Radioactive Implantation Research Articles

Tumor Shape-Specific Brachytherapy Implants by 3D-Printing, Precision Radioactivity Painting, and Biomedical Imaging.

In brachytherapy (BT), or internal radiation therapy, cancer is treated by radioactive implants. For instance, episcleral plaques (EPs) for the treatment of uveal melanoma, are designed according to generic population approximations. However, more personalized implants can enhance treatment precision through better adjustment of dose profiles to the contours of cancerous tissues. An original approach integrating biomedical imaging, 3D printing, radioactivity painting, and biomedical imaging, is developed as a workflow for the development of tumor shape-specific BT implants. First, computer-aided design plans of EP are prepared according to guidelines prescribed by the Collaborative Ocular Melanoma Study protocol. Polyetheretherketone (PEEK), a high-performance polymer suitable for permanent implants, is used to 3D-print plaques and the geometrical accuracy of the printed design is evaluated by imaging. The possibility to modulate the dose distribution in a tridimensional manner is demonstrated by painting the inner surfaces of the EPs with radioactive 103Pd, followed by dose profile measurements. The possibility to modulate dose distributions generated by these 3D-printed plaques through radioactivity painting is therefore confirmed. Ex vivo surgical tests on human eyeballs are performed as an assessment of manipulation ease. Overall, this work provides a solution for the fabrication of tumor-specific radioactive implants requiring higher dose precision.

Low energy radioactive ion beams at SPES for nuclear physics and medical applications

Over the past decades many accelerator facilities have been built in order to produce radioactive nuclei. Among the falcility under construction, SPES (Selective Production of Exotic Species) is the Italian ISOL (Isotope Separation On Line) facility in the installation phase in these years in the Laboratori Nazionali di Legnaro. The innovative aspect of this facility is that the radioactive beam produced by fission induced by the proton beam, produced by a high power cyclotron, interact with a multi-disks uranium carbide target. The formed RIB will be sent directly to the low energy experimental area and, afterwards, to the post-acceleration complex. Currently the installation program concerning the SPES RIB source provides the set-up of the apparatus around the production bunker. The main objective of SPES project is to provide, in the next years, the first low-energy radioactive beams for beta decay experiments using the b-DS (beta Decay Station) set-up and for radiopharmaceutical applications by means of the IRIS (ISOLPHARM Radioactive Implantation Station) apparatus. In this work, all the specific issues related to the SPES RIB and the Low Energy beam lines will be reported. The main RIB systems, such as ion source systems, target-handling devices and the installation of low energy transport line, will be presented in detail.

Effects of different types of radiation therapy on cardiac-specific death in patients with thyroid malignancy.

Radiation therapy (RT) is one of the common and widely used treatment method for thyroid tumors. Considering that the thyroid is located close to the heart, the radiation generated during the treatment of thyroid tumors may have an adverse greater impact on the heart. This study is to explore the influencing factors, especially additional effects of RT, on cardiac-specific death among patients with malignant thyroid tumors. Collecting information from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database using SEER*Stat. Patients with malignant thyroid tumors were searched, whether receiving RT or not. Ultimately, 201, 346 eligible patients were included. Propensity Score Matching (PSM) was used to minimize bias of baseline characteristics by adjusting for confounding factors. COX (proportional hazards) and fine-gray (competing risk) model regression analysis were used to explore the effects of various influencing factors on cardiac-specific death. The present analysis showed that, compared with non-RT, RT based upon radioactive implants and beam radiation were associated with lower risk of cardiac-specific death in patients with thyroid malignancy, beam radiation therapy may had a similar effect. Besides, the remaining RT methods did not significantly increase the risk of cardiac-specific death. In addition, Asian or Pacific Islander ethnicity, female sex, marital status, combined summary stage (localized, regional, and distant), high-income, and later year of diagnosis were associated with lower risk of cardiac-specific death. While older age of diagnosis, African ethnicity, non-Hispanic ancestry, and derived AJCC stage (IV) were risk factors for cardiac-specific death. These results help to identify the factors influencing cardiac-specific death among patients with thyroid malignancies. Furthermore, it may helps to improve the clinical application of RT without too much concern about adverse cardiac effects.

Artificial intelligence in brachytherapy for cervical cancer.

Brachytherapy (BT) consists in the insertion of radioactive implants directly into the tissue through an applicator, in order to kill tumor cells. This is for the tumor tissue to receive a higher dose, whereas the surrounding normal tissues receive a lower dose of radiation because of the rapid fall of the dose. Because of the special anatomical position of the cervix, smaller organ mobility, and higher tolerable doses of radiotherapy in the vagina and uterus, BT has been most widely used to treat cervical cancer and is an important part of radical radiotherapy for this type of cancer. Furthermore, it is closely related to the prognosis of patients. However, the treatment process, including target area delineation, applicator reconstruction, plan design, and optimization, is time-consuming, which may lead to changes in patient's bladder filling or gastrointestinal peristalsis. Therefore, this not only yields a poor patient experience, but may also affect the accuracy of the treatment and prognosis. With the development of computer hardware, deep learning has been gradually applied in different fields and different networks have been developed to solve various problems. By combining deep learning technology with three-dimensional BT technology, the automation of BT planning can be realized, which, in turn, can significantly shorten the treatment time, alleviate the pain of the patient, and improve treatment efficacy. This article summarizes and gives the prospects of the application of artificial intelligence in the context of BT for cervical cancer.

Pr(H3BNMe2BH3)3 and Pr(thd)3 as Volatile Carriers for Actinium-225. Deposition of Actinium-Doped Praseodymium Boride Thin Films for Potential Use in Brachytherapy.

Here we show that the praseodymium N,N-dimethylaminodiboranate complex Pr(H3BNMe2BH3)3 and the 2,2,6,6-tetramethylheptane-3,5-dionate complex Pr(thd)3 can serve as volatile carriers for 225Ac. The actinium coordination complexes Ac(H3BNMe2BH3)3 and Ac(thd)3 are the likely species subliming with the carrier material. A sample of 225Ac-doped Pr(H3BNMe2BH3)3 was used to deposit amorphous 225Ac-doped praseodymium boride films on glass and Si(100) at 300 °C. The α emission spectra of the refractory films are well-resolved, suggesting that they could be used as radioactive implants for brachytherapy and related treatments.

Impact of Therapy & Age in Choroidal Cancers: A Retrospective Cohort Analysis of 7722 Patients from a US National Database.

BackgroundCollectively, choroidal cancers represent a vast array of histopathologically diverse constituencies with profound repercussions related to mortality and metastasis. Prognosticated factors provide utility in determining clinical management and outcome propensities. To date, measures to collectively characterize choroidal cancers as a class are not impressive. This study aims to shed light on the affiliation of age and therapeutic modalities to survival in patients diagnosed with choroidal cancers.MethodsCohort analysis using the Surveillance, Epidemiology, and End Results (SEER) program, a freely accessible population-based database, was executed from 1975 to 2016, a 41-year time window. Univariable and multivariable Cox regression assessed survival with age and various therapeutic modalities as primary independent variables. Adjustment for several demographical and clinical variables was performed.ResultsThis cohort consisted of 7722 patients at the time of diagnosis. Multivariable Cox regression demonstrated increased cause-specific hazards of 71.8% for patients aged 75+ years (HR = 1.718, CI 1.155–2.555, p < 0.008) as compared to patients aged 0–24 years. 16.2% and 58.0% increases in cause-specific mortality were showcased in patients diagnosed with 8770/3: mixed epithelioid and spindle cell melanoma (HR = 1.16, p = 0.029) and 8771/3: epithelioid cell melanoma of the choroid (HR = 1.580, p < 0.001) compared to individuals diagnosed with 8720/3: malignant melanoma NOS of the choroid. Chemotherapy significantly influenced survival in patients with choroidal cancers compared to those who did not receive chemotherapy or had an unknown status (HR = 0.377, CI 0.292–0.486, p < 0.001).ConclusionLike most cancers, choroidal cancers showcase poor clinical trajectory with advanced age. Specific ICD-O-3 histological subtypes predispose to increased mortality. Therapeutic modalities such as radioactive implants and chemotherapeutic agents demonstrate decreased cause-specific mortality compared to alternative treatments. Altogether, nuanced influences of age and therapy are revealed when evaluating choroidal cancers as a class, irrespective of subtype.

A custom-made brachytherapy applicator for recurrent endometrial and vaginal cancer: A dental technique for prosthesis fabrication

The role of the prosthodontist in radiation therapy includes fabrication of radiation therapy prosthetic applicators. Brachytherapy is a form of cancer treatment that involves direct insertion of radioactive implants into the tissue. In the case of vaginal cancer, brachytherapy requires the radiation oncologist to use a device called an applicator. Conventional applicators have limitations in terms of the number of radiation tubes that can be inserted, positioning of the tubes, applicator misfit, and pain when inserted. A well-fitted applicator is needed to improve the orientation of the radiation source toward the target area and to reduce the amount of scatter radiation and tissue irritation. Using an appropriate dental material to make an impression can serve to achieve these aims. This article describes a technique for fabricating an acrylic resin custom-made applicator by using techniques used in dentistry.

Intraoperative radiotherapy versus whole-breast external beam radiotherapy, and other factors associated with the prognosis of early breast cancer treated with breast-conserving surgery and radiotherapy: a retrospective study from SEER database.

BackgroundThis study was aimed to investigate the prognostic factors of early breast cancer treated with breast-conserving surgery (BCS) and radiotherapy. Besides, we focused our attention exclusively on the comparison of the impact on prognosis between intraoperative radiotherapy (IORT) and whole-breast external beam radiotherapy (EBRT).MethodsAn observational cohort study was performed on patients with Tis-2 N0–1 M0 breast cancer from the Surveillance, Epidemiology, and End Results (SEER) database who treated with BCS and radiotherapy. Cox regression analysis, Kaplan-Meier analysis, and propensity score matching (PSM) were used to estimate risk factors for overall survival (OS) and breast cancer-specific survival (BCSS).ResultsOf the 98,614 early breast cancer patients treated with BCS and radiotherapy, 97,164 (98.5%) patients underwent EBRT and 1,450 (1.5%) underwent IORT. Multivariable Cox regression analysis showed that early breast cancer patients with age ≥65, poor marital status, lack of medical insurance, histological grade III/IV (SEER 4 grades), high T stage, high N stage, and TNBC were associated with a decreased OS/BCSS, whereas ER-positive and PR-positive were associated with an improved OS/BCSS. No significant difference was observed in survival between IORT and EBRT groups (P=0.213 for OS, P=0.180 for BCSS), or between intraoperative beam radiation and intraoperative radioactive implants groups (P=0.319 for OS, P=0.972 for BCSS).ConclusionsOur study can help clinicians identify patients with poor prognosis after breast-conserving therapy. IORT may be an alternative to EBRT for early breast cancer patients who are unable to complete the long-term postoperative radiation treatment. Beam radiation and radioactive implants are both ideal alternatives for patients who choose IORT.

Assessing the Survival Benefit of Surgery and Various Types of Radiation Therapy for Treatment of Hepatocellular Carcinoma: Evidence from the Surveillance, Epidemiology, and End Results Registries.

ObjectiveTo evaluate the survival benefit of surgery and radiation for hepatocellular carcinoma (HCC) after adjusting for patient-specific and tumor-specific factors.MethodsThis study analyzed HCC patients who enrolled in the Surveillance, Epidemiology, and End Results (SEER) registry between January 2004 and December 2013. Of the 5552 HCC patients, 4597 received surgery and 955 received radiation. Patients who received radiation were further divided into 3 subgroups: 541 who received beam radiation (BR), 197 who received radioactive implants (RI), and 217 who received radioisotopes (RIT). Propensity score weighting analysis derived from generalized boosted models (GBMs) was performed to ensure well-balanced characteristics in all comparison groups.ResultsOverall survival rates and HCC-specific survival rates were higher in those receiving surgery compared with those receiving radiotherapy. This was confirmed by Cox proportional hazard regression both before and after inverse probability of treatment weighting (IPTW). Before IPTW, the RIT group had a better outcome than the BR group in terms of overall and HCC-specific survival rates, but there was no significant difference between the RI and BR groups. After IPTW, Cox proportional hazard regression demonstrated that both the RIT and RI groups had higher survival rates than the BR group.ConclusionIn HCC patients, surgery was associated with higher survival rates compared with radiotherapy while adjusting for other factors. Among those who received radiotherapy, RIT and RI granted survival benefits.

48 Medical physicist responsibilities in internal radionuclide therapy

Introduction. The internal radionuclide therapy brings together therapy techniques using radiophamaceuticals and radioactive implants. Mostly used in oncology, two kinds of therapy techniques can be distinguished: selective and systemic methods.

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

Primary study of chemoradiotherapy combined with radioactive iodine-125 implantation for locally advanced non-small cell lung cancer

Objective To comparatively evaluate the clinical efficacy and adverse events of chemoradiotherapy combined with/without radioactive iodine-125(125-I) implantation for locally advanced non-small cell lung cancer. Methods With locally advanced non-small cell lung cancer admitted to Department of Radiotherapy of Jianhu County People's Hospital and Yancheng Third People's Hospital from March 2014 to March 2015 of 38 patients were enrolled and randomly divided into the observation (chemoradiotherapy+ radioactive 125-I implantation, n=20) and control groups (chemoradiotherapy, n=18). All patients underwent conventional three-dimensional conformal radiotherapy and TC chemotherapy. In the observation group, 125-I implantation was performed at 3 months after chemoradiotherapy. The short-term clinical efficacy, progression-free survival, overall survival and adverse events were statistically compared between two groups. Results The total effective rate in the observation group was 85%, significantly higher than 56% in the control group (P=0.046). Until May, 2018, the progression-free survival rates in the observation and control groups were 65% and 61%(P=0.457), the overall survival rates were 32% and 26%, and the median survival time was 22.8(95%CI: 20.5-23.5) and 21.3(95%CI: 15.9-26.0) months (P=0.633). The incidence rates of adverse events in the observation and control groups were 45% and 78%(P>0.05). Conclusions Concurrent chemoradiotherapy combined with radioactive 125-I implantation yields high short-term efficacy in the treatment of locally advanced non-small cell lung cancer. It can prolong the long-term survival to certain extent and yield a low incidence rate of severe adverse events, which deserves to be validated by large sample-size investigations. Key words: Lung neoplasm/concurrent chemoradiotherapy; Lung neoplasm/radioactive particle implantation; Treatment outcome

Multidisciplinary evaluation of locally advanced leiomyosarcoma in the lower rectum: a case report and literature review

Rectal leiomyosarcoma is a rare neoplasm, and no standard therapeutic strategy has been established, other than surgical resection. The prognosis of advanced leiomyosarcoma in the rectum is poor. We describe a case of a 47-year-old man with a locally advanced rectal leiomyosarcoma who presented with anal bleeding and lower abdominal pain. After discussions by a multidisciplinary team (MDT), the patient received preoperative pelvic short-course radiotherapy followed by laparoscopic-assisted abdominoperineal resection. Adjuvant chemotherapy with doxorubicin and ifosfamide was administered postoperatively. Local recurrence was detected 13 months after the resection. The patient received chemotherapy with gemcitabine and docetaxel followed by radioactive particle implantation. Thereafter, apatinib was administered to gain systemic control. The patient died 24 months after the diagnosis. This case report draws attention to treatment with multidisciplinary therapy, as discussed by MDT, for rare locally advanced rectal leiomyosarcoma.

Impact of prostate cancer radiotherapy on the biological behavior and specific mortality of subsequent bladder cancer.

The impact of different radiotherapy modalities on the development and characteristics of second primary bladder cancers (BCa) and BCa-specific mortality (BCa-SM) remains unclear. Thus, we evaluated the incidence and biological behavior of subsequent BCa and related survival in patients who underwent radiation therapy for prostate cancer (PCa). A total of 530,581 patients in the surveillance, epidemiology, and end results database with localized PCa between 1988 and 2013 were identified. PCa treatments included radical prostatectomy (RP), external beam radiotherapy (EBRT), radioactive implants (RI), and combined EBRT and RI (EBRI). A multivariable competing risk analysis based on a proportional sub distribution hazards model was used to determine the impact of different radiotherapy modalities on BCa incidence and specific mortality. Incidence of BCa was significantly high in patients treated with EBRT, RI, and EBRI vs. RP [sub distribution hazard ratio (SHR) 1.41, P < 0.001; SHR 1.58, P < 0.001; SHR 1.56, P < 0.001, respectively]. BCa following EBRT, RI, and EBRI were more commonly non-urothelial (3.3%, 2.9%, 3.3%, respectively, versus 1.2%) and T4 (3.5%, 6.1%, 5.0%, respectively, versus 1.6%) compared with RP. RI associated with a higher rate of BCa metastasis than RP (2.6% vs. 1.1%). Prior EBRT, RI, and EBRI increased BCa-SM (SHR 1.44, P = 0.001; SHR 1.21, P = 0.047; and SHR 1.42, P = 0.032, respectively). Patients receiving radiotherapy for PCa have a higher risk of BCa. BCa after EBRT, RI, and EBRI is more likely to be non-urothelial, stage T4, and with increased BCa-SM. Prior RI associated with a higher rate of BCa metastasis.

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

Non-surgical management of patients with intrahepatic cholangiocarcinoma in the United States, 2004-2015: an NCDB analysis.

Surgical resection is the standard of care for intrahepatic cholangiocarcinoma (ICC), but only a minority of patients are managed surgically. Other modalities, including external beam radiation (XRT), radiofrequency ablation (RFA), and radioactive implants (RIs) have been employed with significant heterogeneity of prognosis reported in the literature. The aim of this study was to evaluate the demographics of patients with ICC managed non-surgically and compare prognosis in patients managed surgically to those that underwent XRT, RFA, or RI. All patients diagnosed with ICC from 2004 to 2015 in the National Cancer Database (NCDB) were reviewed. Patient demographics, treatments, and survival outcomes were analyzed. Of the 6,140 patients with ICC, 4,374 (71%) did not undergo surgery. Patients managed non-surgically were typically older, treated at community centers, more likely to have severe fibrosis or cirrhosis, and present with higher stage disease. The strongest association to receipt of XRT, RI, or RFA modalities was treatment at an academic center. Increased clinical stage was associated with decreased use of RFA; a significantly higher proportion of patients with stage IV disease were given no local therapy. RFA associated with a statistically significant survival benefit over no local therapy only in stage I disease (2.1 vs. 0.7 years, P=0.012) as well as XRT over no local therapy (1.7 vs. 0.7 years, P=0.009). No survival benefit was realized for any treatment in stage II disease. Patients with stage III disease had a survival benefit from XRT versus no local therapy (0.9 vs. 0.6 years, P=0.029) and RI over no local therapy (1.2 vs. 0.6 years, P=0.013). Patients with stage IV disease only demonstrated survival benefit from RI over no local therapy (0.9 vs. 0.3 years, P=0.014). The majority of patients with ICC in the United States continue to be managed non-surgically. RFA was associated with improved survival only in stage I disease. XRT was associated with improved survival in stage I & III disease, while RI was associated with improved survival in stage III and IV disease.

Short-term efficacy of iodine-125 radioactive seed implantation therapy for hypoxic tumors

Objective To study the short-term efficacy of computed tomography (CT)-guided iodine-125(125I) radioactive seed implantation in the treatment of hypoxic tumors. Methods Twenty-two patients treated with 125I radioactive seed implantation in our department from 2014 to 2016 were divided into hypovascular tumor group (hypoxic group, n=12) and hypervascular tumor group (non-hypoxic group, n=10) based on the hemodynamics of solid tumor evaluated by color Doppler ultrasound. The enhanced CT images were loaded to the three-dimensional particle implantation planning system for preoperative planning. After 125I radioactive seed implantation, the D90 for target volume was verified to be 106-128 cGy. Treatment outcomes were evaluated according to the World Health Organization criteria at 1-3 months after surgery. Results In all the patients, the overall response rate was 82% at 3 months after surgery. There were no significant differences in response (complete response+ partial response) rates at 1, 2, or 3 months after surgery between the hypoxic group and the non-hypoxic group (P=0.840, 0.696, 0.840). Conclusions In the treatment of solid malignant tumor, 125I radioactive seed implantation can overcome the resistance of hypoxic tumor to radiotherapy in vitro and achieve satisfactory short-term efficacy. Key words: Iodine-125 radioactive seed; Hypoxic tumor; Short-term efficacy

The effectiveness of modified radical mastectomy combined with radioactive particle implantation in the treatment of patients with advanced breast cancer

Objective To explore the effectiveness of modified radical mastectomy combined with radioactive particle implantation in treating advanced breast cancer. Methods A total of 106 patients diagnosed with advanced breast cancer at our hospital from January 2012 to July 2014 were included in this study and were randomly divided into an intervention group (n=53), in which patients were treated with modified radical mastectomy combined with radioactive particle implantation, and a control group (n=53), in which patients received modified radical mastectomy alone.Rates of 1-and 3-year survival, over-1-year local control, disease recurrence, and post-treatment complications were recorded and compared between the two groups. Results There was no difference in 1-and 3-year survival rates between the two groups (both P>0.05). The over-1-year local control rate of cancer in the intervention group (92.5%) was higher than in the control group (77.4%) (χ2=4.7111, P=0.030). The disease recurrence rate within 1 year in the intervention group (9.4%) was lower than that in the control group (24.5%) (χ2=4.2828, P=0.0385). The rate of post-treatment complications in the intervention group (11.3%) was significantly lower than in the control group (26.4%) (χ2=3.9442, P=0.0470). Conclusions Radical mastectomy combined with radioactive particle implantation not only helps to improve the local control rate of patients with advanced breast cancer, but also significantly reduces the recurrence rate of disease and the incidence of complications. Key words: Mastectomy, modified radical; Breast cancer; Radioactive particle implantation

Clinical behaviors of rare variants of papillary thyroid carcinoma are associated with survival: a population-level analysis.

ObjectiveThis study was to evaluate the risk factors of survival in patients with columnar cell variant (CCV) and encapsulated variant (ECV).Materials and methodsThe Surveillance, Epidemiology, and End Results database (1988–2013) was used to compare the characteristics of CCV and ECV with those of classic papillary thyroid carcinoma (PTC). Survival was analyzed by the Kaplan–Meier method, the log-rank test, and Cox multivariate regression. Multivariate logistic regression was used to further analyze lymph node metastases and distant metastasis. There were 765 CCV, 529 ECV, and 39,035 PTC patients. ECV tumors were similar to PTC in terms of overall survival, disease-specific survival, age, sex, and distant metastasis.ResultsCompared with PTC, CCV tumors tended to be larger, with a higher incidence rate among males and in patients ≥65 years of age. CCV was associated with higher rates of extrathyroidal extension, multifocality, lymph node examinations, and lymph node and distant metastases (p<0.0001). Significant differences were found in 10-year overall survival (97.14% vs 89.15%, p<0.0001) and disease-specific survival (99.08% vs 93.07%, p<0.0001) between PTC and CCV. In CCV, distant metastasis (hazard ratio 5.125, p<0.0001) and lymph nodal metastasis (hazard ratio 2.152, p=0.032) predicted a poor prognosis. After adjustment, distant metastasis was independently associated with age ≥65 years, and lymph nodal metastasis was independently associated with female sex (odds ratio [OR] 0.341 [0.234–0.496]), extrathyroidal extension (OR 2.453 [1.368–4.397]), multifocality (OR 2.168 [1.318–3.569]), size >20 mm, ≤40 mm (OR 1.851 [1.170–2.928]), and size >40 mm (OR 1.847 [1.088–3.136]).ConclusionECV appears to have a similar prognosis to PTC, while CCV has a worse prognosis than classic PTC. Treatment with external beam radiotherapy and radioactive implants should be conducted carefully in patients with CCV.

Efficacy analysis of chemotherapy in combination with 125I seed implantation for treatment of inoperational pancoast tumor

Objective To explore the therapeutic effect of radioactive 125I seeds combined with chemotherapy on the treatment of inoperative pancoast tumor by CT-guided percutaneous implantation of treatment planning system (TPS). Methods From December 2002 to December 2010, 36 patients with pancoast tumor were confirmed by imaging and pathology. Among them, 26 cases suffered from squamous cell carcinoma and 10 cases with adenocarcinoma. At 1 week after radioactive 125I implantation, chemotherapy was administered as intravenous 1 000 mg / m2 gemcitabine at 1 and 8 d and intravenous cisplatin 75 mg / m2 at 1 d for 4 consecutive cycles. The prescribed dose (PD) was 120 Gy, and the median activity of the seeds was 0.7 mCi(2.59×107 Bq)with the range of 0.68-0.82 mCi (2.52×107-3.03×107 Bq). The patients were followed-up and the median follow-up time was 48 months. The survival rate was observed. Results The mPD of the target tumor was (118.7± 7.2) Gy, D90 (126± 4.7) Gy, D90> mPD. The rate of CR (11 cases) was 63.6%, and the effective rate (CR+ PR) was 83.4%. The follow-up last till December 1st, 2016. 1-, 3-and 5-year local control rates were 92%, 83%, and 67%, respectively. 1-, 3-and 5-year cumulative survival rate were 84.1%, 56.7%, and 36.8%, respectively. Median survival was 38 months. Conclusions Chemotherapy combined with tissue radioactive 125I seed implantation is a minimally invasive and effective method for the treatment of pancoast tumor. Key words: 125I; Brachytherapy; Pancoast tumor; Efficacy