than that before treatment. There was no significant difference in the bioluminescence signal intensity between the four groups before treatment. The numbers of biofluorescence photons difference were statistically significant in the four groups (F = 28.975, P < 0.05). The bioluminescence signal intensity in the gefitinib combined with 125I particles group was significantly lower than that in the 125I particles, gefitinib and control groups and significantly lower than that before treatment. Gefitinib combined with 125I radioactive particles brachytherapy can significantly inhibit tumor growth.

Biliary stenting alone versus biliary stenting combined with 125I particles intracavitary irradiation for the treatment of advanced cholangiocarcinoma

We aimed to compare the efficacy of percutaneous transhepatic biliary stenting (PTBS) and PTBS combined with 125I particles implantation in the treatment of advanced extrahepatic cholangiocarcinoma (EHC). A total of 184 advanced EHC patients, who received PTBS (PTBS group) or PTBS combined with 125I particles implantation (PTBS + 125I group) from January 2012 to April 2017 in our department, were retrospectively reviewed. The improvement of jaundice and liver function was observed in both groups. The postoperative complications, risk of biliary re-obstruction, and overall survival (OS) were compared between the two groups. Amongst, 71 cases received PTBS and 113 had the additional implantation of 125I particles. The jaundice and liver function were significantly improved in all patients, especially in PTBS + 125I group. There was no significant difference in the risk of postoperative complications between the two groups. However, the risk of biliary re-obstruction significantly reduced in PTBS + 125I group (19.5% vs. 35.2%, p = 0.017). Kaplan Meier analysis showed that patients in PTBS + 125I group had a significantly better OS, both for hilar and distal cholangiocarcinoma. Univariate analysis demonstrated that preoperative levels of carbohydrate antigen 19-9 (CA19-9), total bilirubin, neutrophil count, lymphocyte count, and different therapeutic method were significant factors affecting OS. Multivariate analysis further identified the treatment of PTBS combined with 125I particles implantation as an independent protective prognostic factor (HR = 0.26, 95% CI: 0.17–0.39, p < 0.001). In conclusion, for patients with advanced EHC, PTBS combined with 125I particles implantation is superior to PTBS alone in improving liver function, inhibiting biliary re-obstruction, and prolonging survival time.

Clinical study on 48 children with head and neck rhabdomyosarcoma treated by multi-disciplinary therapy

Objective To explore the short-term efficacy in children with head and neck rhabdomyosarcoma (HN-RMS) treated by multidisciplinary therapy, and to analyze the prognostic factors, so as to guide the diagnosis and treatment. Methods Patients with HN-RMS admitted at Hematology Oncology Center of Beijing Children′s Hospital (BCH), Capital Medical University between December 2012 and May 2017, were included in this case-observation study.The clinical characteristics were analyzed and the treatment effect and prognostic factors were summarized. Results A total of 48 cases were collected, including 36 boys and 12 girls, with a median age of 4.6 years.Primarysite parameningeal RMS(PM-RMS)(34 cases, 70.8%), orbital(2 cases, 4.2%) and non-orbital, non-parameningeal region(12 cases, 25.0%) were found.Twenty cases belonged to alveolar type(41.7%), and 28 cases were of embryonal type(58.3%). The diameter of the tumor was >5 cm(n=25, 52.1%), and ≤5 cm(n=23, 47.9%). IRS staging: there were 29 cases(60.4%) of stage Ⅱ-Ⅲ, 19 cases(39.6%) of stage Ⅳ; 29 cases(60.4%) of low-medium risk, and 19 cases(39.6%) of high risk.Twenty-three patients(47.9%) received surgery, and 25 cases (52.1%) received biopsy only.All patients (48 cases) received systemic chemotherapy.Twenty patients(41.6%) received external radiation, 15 cases (31.3%)received 125I particle implantation, 6 cases (12.5%)received proton therapy, but 3 cases (6.2%)did not receive radiation.The follow-up time lasted 13-57 months[(24.1±12.3) months]. The 2-year overall survival(OS) rate was (66.4±7.2)%, and 2-year event free survival (EFS) rate was (59.9±7.5)%.Patients with tumor diameter ≤5 cm had higher OS and EFS than patients with tumor diameter >5 cm [2-year OS (87.4±6.8)% vs.(42.9±6.8)%, 2-year EFS (78.8±8.6%) vs.(38.5±10.8)%], and the differences were statistically significant (all P=0.006). Patients with orbital and non-orbital, non-parameningeal RMS had higher OS and EFS than PM-RMS [2-year OS 100% vs.(87.5%±11.7)% vs.(57.0±8.8)%; 2-year EFS 100% vs.(88.9±10.5)% vs.(51.1±8.9)% ], and the differences were statistically significant (P=0.008, P=0.030). Patients who received surgery had higher OS and EFS than those who did not received surgery[2-year OS (80.7±8.8)% vs.(53.3±10.4)%; 2-year EFS (71.1±10.1)% vs.(49.5±10.4)%], and the differences were statistically significant (P=0.008, P=0.026). COX regression analysis showed tumor diameter >5 cm was an adverse prognostic factor (OR=4.124, 95%CI: 1.213-14.025, P=0.023). Conclusions PM-RMS accounted for a high proportion in RMS patients.The primary site and the size of the tumor are the main prognostic factors.Intensive therapy is expected to improve the prognosis of HN-RMS with meningeal invasion. Key words: Head and neck rhabdomyosarcoma; Multi-disciplinary treatment; Parameningeal rhabdomyosarcoma; Child

The efficacy and safety of 125I particle intraoperative implantation combined with chemotherapy in the treatment of locally advanced pancreatic cancer

The effect of the treatment of 125I particle therapy in solid tumor is remarkable and with less side effect. This study retrospectively analyzed the clinical data of 125I particles implantation combined systemic chemotherapy in the treatment of locally advanced pancreatic cancer patients. Main observation indexes included: the overall median survival, 1 year survival rate, pain relief rate, the postoperative complications. Intraoperative 125I particles implantation combined with postoperative chemotherapy in treatment of locally advanced pancreatic cancer patient was safety, which can effectively prolong patient survival and relieve patients' pain. Key words: Pancreatic cancer; 125I implantation; Chemotherapy; Local treatment

Evaluation of therapeutic effects of 125I particles brachytherapy for recurrent bladder cancer.

The aim of the present study was to evaluate the clinical value of 125I particles implantation in the treatment of recurrent bladder cancer. The study is a retrospective analysis of 32 patients with recurrent bladder cancer treated between May 2010 and January 2010. Of these, 16 cases (chemotherapy group) received conventional chemotherapy. A total of 16 patients (125I group) received radiotherapy with 125I particles, followed by conventional chemotherapy. By guidance of B ultrasound, 125I radioactive particles were implanted. All 32 patients were relieved after treatment, and the tumors were significantly reduced after 2 months. However, the tumors in the 125I group were significantly smaller than those in the chemotherapy group (P<0.05). The patients were followed-up for 1 year and no recurrence was found. Additionally, no complications occurred. Compared with the chemotherapy group, the tumor volume of the 125I group was significantly reduced (P<0.05). The disease-free survival and 5-year survival rates of the patients in the follow-up showed that the disease-free survival and 5-year survival rates of the patients in 125I group were significantly improved compared to those in the chemotherapy group. Therefore, the results have shown that 125I radioactive particles in the treatment of bladder cancer improve the symptoms of patients with bladder cancer in the short term, and continuously kill residual tumor and prevent recurrence.

Effectiveness of 125I seed implantation in the treatment of non-small cell lung cancer during R2 resection.

The aim of the present study was to investigate the effectiveness of 125I particle implantation during R2resection for non-small cell lung cancer (NSCLC). Data from 23 patients with NSCLC and macroscopic residual diseasefollowing surgery (R2 resection) between March 2010 and May 2014 were retrospectively analyzed. Among these patients, 12 patients [4 with T-residual disease (incomplete resection of primary tumor but complete dissection of regional lymph node), 8 with N-residual disease (complete resection of primary tumor but incomplete resection of metastatic regional lymph node)] underwent 125I particle implantation during the operation, while the other 11 (4 with T-residual disease and 7 with N-residual disease) received postoperative conventional radiotherapy. The local control rate, overall survival, and distant metastasis were evaluated. Additionally, the efficacy and safety of brachytherapy using 125I particle implantation during surgery for locally advanced NSCLC were investigated. The 23 patients were followed up for 3–40 months. For the 125I group, the 2-year local control rate was 100%, and the median survival time was 24 months. The 1–2-year survival rates were 83.3 and 58.33%, respectively. For the postoperative radiotherapy group, the median survival time was 12 months, andthe 1- and 2-year survival rates were 54.5 and 27.7%, respectively. No statistically significant difference in 2-year survival rates was detected between the two treatment groups, but the particle implantation group exhibited a higher survival rate trend. For patients with T-residual disease, the survival rate was higher for the 125I seed implantation group compared with the postoperative radiotherapy group. However, there was no significant difference in the rates of metastasis between the two groups for patients with N-residual disease. Therefore, intraoperative implantation of 125I particles during R2 resection of NSCLC may be a safer and more reliable method to reduce the local recurrence rate compared with conventional radiotherapy. Although not statistically significant, the overall survival rate of patients in the 125I seed implantation group was higher compared with the postoperative radiotherapy group.

An analysis of the effect of midazolam conscious sedation therapy in patients with 125I seed implantation

Objective To investigate the clinical effect of midazolam in CT-guided 125I seed implantation. Methods Totally 86 patients who underwent CT-guided radioactive 125I seed implantation were collected from December 2015 to February 2017 in the Second Hospital of Tianjin Medical University and randomly divided into two groups: the test group and the control group. The test group was given intravenous infusion of midazolam and local anesthesia of lidocaine while the control group were given the same amount of saline and lidocaine. The changes of heart rate (HR), mean arterial pressure (MAP), respiration (RR) and oxygen saturation (SpO2) were observed and compared between the two groups at 15 min before the midazolam(T0), 15 min after the midazolam(T1), 15 min after lidocaine local anesthesia(T2), the moments the lesion was punctured (T3), and after implantation of the seeds (T4) and the end of the operation(T5), respectively. In addition, the body reaction, operation time, the amount of lidocaine, the effect of analgesic and adverse reactions were also observed. Results The levels of HR, MAP, RR and SpO2 in test group were significantly lower than those in control group(t=38.9, 31.0, 14.1, 2.4, P 0.05). In control group, HR, MAP and RR were significantly higher than those before operation (t=-23.6, -18.0, -9.5, P<0.05). The difference of HR, MAP, RR and SpO2 among T1, T2, T3, T4 and T5 was statistically significant (F=997.3, 833.7, 120.1, 77.5, P<0.05). In addition, the incidence of adverse reactions was both less in the two groups, and the incidence of response of patients, operation time, the amount of lidocaine and other indicators and analgesic effect in the test group were superior to the control group(-15.4, 9.2, -56.3, P<0.05). Conclusions Midazolam in CT-guided 125I particle implantation can improve the patient′s tolerance and shorten the operation time, guarantec security. Key words: CT guided; 125I seeds; Brachytherapy; Midazolam; Sedation

Comparison of the therapeutic efficacy of combined intracavitary therapy with palliative surgery in patients with extrahepatic ductal cholangiocarcinoma

Objective To compare the therapeutic efficacy of combined biliary stent and 125I seed intracavity irradiation with palliative surgery in the treatment of extrahepatic ductal cholangiocarcinoma. Methods A prospective analysis was conducted on 142 patients with cholangiocarcinoma who were treated in The First Affiliated Hospital of Bengbu Medical College from January 2012 to December 2015. There were 80 patients who underwent percutaneous biliary metal stenting combined with 125I particles implantation (the stenting-particle group) and 62 patients who were treated by palliative biliary drainage (the surgical group). The surgical group included R1 resection in 17 patients, R2 resection in 26 patients and biliary enteric drainage in 19 patients). The levels of jaundice, liver function, survival time, hospitalization time and hospitalization cost before and after therapy were analyzed. Results Jaundice was effectively alleviated in the two groups after a short period. The liver function in the 2 groups improved significantly at 1, 3 and 6 months when compared with that before operation, (P 0.05). Conclusions For patients with extrahepatic ductal cholangiocarcinoma who were not suitable for radical surgery, percutaneous biliary stenting combined with 125I seed brachytherapy effectively reduced jaundice, improved liver function, shortened average length of hospital stay and reduced average cost of hospitalization. When compared with palliative surgery, it was a minimally invasive, easy, safe and efficacious treatment, especially for elderly patients with poor physical conditions. Key words: Cholangiocarcinoma; Palliative surgery; Biliary stent; 125I seed; Obstructive jaundice

Combined brachytherapy with intermittent hormonal therapy in treating clinical moderate and high risk non-metastatic prostate cancer

Objective To investigate the clinical value of 125I particle implantation brachytherapy combined with intermittent hormonal therapy for treating clinical moderate and high risk non-metastatic prostate cancer. Methods A prospective study was proceeded and 100 cases with moderate and high risk(cT≥T2b, Gleason score≥7, pre-biopsy PSA≥10 ng/ml)non-metastatic prostate cancer were included. The selected patients were divided into two group. In the study group, patients were treated with 125I particle implantation combined with intermittent hormonal therapy. In the control group, patients were treated with only intermittent hormonal therapy. Hormonal therapy was maximal androgen blockage for two groups, including bicalutamide 50 mg oral every day and Leuprorelin 3.75 mg subcutaneous injection every 28 days. There were 50 cases in each group and clinical trial agreements were signed. During follow-up, PSA were tested every month. Chest X-ray and whole-body bone scanning were checked every 6 months. Hormonal therapy was stopped when patient's PSA level fell to 0.2 ng/ml, and keep stabilized for 3 months. When PSA level elevated for 3 times continuously and over 1ng/ml, hormonal therapy was initiated again. The IPSS scores were documented before treatment and every 3 months after treatment. Adverse reactions of urinary tract and rectum were assessed every 3 months after 125I particle implantation in study group. The ratio of the first time to stop hormonal therapy, the time duration of first hormonal therapy and stable phase, re-hormonal therapy free survival rate, bone metastasis free survival rate, castration resistance prostate cancer(CRPC) free survival rate, cancer-specific free survival rate and overall survival rate were compared. Results The 100 cases in this study were followed up for 24-40 months, with an average time of 31.6 months. In study group, the PSA level in all cases descended to the level of stopping hormonal therapy. The time duration of hormone therapy ranged from 4 to 12 months, with an average time of 6.3 months. 21 (42%) cases had a PSA elevation again to restart hormonal therapy. In control group, the PSA level in 47 cases descended to the level of stopping hormonal therapy. The time duration of hormone therapy ranged from 5 to 15 months, with an average time of 7.2 months. 34 (68%) cases had a PSA elevation again to restart hormonal therapy. There was no significant difference in percentage of cases of stopping hormone therapy and in time duration of hormonal therapy for the first cycle. Instead, there were significant differences in stable phase after first cycle hormonal therapy between two groups ( 27.2 months vs. 17.7 months; P<0.001). When analyzed by Kaplan-Meier survival curve, there was no significant difference in cancer-specific survival rate and overall survival rate. There were significant differences in Re-hormonal therapy free survival (P=0.002), bone metastasis free survival (P=0.04) and CRPC free survival(P=0.005). Conclusions Compared with intermittent hormonal therapy alone, 125I particle implantation brachytherapy combined with intermittent hormonal therapy could prolong the hormonal sensitive time in moderate and high risk non-metastatic prostate cancer patients and control the progress of the prostate cancer. Key words: Prostaticneoplasms; Brachytherpay; Hormonal therapy