125I Seeds Implantation Research Articles

Response of extra-axial tumors to stereotactically implanted high-activity 125I seeds.

125I seeds can deliver a very high dose of radiation (100-500 Gy) to a well-circumscribed area over their average life of 87 days, which enable them to destroy slow-growing extra-axial tumors after permanent implantation. Stereotactic implantation of 125I seeds was performed in 26 patients with extra-axial tumors, with a median follow-up of 32 months. No acute morbidity or mortality resulted from the procedure. Cranial nerve involvement in 5 patients was the only delayed complication. One patient developed radionecrosis outside the range of 125I dose distribution, which was felt to be due to the hyperfractionated external radiation the patient had received prior to 125I seed placement. All 26 patients showed tumor regression. The results indicate that this form of treatment is relatively safe and effective in the management of extra-axial tumors.

Iodine-125 Brachytherapy for Clinically Localized Prostate Cancer: A 5-Year Follow-Up of Outcome and Complications

Thirty-seven patients with clinically localized prostate cancer of all grades were treated by suprapubic digitally guided implantation of 125I seeds. The median age at the time of diagnosis was 68 years. The mean follow-up period was 62 +/- 19 months. At last follow-up 18 patients were clinically free of disease; 11 deaths occurred: 9 from prostate cancer and 2 from another disease. Complications occurred in 24 patients most commonly urgency and proctitis, attributable to the treatment. Four patients had severe late rectal complications, and 2 patients died of sepsis secondary to rectal fistulae. Digitally directed retropubic implantation of 125I appears inferior to other treatments of clinically confined prostate cancer both regarding outcome as well as complication rate.

Long Term Results of Ultrasonically Guided Implantation of 125-I Seeds Combined with External Irradiation in Localized Prostatic Cancer

Transperineal 125-iodine seed implantation guided by transrectal ultrasonography and subsequent external beam irradiation was employed in the treatment of 32 patients with localized prostatic carcinoma (16 poorly differentiated). Follow-up is currently 35–98 months with a median of 65 months. Distant metastases have developed in 18 patients, of whom 11 have died from prostatic cancer. Median change in prostatic volume was a reduction of 35%. Re-biopsy or transurethral resection of the prostate was performed in 25 patients after 1–4 years, revealing still malignant histology in 10 (40%), of whom 8 have developed distant metastases or died from prostatic cancer. Fourteen patients suffered from late complications of which surgical intervention was indicated in five cases. Nine patients are presently free of progression and prostate specific antigen is <0.5 ng/ml in 8 of these. The future role of ultrasonically guided implantation in the management of prostatic cancer is discussed.

Transperineal Ultrasound-Guided 125I Seed Implantation for Stage B Adenocarcinoma of the Prostate: Preliminary Report

Fifty-four consecutive patients were treated with transperineal ultrasound-guided 125I seed implantation for Stage B adenocarcinoma of the prostate by a single team. The planned dosimetry was 16,000 rads. The tabulated results indicate an excellent response to interstitial radiation with remarkably few complications and side effects.

Ultrasonically guided percutaneous implantation of iodine-125 seeds in pancreatic carcinoma

Cancer of the pancreas is most often not diagnosed before it has reached unresectable stages. The development of effective palliative treatment for these patients and for those with recurrence after resection is clearly needed. The present study reports the results of ultrasonically guided percutaneous implantation of 125I seeds in 19 patients with cancer of the pancreas. Twelve patients had further adjuvant external radiation. Despite satisfactory seed placement and delivery of the planned radiation dose in most cases, clinical improvement was lacking or only slight and short-lived. No difference in survival or palliation was observed between patients treated with seeds alone compared with patients treated with seeds and external radiation. Survival after seed implantation was short (median 140 days, range 7–401 days). Ultrasonically guided percutaneous implantation of 125I seeds cannot be recommended in the treatment of unresectable carcinoma of the pancreas.

Interstitial radiation in recurrent malignant gliomas.

Twelve patients with recurrent supratentorial gliomas were treated with implanted 125I seeds. The interval from initial surgery to interstitial radiation ranged from 3 months to 9 years. The techniques for brachytherapy included volume implantation by craniotomy in one, stereotactic implantation with low-activity seeds in 7 and high-activity seeds in 4 patients. The total dose received ranged from 5,500 to 27,000 cGy. CT scans performed sequentially on all patients showed progressive attenuation in areas previously enhancing, suggestive of tumor necrosis produced by the interstitial sources. The mean and median survival of these patients was 23 and 22 weeks, with the 4 most recent patients still alive.

125Iodine implants as an adjuvant to surgery and external beam radiotherapy in the management of locally advanced head and neck cancer.

125Iodine seeds either individually placed or inserted into absorbable Vicryl suture carriers were utilized in conjunction with surgery and external beam radiotherapy in an attempt to increase local control rates in patients with (1) advanced oropharyngeal and laryngopharyngeal cancers (T3-T4, N2-N3), (2) massive cervical lymphadenopathy (N3) and an unknown primary site and (3) locally recurrent head and neck cancers. Forty-eight patients were treated with 55 implants. The carotid artery was implanted in 15 patients, while seven patients had seeds inserted into the base of the skull region, and another three patients had implants near cranial nerves. Eighteen of the 48 patients were treated for cure. The actuarial survival at five years in this subgroup was 50%. The overall local control in the head and neck area was 58%. In this group no patients to date have had a local failure in the implanted volume. Seventeen patients with comparable stage of disease treated prior to 1974 with curative intent without 125I implants were analyzed retrospectively for comparison with the implanted patients. The actuarial survival of these patients was 18% and the overall head and neck control was 21%. These differences are statistically significant at a P value of 0.01 and 0.007, respectively. Seventeen patients received implants for local recurrence. The local control in the head and neck area was 50%; however, the 2.5 year actuarial survival was only 17%. The complication rate was 11% (six of 55 implants). The improved survival, the high local control, and the minimal complication rates in this series makes the intraoperative implantation of 125I seeds and effective adjunctive treatment to surgery and external beam irradiation.

Value of computed tomography in interstitial 125I brachytherapy of prostatic carcinoma.

Computed tomography (CT) was performed in 20 patients with localized prostatic carcinoma before and after interstitial implantation of 125I seeds. Scans were analyzed to determine prostate volume, seed location, tumor response, and periprostatic tumor spread. CT volumes were an average of 25-30% greater than clinical estimates. In addition, CT demonstrated errors in implantation, including inhomogeneous distribution and extraprostatic seeds, in 17 patients (85%). Serial post-implantation scans showed no change in prostate volume in 12 patients (60%), a decrease in 7 (35%), and an increase in 1 (5%), concurring with clinical assessment of response to therapy. In 2 patients, clinically unsuspected tumor spread was identified on the CT scan.

125 Iodine prostate implants for recurrent carcinomas after external beam irradiation: Preliminary results

Fourteen patients with locally recurrent prostate carcinomas after external beam irradiation received 135I seed implants at Stanford between 1975 and 1979. Clinical local control has been obtained in 11 of the 14 patients for follow-up periods of 6 to 36 months. Eight remain without evidence of disease, but 2 of the 3 patients whose pelvic lymph nodes were involved by carcinoma have developed distant metastases. Complications, consisting of either cystoproctitis, urinary incontinence, or the development of a vesicorectal fistula occurred in 4 of the 14 patients. These complications were noted only in those patients who had implantation of high intensity 125I seeds (greater than 0.50 mCi) into large prostatic volumes (greater than or equal to 50 cc). No complications occurred in patients who received lower intensity 125I seed implants in smaller prostatic volumes. We conclude that 125I seed implants may be used in a second attempt to obtain local control after a local relapse following external beam irradiation, if the use of high intensity 125I sources and/or the implantation of large prostate volumes are avoided.

Results of Biopsy After Early Stage Prostatic Cancer Treatment by Implantation of 125I Seeds

We have treated 77 patients for clinically early stage carcinoma of the prostate, 9 stage A2, 63 stage B and 5 stage C, with direct implantation of 125I seeds into the prostate and pelvic lymphadenectomy. It is estimated that a minimum dose of 15,000 rad but a maximum dose of 35,000 rad is delivered to the prostate over several months. Of the 77 patients 14 (18 per cent) had metastatic disease in the pelvic lymph nodes.In 22 cases perineal needle biopsy was done 12 to 18 months after treatment and in 3 cases a second biopsy was performed after 2 to 3 years. Persistent tumor was present in 11 biopsies. Cytological changes were observed in 8 of these, primarily cytoplasmic vacuolation and nuclear pyknosis. There seemed to be no relationship between grade and stage of disease and histological evidence of persistence of tumor after radiation.One patient with persistent tumor in the postoperative biopsy has shown progression of disease after 2 years and another with a negative biopsy has a bony metastasis. The remaining 10 patients with persistent tumor have shown no sign of progression of disease during a 2 to 4-year interval.

Orthogonal xeroradiography for 125I seed implantation.

HomeRadiologyVol. 127, No. 3 PreviousNext Technical NotesOrthogonal Xeroradiograph/ for 125I Seed ImplantationRao Mantravadi, Edwin J. Liebner, Jayant V. Ginde, Richard E. HaasRao Mantravadi, Edwin J. Liebner, Jayant V. Ginde, Richard E. HaasRao MantravadiEdwin J. LiebnerJayant V. GindeRichard E. HaasPublished Online:Jun 1 1978https://doi.org/10.1148/127.3.832aMoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractThe authors recommend orthogonal xeroradiography as superior to conventional orthogonal radiography for implantation of 125I seeds in the head and neck.Article HistoryAccepted: May 1977Published in print: June 1978 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 127, No. 3 Metrics Altmetric Score PDF download