Implantation Of Radioactive Seeds Research Articles

Long-Term Outcomes and Prognostic Analysis of Computed Tomography-Guided Radioactive 125I Seed Implantation for Locally Recurrent Rectal Cancer After External Beam Radiotherapy or Surgery

BackgroundManagement of locally recurrent rectal cancer (LRRC) after surgery or external beam radiotherapy (EBRT) remains a clinical challenge, given the limited treatment options and unsatisfactory outcomes. This study aimed to assess long-term outcomes of computed tomography (CT)-guided radioactive 125I seed implantation in patients with LRRC and associated prognostic factors.MethodsA total of 101 patients with LRRC treated with CT-guided 125I seed implantation from October 2003 to April 2019 were retrospectively studied. Treatment procedures involved preoperative planning design, 125I seed implantation, and postoperative dose evaluation. We evaluated the therapeutic efficacy, adverse effects, local control (LC) time, and overall survival (OS) time.ResultsAll the patients had previously undergone surgery or EBRT. The median age of patients was 59 (range, 31–81) years old. The median follow-up time was 20.5 (range, 0.89–125.8) months. The median LC and OS time were 10 (95% confidence interval (CI): 8.5–11.5) and 20.8 (95% CI: 18.7–22.9) months, respectively. The 1-, 2-, and 5-year LC rates were 44.2%, 20.7%, and 18.4%, respectively. The 1-, 2-, and 5-year OS rates were 73%, 31.4%, and 5%, respectively. Univariate analysis of LC suggested that when short-time tumor response achieved partial response (PR) or complete response (CR), or D90>129 Gy, or GTV ≤ 50 cm3, the LC significantly prolonged (P=0.044, 0.041, and <0.001, respectively). The multivariate analysis of LC indicated that the short-time tumor response was an independent factor influencing LC time (P<0.001). Besides, 8.9% (9/101) of the patients had adverse effects (≥grade 3): radiation-induced skin reaction (4/101), radiation-induced urinary reaction (1/101), fistula (2/101), and intestinal obstruction (2/101). The cumulative irradiation dose and the activity of a single seed were significantly correlated with adverse effects ≥grade 3 (P=0.047 and 0.035, respectively).ConclusionCT-guided 125I seed implantation is a safe and effective salvage treatment for LRRC patients who previously underwent EBRT or surgery. D90 and GTV significantly influenced prognosis of such patients.

前列腺癌放射性粒子植入后并发溃疡性结肠炎1例并文献复习

前列腺癌放射性粒子植入后并发溃疡性结肠炎1例并文献复习

Study on the Low Velocity Stability of a Prostate Seed Implantation Robot’s Rotatory Joint

Prostate cancer has one of the highest incidences of male malignant tumors worldwide. Its treatment involves the robotic implantation of radioactive seeds in the perineum, a safe and effective procedure for early, low-risk prostate cancer. In order to ensure precise positioning, the seed implantation needle is set at low terminal velocity. In this paper, the motion output position instability caused by the friction torque of the robot’s motor and rotating joint during low velocity motion was analyzed and studied. This paper also presents a compensation control method based on the LuGre friction model, which offers piecewise parameter identification with GA-PSO. First, based on an analysis of its structure and working principle, the friction torque model of the robotic system and the torque model of the driving motor are established, and the influence of friction torque on motion stability analyzed. Then, based on experimental data of the relationship between velocity and friction torque for no-friction compensation, the velocity point of the minimum torque of the rotating joint and the critical Stribeck velocity point were used for segmental parameter identification; cubic spline interpolation was used for segmental fitting. Furthermore, on the basis of the LuGre model identification method, parameter identification of the genetic algorithm-particle swarm optimization, and compensation control of the LuGre friction model, a control method is analysed and set forth. Malab2017a/Simulink simulation software was used to simulate and analyze the control method, and verify its feasibility. Finally, the cantilever prostate seed implantation robot system was tested to verify the effectiveness of the segmented identification method and the compensation control strategy. The results reveal that motion output position stability at low velocity meets the requirements of the cantilever prostate seed implantation robot, thus providing a vital reference for further research.

Computed tomography-guided implantation of 125I radioactive seeds in patients with malignant airway compression induced by advanced lung cancer: effectiveness and safety in 40 patients.

PurposeTo evaluate the safety and efficacy of computed tomography (CT)-guided 125I radioactive seed implantation in patients with malignant airway compression induced by advanced lung cancer.Material and methodsBetween June 2015 and June 2018, 40 patients from three medical institutions with malignant airway compression induced by advanced lung cancer were treated with 125I seed implantation. The outcomes were measured in technical success and safety, objective response rate, complications, Karnofsky performance status (KPS) score, and survival time.ResultsAll 40 patients successfully underwent implantation procedure. No procedure-associated death occurred. The most common complications were irritable cough, temporary hemoptysis, chest pain, fever, and pneumothorax, which occurred in 26 (65.0%), 31 (77.5%), 12 (30.0%), 15 (37.5%), and 11 (27.5%) patients, respectively. The objective response rates were 100%, 100%, 100%, 87.5%, and 83.3% at the 3rd, 6th, 12th, 24th, and 36th months post-procedure, respectively. The KPS score significantly improved at post-procedure. Median survival time was 25.1 months. Actuarial survival rates were 100%, 60%, and 15% at the 12th, 24th, and 36th months after the procedure, respectively.ConclusionsFor patients with malignant airway compression induced by advanced lung cancer, implantation with 125I seed is a safe and effective alternative treatment option.

Self-management and the influencing factors of discharged patients with cancer after 125I seeds implantation

Objective To investigate the status of self-management of discharged patients after radioactive 125I seeds implantation and analyze the possible influencing factors, so as to provide reference for postoperative continuous nursing guidance. Methods From March to April 2018, convenient cluster sampling was used to select out of hospital tumor patients who met the inclusion criteria after 125I seed implantation in the Department of Radiation Oncology of Peking University Third Hospital within half a year. The self-designed Radiation Protection Knowledge and Self-management Behavior Evaluation Questionnaire was used to collect data through telephone follow-up and medical record review. In the self-designed part of the questionnaire, 2 particle group doctors and 2 deputy directors and 1 associate professor was invited to evaluate the content validity of the questionnaire. The total number of questionnaires was 72 and 72 valid questionnaires were collected. SPSS 21.0 statistical software was used for data entry and analysis. Results After 125I seed implantation, the patients' knowledge score of radiation protection outside hospital was (3.33±1.22) with a full score of 5; the self-management score of radiation protection was (27.40±9.47) with a full score of 44; the total self-management score of patients with lead-free clothing was higher than that of patients with lead-free clothing (t=5.51, P<0.001) ; the self-management level of radiation protection of medical insurance patients was higher than that of self paid patients (t=2.15, P<0.05) ; family economic pressure was the influencing factor of self-management of radiation protection (F=-4.41, P<0.05) ; the knowledge of radiation protection was positively correlated with self-management behavior of radiation protection (r=0.544, P<0.001) . Multivariate linear regression analysis showed that, the family economic incorne, the total score of radiation protection knowledge, and whether they have their own lead clothing were the main influencing factor of discharged patients with cancer after 125I seeds implantation (P<0.05) . Conclusions The knowledge of radiation protection outside the hospital and the ability of self-management of radiation protection of the patients after 125I seed implantation are medium level. The important factors influencing the self-management of radiation protection of the patients after seed implantation are whether they have their own lead clothing, family economic income, and the cognitive level of radiation protection. In order to achieve better self-management level of radiation protection, medical staff should educate patients about the hazards and protection of radiation, improve patients' awareness of radiation protection, and encourage patients to buy lead clothing. Key words: Neoplasm patients; Radioactive seeds implantation; Radiation protection; Self-management

Implantation of 125I radioactive seeds via c-TBNA combined with chemotherapy in an advanced non-small-cell lung carcinoma patient

BackgroundThe critical management of advanced non-small-cell lung carcinoma (NSCLC), especially when complicated by severe airway stenosis, is difficult and often leads to high clinical risks and medical costs.Case presentationA 51-year-old previously healthy male was admitted to the Department of Respiratory and Critical Care Medicine, Taizhou People’s Hospital, in November 2018 for haemoptysis and difficulty breathing during a 15-d period. Following admission, chest computed tomography (CT) showed a large mass in the left hilum with atelectasis in the left upper lobe and obstructive pneumonia in the left lower lobe. Bronchoscopy revealed that the lesions occurred in the distal segment of the left main trachea, with occlusion of the left upper bronchus and significant narrowing of the lower bronchus. A basal mucosal biopsy of the lump tissue was performed after haemostasis treatment with sub-plasma coagulation (APC), and squamous lung carcinoma was confirmed. Following the final diagnosis, the patient was successfully treated with implantation of 125I radioactive seeds via transbronchial needle aspiration (c-TBNA) combined with chemotherapy.ConclusionWe believe that implantation of 125I radioactive seeds via c-TBNA is an effective treatment for patients with advanced lung cancer and those presenting with severe and mixed main bronchus stenosis.

Endobronchial Ultrasound-Guided Iodine-125 Radioactive Seed Implantation as a Novel Therapy for Mediastinal Tumors.

Objective: This study aims to test the treatment effect of endobronchial ultrasound (EBUS)-guided interstitial iodine-125 (125I) seed implantation for mediastinal lymph node metastasis or advanced mediastinal lung cancer. Materials and Methods: The patients with mediastinal lymph node metastasis or advanced mediastinal lung cancer, who had undergone surgery for resection of primary lesions and repeated chemotherapy or external radiotherapy, were selected and scheduled to undergo EBUS-guided 125I seed implantation from December 2015 to May 2017. Forty patients were included into this study. Clinical data of these patients were collected and the short-term effects were observed. Then, the feasibility for treating mediastinal tumors was retrospectively analyzed. The follow-up period ranged within 1-6 months. Results: The procedure was successfully completed, and all patients well tolerated the procedure without any major complications. The response evaluation criteria in solid tumors were utilized to test the treatment effect, and the overall response rates (complete remission + partial remission) at postoperative 2, 4, and 6 months were 65.00% (13/20), 80.00% (16/20), and 85.0% (17/20), respectively. All patients of this study survived throughout the follow-up period. Conclusions: This experience revealed that EBUS-guided 125I radioactive seed implantation is effective and safe, and is a prospective approach for treating patients with mediastinal lymph node metastasis or advanced mediastinal lung cancer.

Comparison of Planning between 3D-Printing Non-Coplanar Template and 3D-Printing Coplanar Template-Assisted Radioactive Seed Implantation As Re-Irradiation for Pelvic Wall Recurrent Gynecological Malignant Tumors

Comparison of Planning between 3D-Printing Non-Coplanar Template and 3D-Printing Coplanar Template-Assisted Radioactive Seed Implantation As Re-Irradiation for Pelvic Wall Recurrent Gynecological Malignant Tumors

Comparison of therapeutic effects of TACE combined with microwave ablation, 125I radioactive seed implantation, Apatinib targeted therapy for large hepatocellular carcinoma

Objective To observe the efficacy of transcatheter arterial chemoembolization (TACE) combined with microwave ablation, 125I radioactive seed implantation and Apatinib targeted therapy for large hepatocellular carcinoma. Methods 120 patients with large hepatocellular carcinoma admitted to our hospital from May 2015 to May 2017 were selected as the subjects and randomly divided into four groups. 30 patients in the control group were treated with TACE, 30 patients in the combined treatment group 1 were treated with TACE combined with microwave ablation, 30 patients in the combined treatment group 2 were treated with TACE combined with 125I radioactive seeds implantation, and 3 patients in the combined treatment group 3 were treated with TACE combined with Apatinib. The clinical efficacy, changes of alpha-fetoprotein (AFP), survival rate, levels of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) and adverse reactions were compared among the four groups. Results The disease control rate of the combined treatment group was significantly higher than that of the control group (P 0.05), while the survival rate of the combined treatment group 1 was significantly higher than that of the control group (P<0.05). After treatment, the levels of VEGF and MMP-9 in the four groups were significantly lower than those before treatment (P<0.05), and the combined treatment group was significantly lower than the control group (P<0.05). The incidence rates of adverse reactions such as elevated blood pressure, nausea and vomiting, skin itching, proteinuria and bone marrow suppression in the combined treatment group 1 were significantly lower than those in the control group (P<0.05), and the incidences of skin itching in the combined treatment group 2 and the combined treatment group 3 were significantly lower than those in the control group (P<0.05). Conclusions TACE combined with microwave ablation, 125I radioactive seed implantation and Apatinib targeting therapy for large hepatocellular carcinoma are more effective than TACE alone, and TACE combined with microwave ablation can significantly prolong the survival time of patients. Key words: Liver neoplasms; Catheterization; Chemoembolization, therapeutic; Hepatic artery; Microwaves; Ablation techniques; Iodine radioisotopes; Apatinib

CT-guided Radioactive I-125 Seeds Implantation for Early Stage Lung Cancer

CT-guided Radioactive I-125 Seeds Implantation for Early Stage Lung Cancer

Therapeutic effect analsysis of ultrasound-guided radioactive 125I seed implantation in the treatment of hepatic tumors at dangerous sites

Objective To study the local efficacy of ultrasound-guided interstitial implantation of radioactive 125I seeds in the treatment of hepatic tumors at dangerous sites. Methods A retrospective study was conducted on 39 patients who were admitted into the First Medical Center, PLA General Hospital from November 2011 to January 2018. There were 23 males and 16 females. A three-dimensional planning before 125I seed implantation was performed for all these patients using the treatment planning system (TPS). The implantation was performed under ultrasound guidance. Liver CT scan was performed in all the patients after implantation to evaluate the actual distribution of the seeds in the tumors. Follow-up was performed at 2, 4, 6, 9 and 12 months after implantation, respectively, to evaluate using complete response (CR), partial response (PR), steady disease (SD), progressive disease (PD) and local control rates (LCR). Results Implantation was successfully performed in all the 39 patients. CT scan showed that 5 patients (12.8%) required additional implantation. Follow-up imaging after implantation showed local control of the lesions was good. The rates of CR, PR, SD and LCR were 2.6% (1/39), 28.2% (11/39), 66.7% (26/39) and 97.4% (38/39), respectively. One patient (2.6%, 1/39) showed local progressive disease. The LCR reached 97.4% (38/39) at 12 months of follow-up. Conclusion Ultrasound-guided radioactive 125I seed implantation was efficacious in the treatment of hepatic tumors at dangerous sites. Key words: Liver neoplasms; Iodine radioisotopes; Treatment outcome; Ultrasound-guided

Interpretation of adverse reactions and complications in Chinese expert consensus of Iodine-125 brachytherapy for pancreatic cancer.

Owing to the location of the pancreas and its complex anatomical relationship, it is difficult to perform radioactive Iodine-125 seed implantation in patients with pancreatic cancer as it can cause surgical side effects and further complications. To standardize the procedure of radioactive Iodine-125 seed implantation in the treatment of pancreatic cancer and reduce the occurrence of adverse reactions and complications during and after operation, the Chinese Medical Doctor Association of Radioactive Seed Implantation Technology Expert Committee, Committee of Minimally Invasive Therapy in Oncology, Chinese Anti-Cancer Association, and the Radioactive Seed Therapy Branch organized and helped establish an expert consensus in China regarding radioactive Iodine-125 seed implantation in the treatment of pancreatic cancer. This article aims at interpreting the adverse reactions and complications after the implantation of radioactive seeds.

Comparative study for CT-guided 125I seed implantation assisted by 3D printing coplanar and non-coplanar template in peripheral lung cancer.

PurposeWe compared the three-dimensional printed non-coplanar template (3DPNCT) plans with 3D-printed coplanar template (3DPCT) plans for radioactive seed implantation (RSI) in lung cancer and explored the differences between the two technologies.Material and methods33 patients with peripheral lung cancer that received 3DPCT-assisted RSI in our department between June 2017 and February 2018 were analyzed. A 3DPNCT plan was re-designed for all patients. The prescribed dose and seed activity in the new plan were the same as the 3DPCT plan. The data in the two plans were compared, including seed number, needle number, number of needles needed to cross the ribs, and dosimetry parameters. Dosimetry parameters included D90, Dmean, MPD (minimum peripheral dose), V100, V150, CI (conformity index), EI (external index), HI (homogeneity index) of target volume, D2cc of spinal cord and aorta, and V20 of affected side lung. We used a paired t-test and two groups of related non-parameters tests to examine statistical significance. A p value < 0.05 was considered statistically significant.ResultsWe found no significant difference in dosimetry parameters (p > 0.05), except MPD. The mean MPD of the 3DPNCT plan was significantly higher than the 3DPCT plan (88.5 Gy and 81.8 Gy, respectively, p = 0.017). The number of needles used in the 3DPNCT plan and the number of needles needed to cross the ribs were significantly less compared with the 3DPCT plan (p = 0.000).ConclusionsThe dose distributions of the two 3DPCT plans were similar. 3DPNCT plan had a higher dose in target volume margin, with fewer needles and fewer breaks to the ribs.

Dosimetry verification of radioactive seed implantation for recurrent malignant tumor of head and neck assisted by 3D printing individual guide plate

Objective To compare the dose distributions of postoperative plans with preoperative plans for 3D printing guide plate assist radioactive seeds implantations, explore the effects of the technology for seeds implantations in dosimetry level. Methods From January 2016 to December 2016, a total of 42 patients of local recurrent malignant tumor of head and neck received 3D printing guide plate assist radioactive seeds implantations in in Peking University Third Hospital, and included in the retrospective study. The prescribed dose was 110-160 Gy. All patients carried out preoperative planning design, individual guide plate production, and compared the dose distribution of postoperative plan with preoperative plan. Dose parameters include D90, mPD, V100, V150, V200, CI, EI and HI. Statistical method was paired t-test. Results A total of 42 3D printing individual templates were produced. The mean GTV volume of all patients was 28.6 cm3, and mean D90 of postoperative target area (GTV) was 142.6 Gy. For postoperative plans, the mean D90, mPD, V100, V150, V200 was 142.6 Gy, 77.3 Gy, 92.48%, 68.40% and 42.98%, respectively, and 144.5 Gy, 70.2 Gy, 91.45%, 63.12% and 34.74%, respectively, in preoperative plans. Except mPD, V150, V200(t=-2.166, -2.863, -4.778, P<0.05), there was no significant difference between the two groups. Conclusions 3D printing guide plate could provide good accuracy for positioning and direction. For local recurrent malignant tumor of head and neck, the actual dose distributions in postoperative validations were close to the expectations of preoperative plans which mean the improvement of accuracy in treatment. Key words: 3D printing; Radioactive seed implantation; Dosimetry; Malignant tumor; Head and neck; Cancer

The Effectiveness and Prognostic Factors of CT-Guided Radioactive I-125 Seed Implantation for the Treatment of Recurrent Head and Neck Cancer After External Beam Radiation Therapy

To analyze the efficacy and safety of radioactive I-125 seed implantation in the treatment of recurrent head and neck tumors after radiation therapy. The data of 101 patients with recurrent head and neck cancer after radiation therapy who received computed tomography guided radioactive I-125 seed implantation were analyzed. The median previous cumulative external irradiation dose was 66Gy, and the median dose to 90% of the target volume (D90) after operation was 117Gy. The short-term efficacy was evaluated by Response Evaluation Criteria in Solid Tumors version 1.1, and the adverse event was evaluated by Common Terminology Criteria for Adverse Events version 4.0. The 5-year local control rate was 26.6%, and the 5-year overall survival rate was 15.5%. Univariate analysis showed that factors related to local control rate included age, pathologic type, implantation site, lesion volume, and D90. The 5-year local control rate was 11.5% (2-year) if D90 was <120Gy and 44.2% if D90 was ≥120Gy(P=.001). Multivariate analysis showed that pathologic type, lesion volume, and D90 were independent factors related to local control (P=.002, 0, .014, respectively); Karnofsky performance status and lesion volume were independent factors associated with survival (P=.021 and 0, respectively). For the side effects, there were 26 cases of skin or mucosa ulceration (25.7%), 14 cases of pain (13.9%), and 2 cases of dry mouth (2%). The correlation between toxicity and dose had not been found. Radioactive I-125 seed implantation in the treatment of recurrent head and neck cancer after radiation therapy showed acceptable efficacy and safety. Nonsquamous carcinoma, small lesion volume, and high dose (D90) were correlated with better local control.

Dosimetric study of 125I seed implantation by 3D-printing coplanar template for pelvic wall recurrent cervical cancer after radiotherapy

Objective To investigate the feasibility of 3D-printing coplanar coordinate template (3D-PCT) for guiding 125I radioactive seed implantation in the treatment of pelvic wall recurrence of cervical cancer on ensuring the accuracy of dose. Methods From Oct 2016 to Dec 2017 in Peking University Third Hospital, totally 10 patients with pelvic wall recurrent cervical cancer after radiotherapy were treated with 125I radioactive seed implantation assisted by 3D-PCT. The median age was 53.5 years old (37-71 years old). KPS score of the cohort were more than 70. All patients had received pelvic radiation therapy previously. The median volume of the lesion was 31.9 cm3 (3.5-58.0 cm3). The prescription dose was 120-180 Gy. The activity of seeds was 0.55-0.67 mCi(1 Ci=3.7×1010Bq), while the number of seeds was 12-81 (median 50) on preoperative plan. Radioactive seeds implantation was performed under 3D-PCT guidance according to the preoperative plan. The actual number of implanted seeds was 53(10-82). Dosimetry parameters of preoperative plan and postoperative plan including D90, D100, V100, V150, V200, external index (EI), conformal index (CI), heterogeneity index (HI), and organ-at-risk doses of D2 cm3, D1 cm3 and D0.1 cm3 were compared using the nonparametric test. Results The seed number of postoperative plan was more than that of preoperative plan (Z=-2.255, P 0.05). D2 cm3 and D1 cm3 of rectum for postoperative plan were lower than that of preoperative plan (Z=-2.100, -2.240, P 0.05). Conclusions Assisted by 3D-PCT for 125I radioactive seed implantation in pelvic wall recurrence of cervical cancer, the actual postoperative dose could meet the requirement of the preoperatie plan through the intraoperative optimization of dose. 3D-PCT could ensure the precise of delivered dose of 125I radioactive seed implantation. Key words: Pelvic wall recurrent cervical cancer; 125I radioactive seed; Dosimetry; 3D-printing coplanar coordinate template

Dosimetry and Efficacy Analysis of 125I Radioactive Seeds Implantation for Cervical Cancer with Pelvic Recurrent after Radiation Therapy

Dosimetry and Efficacy Analysis of 125I Radioactive Seeds Implantation for Cervical Cancer with Pelvic Recurrent after Radiation Therapy

Clinical Outcome of CT Guided Radioactive Iodine-125 Seeds Implantation in the Treatment of Recurrent Head and Neck Tumors after External Beam Radiotherapy

The treatment of recurrence of head and neck cancer after radiotherapy is very difficult. Surgery and re-irradiation can only be used in a few patients. The purpose of this study is to analyze the efficacy and safety of radioactive I-125 seeds implantation in the treatment of recurrent head and neck tumors after radiotherapy.

Ct and Template-Guided Radioactive Seed Implantation for Inoperable Early Stage Non-Small Cell Lung Cancer

To investigate the efficacy and side effects of radioactive seed implantation in the treatment of non-surgical early stage non-small cell lung cancer on the guiding of Computer Tomography(CT) combined with template.

Ct-Guide Implantation of 125I Radioactive Seeds for 4l Mediastinal Lymph Node Metastasis of Lung Cancer

To investigate the technique, safety and clinical value of CT-guided implantation of 125I radioactive seeds for 4L mediastinal lymph node metastasis of lung cancer.