Efficacy Of 125I Seed Implantation Research Articles

Factors influencing the short-term efficacy of CT-guided 125I seeds implantation in the treatment of recurrent and metastatic tumors of head and neck

Objective To analyze the factors influencing the short-term efficacy of CT-guided 125I seeds implantation in the treatment of recurrent and metastatic tumors in head and neck. Methods A total of 73 patients (61 males, 12 females; age: (59.1±11.5) years) with head and neck tumors recurrence and metastasis treated by 125I seeds implantation in Hebei General Hospital from January 2015 to April 2019 were retrospectively enrolled. The implanted seeds activity was 11.1-29.6 MBq, and the prescription dose was 80.0-145.0 Gy. CT examination was conducted 3 months after 125I seeds implantation. According to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, short-term efficacy was classified as effective (complete remission (CR), partial remission (PR)) and ineffective (stable disease (SD), progressive disease (PD)). Univariate analysis of factors affecting short-term effect (gender, age, history of radiation therapy, Karnofsky performance status (KPS) scores, pathological type, the longest diameter of tumor, implantation patterns, seeds activity, immediate postoperative dose delivered to 90% gross tumor volume (D90), and with adjuvant chemotherapy post-surgery or not) were conducted. Variables with P<0.2 were enrolled in logistic multivariate regression analysis. In addition, artificial neural network (ANN) was constructed with all influencing factors as independent variables and short-term efficacy as dependent variables. Finally, receiver operating characteristic (ROC) curve analysis was performed for the common influencing factors in logistic regression analysis and ANN analysis. Results There were 34 with effective results and 39 with ineffective results. Logistic regression analysis indicated that the longest diameter of tumor, immediate postoperative D90, with adjuvant chemotherapy post-surgery or not had significant impacts on the short-term efficacy (Wald values: 6.950, 4.804, 4.790, all P<0.05); According to results of ANN analysis, the top 5 in order of importance for short-term efficacy prediction were immediate postoperative D90, the longest diameter of tumor, age, seeds activity and gender. ROC curve analysis indicated that the longest diameter of tumor and immediate postoperative D90 were the best predictors for short-term efficacy, with the threshold of 5.25 cm and 110.05 Gy respectively, and the area under the curve (AUC) was 0.843 and 0.847 respectively (both P<0.001). Conclusions The short-term efficacy of 125I seeds implantation in the recurrence and metastasis of head and neck tumors is mainly related to the longest diameter of tumor and immediate postoperative D90. Patients with the longest diameter of tumor 110.05 Gy can achieve better efficacy. Key words: Head and neck neoplasms; Recurrence; Neoplasm metastasis; Brachytherapy; Iodine radioisotopes; Radiotherapy, image-guided; Tomography, X-ray computed

125I seeds implantation for treating residual hepatocellular carcinoma located beneath the diaphragm after transcatheter arterial chemoembolization

PurposeThe effect of 125I seed implantation for the treatment of local residual tumor of hepatocellular carcinoma located beneath the diaphragm (HCC-LBD) after transcatheter arterial chemoembolization (TACE) has not yet been reported. This retrospective study was performed to evaluate the safety and efficacy of 125I seeds implantation (ISI) for the treatment of residual HCC-LBD after TACE. Methods and MaterialsA total of 18 patients treated with ISI between August 2012 and March 2018 for residual HCC-LBD after single or multiple TACE were enrolled. Local control, survival, and postoperative complications were analyzed retrospectively. Overall followup time was displayed by survival curves. ResultsThe 18 patients received a total of 20 ISI treatments. The total number of seeds implanted was 650, with a mean of 36 ± 13 seeds per patients (range, 20–70). Mean D90 was 123 Gy. Complete response + partial response (CR + PR) was documented in 14, 16, and 16 of patients at 3, 6, and 12 months after implantation, respectively. In four patients, seeds implantation was performed through the diaphragm; two of these patients developed small pneumothoraces. Pulmonary compression of pneumothorax is less than 30% combined with a little blood in sputum, no chest tightness, shortness of breath, all symptoms subsided without interventions, and the patients were discharged after observation for 2 days. After the procedure, routine blood examination and liver and kidney function were normal. ConclusionThe combination of TACE with ISI appears to be a safe and efficient treatment for residual HCC-BLD. Implications for PracticeThis study evaluated the feasibility, safety, and short-term efficacy of ISI for local residual tumor of hepatocellular carcinoma located beneath the diaphragm (HCC-LBD) after TACE. Results suggest that residual tumor of HCC after TACE located in the posterosuperior part of the liver (segments seven and eight), laparoscopic liver resection, and alblation is difficult to perform and that as a supplement treatment, 125I seeds implantation is safe and easy accessible. TACE combined with 125I seeds has excellent local control effectiveness, and long-term efficacy and survival benefit still need to be more comprehensively evaluated.

Efficacy of 125I seeds implantation for pelvic recurrence of cervical cancer after radiotherapy

Objective To evaluate the efficacy and adverse effects of 125I seeds implantation for pelvic recurrence of cervical cancer (PRCC) after radiotherapy. Methods From July 2005 to October 2015, 36 PRCC patients (median 44 years) after radiotherapy in Peking University Third Hospital were enrolled in this retrospective study. All patients underwent 125I seeds implantation under ultrasound or CT guidance. Treatment planning was performed before implantation to estimate the number and activity of 125I seeds. The seed numbers ranged from 10-140 (median: 62.5), and the activity ranged from 18.5-29.6(median: 25.9) MBq. Postoperatively, the median dose delivered to 90% gross tumor volume (D90) was 127.3 Gy. Kaplan-Meier method was used to calculate local progress free survival (LPFS) rate and overall survival (OS) rate, and log rank test and Cox regression were used for univariate and multivariate analyses. Results The median follow-up time was 11.5 months. The local control rate was 88.89%(32/36). The 1-year LPFS rate was 34.9% and the 1-year OS rate was 52.0%. Thirty-one patients died, of which 22 (70.97%, 22/31) died from cancer. Univariate analysis showed that the location of recurrence (χ2=5.195), volume of lesion (hazard ratio (HR)=1.012) and D90 (HR=0.988) were significantly correlated with LPFS (all P 0.05), respectively. Vaginal fistula, which may be caused by the treatment, occurred in 1 case. No other sever adverse effects were observed. Conclusions 125I seeds implantation is a safe and effective treatment for PRCC after radiotherapy. With the treatment of 125I seeds implantation, patients with pelvic wall recurrence may achieve better therapeutic effects than those with central recurrence. Key words: Uterine cervical neoplasms; Neoplasm recurrence, local; Brachytherapy; Iodine radioisotopes; Treatment outcome

Short-term efficacy of 125I seed implantation combined with transcatheter arterial chemoembolization in the treatment of advanced primary hepatocellular carcinoma

Objective To evaluate the efficacy and safety of 125I seed implantation combined with transcatheter arterial chemoembolization (TACE) in the treatment of primary hepatocellular carcinoma (PHC). Methods 156 patients who had unresectable PHC seen from January 2012 to December 2015 in our unit were randomly assigned into the study group (76 patients) and the control group (80 patients). The study group of patients were treated with intra-hepatic implantation of 125I seed + TACE, and the control group of patients were treated with three dimensional conformal radiotherapy (3DCRT) + TACE. After radiotherapy the two groups of patients underwent 2 to 3 times TACE treatment. The biomarker levels were compared between the two groups before and after treatment, and the short-term efficacy, clinical safety and 1 year survival rates were assessed. Results The success rates of the treatment for the two groups were both 100%. Patients in the study group were implanted with 1 016 125I seeds, with an average of (13.7±2.5) seeds per patient. The two groups had no significant difference on short-term efficacy (P>0.05). The DCR, ORR and 1 year survival rates in the study group were 63.2%, 92.1%, 55.5%, and they were 61.3%, 90.0%, 58.1% in the control group, respectively. There were no significant differences between these 2 groups (P>0.05). At 1 month after treatment, the two groups had no significant differences on AFP, IGF-II and IGFBP-2 [(5.08±0.85) μg/L vs. (5.12±0.79) μg/L, (4.77±0.58) μg/L vs. (4.86±0.53) μg/L, (4.98±0.67) μg/L vs. (5.04±0.71) μg/L] (P>0.05). There were no significant differences on chemotherapy drug toxicities between the two groups (P>0.05). The incidence of radiation hepatitis in the study group was 1.3%, while the incidences of radiation dermatitis, hepatitis, gastric ulcer in the control group were 5.0%, 8.8%, 2.5%, respectively. The radiation dermatitis incidence in the study group was significantly lower than that of the control group (P<0.05). In the study group, 2 patients (2.6%) had their 125I seed slightly moved. Conclusion The short-term efficacy of 125I seed implantation plus TACE in the treatment of PHC is no less than the 3DCRT + TACE regimen, but with less radiation side effects. Key words: Primary hepatocellular carcinoma; Tumor thrombus; Transcatheter hepatic arterial chemoembolization; 125I seed implantation; Three dimensional conformal radiotherapy; Clinical efficacy

Clinical observation of 125I seed implantation for the treatment of ocular tumor

Objective To observe the feasibiliy, safety and efficacy of 125I seed implantation for the treatment of ocular tumor. Methods Nineteen patients received 125I seed implantation through intra-operative direct vision. In which 3 patients who had tumor spread received secondary 125I seed implantation through CT or MRI guiding. Nineteen patients received the operation successfully according to the preoperative plan. Fourteen cases were implanted 125I seed once, three cases received twice implantation, one case received implantation for three times, and one case received implantation for four times. Results The 19 cases were observed for 2 weeks to 8 years, The average follow-up time was (26.55±5.46) months. Local lesion was controlled without recurrence in 14 cases(73. 68%). New lesions occurance or the primary lesions spreading was found in 5 cases (26. 32%), and they were controlled after secondary 125I seeds implanation. No metastasis occurred. There was no complication associated with the manipulation of implantation surgery, except for 3 cases of mild eyelid swelling and subsutaneous hemorrhage. Conjunctival hyperemia and epithelializeation, tearing, increase of secretion were observed when the 125I seed implanted anterior to the equator, and eyelashes (eyebrow) loss occurred within 1 to 3 months. Those symptoms disappeared 6 months later. One case suffered skin ulceration and fistula because of the implantation site of the seed was close to the skin. In the patients that 125I seed implanted in lacrimal gland area, one case developed dry eye, and it was recovered in 6 months. In the patients that 125I seed implanted in the middle and the posterior part of orbit, fibrosis, sclerosis and skin pigmentation occurred 9 months after surgery. All the complications were recoverable. The anterior part complations were disppear 6 months after the surgery. Conclusion Implantation of 125I seed for the treatment of ocular tumor can utmostly reserve the visual function and the appearance, which has exact effect and safety with less damage and less complication. Key words: Tumors, ocular; 125I seed, implantation; Efficacy; Complication

Efficacy of 125 I seed implantation as an adjunctive therapy for extrahepatic metastasis of primary hepatocellular carcinoma

Objective To evaluate the efficacy of 125Ⅰ seed implantation for extra-hepatic metastasis of primary hepatocellular carcinoma (HCC) treatment. Methods The clinical records of 26 patients with primary HCC and extrahepatic metastasis were reviewed. Twenty six patients had 31 primary hepatic lesions, 14 patients had 32 lung metastasis, 6 had 8 bone metastasis and 6 had 8 hepatohilar or retroperitoneal lymphatic metastasis. The hepatic lesions were heated by combination of transcatheter arterial chemo-embolization(TACE) and radiofrequency ablation(RFA) or percutaneous ethanol injection (PEI) and were followed up by contrast-enhanced CT (CECT) after 1 month. The extra-hepatic lesions were treated by 125Ⅰ seeds implantation and were followed up by CECT 3 months after treatment. The treatments were evaluated by imaging examinations. The patients were followed up every 1 month during the first half year, including CT examinations of chest, abdomen and lesions and chest films. Telephone follow-up were pedormed every 3 months after the 6th month till they were lost and the survival time were calculated. Results Of the extra-hepatic lesions, 16 cases were complete response (CR), 3 cases were partial response (PR), 4 cases were stable disease (SD) and 3 were progressive diseases(PD). Of the hepatic lesions, 11 were CR, 4 were PR, 6 were SD and 5 PD. The 26 patients are survived at the time of end of follow-up (7. 0 to 24. 0 months). The median survival duration was 14. 5 months. Conclusions 125Ⅰ seed implantation integrated interventional and minimally invasive therapy could improve the life and survival and it is an effective adjunctive therapy for primary hepatocellular carcinoma with metastasis outside the liver. Key words: Liver neoplasm; Neoplasm metastasis; Radiolngy; interventional