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Xia MH, Liu KC, Zhao W, Cheng YZ, Shi LP, Bi LQ, Guo XR, Zhang MX, Lv WF. Efficacy and safety of chemotherapy combined with iodine-125 seed brachytherapy for intermediate and advanced oncogenic driver gene-negative non-small cell lung cancer. Brachytherapy 2025; 24:92-102. [PMID: 39818422 DOI: 10.1016/j.brachy.2024.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 07/09/2024] [Accepted: 09/06/2024] [Indexed: 01/18/2025]
Abstract
PURPOSE To compare the effectiveness and safety of CT-guided iodine-125 seed brachytherapy in conjunction with chemotherapy against chemotherapy alone for the management of intermediate and advanced non-small cell lung cancer (NSCLC) lacking oncogenic driving genes. METHODS AND MATERIALS Retrospective analysis was conducted on clinical data from 128 patients diagnosed with intermediate and advanced non-small cell lung cancer who received iodine-125 combined with chemotherapy or chemotherapy alone due to the absence of oncogenic driver gene mutations. The patients in two groups were compared at 6-month follow-up for objective remission rate (ORR), Disease control rate (DCR), local progression-free survival (LPFS), overall survival (OS), clinical symptom improvement, and adverse events. RESULTS A median of 47 (range, 16-100) iodine-125 seeds were implanted. The median D90 was 139.4 Gy. In patients with stage III NSCLC, the 6-month ORR were 40.0% and 8.0% in two groups, while those with stage IV NSCLC had rates of 20.9% and 4.0%. No significant issues arose during the 5-58 months follow-up period. OS did not significantly differ between stage III and IV NSCLC patients. The LPFS for stage III patients was 14 months and 9 months, compared to 8 months and 7 months for stage IV patients. Symptom improvement rates, including cough, chest discomfort, hemoptysis, and chest constriction, were 87.2% versus 20.4%, 77.8% versus 33.3%, and 77.8% versus 26.1%, respectively. CONCLUSIONS CT-guided iodine-125 seed implantation with chemotherapy failed to improve OS in stages III and IV NSCLC. However, it did extend the LPFS of stage III NSCLC. Furthermore, the ORR was much higher than that of the chemotherapy-only group, and lung cancer clinical symptoms were significantly reduced, improving patient quality of life.
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Affiliation(s)
- Meng-Hua Xia
- Department of Nuclear Medicine, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of life Sciences and Medicine, University of Science and Technology, Hefei, Anhui, 230031, PR China
| | - Kai-Cai Liu
- Infection Hospital, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of life Sciences and Medicine, University of Science and Technology, Hefei 230000, PR China
| | - Wei Zhao
- Department of Nuclear Medicine, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of life Sciences and Medicine, University of Science and Technology, Hefei, Anhui, 230031, PR China
| | - Yi-Zhuang Cheng
- Department of Nuclear Medicine, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of life Sciences and Medicine, University of Science and Technology, Hefei, Anhui, 230031, PR China
| | - Liang-Ping Shi
- Department of Nuclear Medicine, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of life Sciences and Medicine, University of Science and Technology, Hefei, Anhui, 230031, PR China
| | - Li-Qin Bi
- Department of Nuclear Medicine, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of life Sciences and Medicine, University of Science and Technology, Hefei, Anhui, 230031, PR China
| | - Xue-Ran Guo
- Department of Nuclear Medicine, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of life Sciences and Medicine, University of Science and Technology, Hefei, Anhui, 230031, PR China
| | - Meng-Xia Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of life Sciences and Medicine, University of Science and Technology, Hefei, Anhui, 230031, PR China
| | - Wei-Fu Lv
- Department of Radiology, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of life Sciences and Medicine, University of Science and Technology, Hefei, Anhui 230022, PR China.
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Wang X, Song J, Hu L, Ren G, Geng N, Song Z. Intrapleural perfusion hyperthermia improves the efficiency of anti‑PD1 antibody‑based therapy for lung adenocarcinoma: A case report. Oncol Lett 2024; 27:217. [PMID: 38586203 PMCID: PMC10995656 DOI: 10.3892/ol.2024.14351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/12/2024] [Indexed: 04/09/2024] Open
Abstract
Chemotherapy based on intrapleural perfusion hyperthermia (IPH) can markedly improve the sensitivity of lung adenocarcinoma cells to anti-programmed cell death receptor 1 (PD1) antibody adjuvant chemotherapy and enhance the clinical response of a patient. In the present study, a unique case of a patient who failed to respond to immunotherapy combined with chemotherapy but achieved prolonged stable disease after treatment with IPH and subsequent sintilimab-based treatment, is reported. A 50-year-old Chinese female patient was admitted to a regional cancer hospital presenting with hemoptysis and persistent fever. The findings of computed tomography imaging and thoracic puncture tissue biopsy indicated a diagnosis of adenocarcinoma. The TNM and clinical stage were identified as cT2N3M0 and stage IIIB, respectively. Immunohistochemical tests showed the expression of programmed death-ligand 1 (PD-L1) with a tumor proportion score of 2%. No other classic genetic alterations were detected. Initially, sintilimab-based chemotherapy at 200 mg was administered, for three cycles from April 2020, and increased pleural effusion was observed on the left side. The best overall response (BOR) assessment of the local lesion was progressive disease. IPH combined with chemotherapy was then carried out from August to September 2020, after which the same course of sintilimab-based chemotherapy as aforementioned was provided from October 2020 to September 2023. The BOR evaluation results during the monotherapy courses were all judged as stable disease. Therefore, it was concluded that IPH can substantially improve the efficiency of anti-PD1 antibody-based therapy for lung adenocarcinoma.
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Affiliation(s)
- Xiaolei Wang
- Department of Medical Oncology, Affiliated Hospital of Hebei University, Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Baoding, Hebei 071000, P.R. China
| | - Jin Song
- Department of Medical Oncology, Affiliated Hospital of Hebei University, Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Baoding, Hebei 071000, P.R. China
| | - Ling Hu
- Department of Medical Oncology, Affiliated Hospital of Hebei University, Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Baoding, Hebei 071000, P.R. China
| | - Guanying Ren
- Department of Medical Oncology, Affiliated Hospital of Hebei University, Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Baoding, Hebei 071000, P.R. China
| | - Nan Geng
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Zizheng Song
- Department of Medical Oncology, Affiliated Hospital of Hebei University, Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Baoding, Hebei 071000, P.R. China
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Hu P, Huang J, Zhang Y, Guo H, Chen G, Zhang F. Iodine-125 seed implantation in the treatment of malignant tumors. J Interv Med 2023; 6:111-115. [PMID: 37846333 PMCID: PMC10577067 DOI: 10.1016/j.jimed.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 10/18/2023] Open
Abstract
Malignant tumors are major causes of morbidity and mortality in China. Despite advances in surgical, radiological, chemotherapeutic, molecular targeting, and immunotherapeutic treatments, patients with malignant tumors still have poor prognoses. Low-dose-rate brachytherapy, specifically 125I seed implantation, is beneficial because of its high local delivery dose and minimal damage to surrounding tissues. Consequently, it has gained increasing acceptance as a treatment modality for various malignant tumors. In this study, we explored the fundamental principles, clinical applications, and new technologies associated with 125I radioactive seed implantation.
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Affiliation(s)
- Pan Hu
- Department of Minimally Invasive & Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People’s Republic of China
| | - Jianwen Huang
- Department of Intervention, Zhuhai People’s Hospital, Zhuhai, Guangdong, 519000, People’s Republic of China
| | - Yanling Zhang
- School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
| | - Huanqing Guo
- Department of Minimally Invasive & Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People’s Republic of China
| | - Guanyu Chen
- Department of Minimally Invasive & Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People’s Republic of China
| | - Fujun Zhang
- Department of Minimally Invasive & Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People’s Republic of China
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Chen ZH, Zhang YL, Yuan B, Chen WJ, Lei GY, Han L. 125I seed implantation enhances arsenic trioxide-induced apoptosis and anti-angiogenesis in lung cancer xenograft mice. Clin Transl Oncol 2023:10.1007/s12094-023-03092-x. [PMID: 36723786 DOI: 10.1007/s12094-023-03092-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/17/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Arsenic trioxide (ATO) exerts anticancer effects on lung cancer. However, the clinical use of ATO is limited due to its systemic toxicity and resistance of lung cancer cells. The present study aimed to investigate the effects of ATO, alone and in combination with 125I seed implantation on tumor growth and proliferation in lung cancer xenograft mice, and investigate the possible molecular mechanisms. METHODS The transmission electron microscope observed the tumor ultrastructure of lung cancer xenograft mice. The proliferation index of Ki-67 and the number and morphology of tumor microvessels were detected with immunohistochemical staining. The protein and mRNA expression were examined by western blot and real-time PCR assay. RESULTS The in vivo results demonstrated that ATO combined with 125I seed significantly inhibited tumor growth and proliferation, as well as promoted apoptosis, and decreased the Ki-67 index and microvessel density in lung cancer xenograft mice. Moreover, ATO combined with 125I seed decreased the protein and mRNA expression levels of HIF-1α, VEGF, and BCL-2, and increased those of BAX and P53. CONCLUSIONS ATO combined with 125I seed significantly inhibited tumor growth and proliferation in lung cancer, which may be accomplished by inhibiting tumor angiogenesis and inducing apoptosis.
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Affiliation(s)
- Zheng-Hong Chen
- Tumor Hospital of Shaanxi Province, Affiliated to the Medical College of Xi'an Jiaotong University, 309 Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Yi-Li Zhang
- Tumor Hospital of Shaanxi Province, Affiliated to the Medical College of Xi'an Jiaotong University, 309 Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Bin Yuan
- Tumor Hospital of Shaanxi Province, Affiliated to the Medical College of Xi'an Jiaotong University, 309 Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Wen-Juan Chen
- Tumor Hospital of Shaanxi Province, Affiliated to the Medical College of Xi'an Jiaotong University, 309 Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Guang-Yan Lei
- Department of Thoracic Surgery and Seed Therapy Center, Tumor Hospital of Shaanxi Province, Affiliated to the Medical College of Xi'an Jiaotong University, 309 Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China.
| | - Le Han
- Department of Thoracic Surgery and Seed Therapy Center, Tumor Hospital of Shaanxi Province, Affiliated to the Medical College of Xi'an Jiaotong University, 309 Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China.
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Wei S, Li C, Li M, Xiong Y, Jiang Y, Sun H, Qiu B, Lin CJ, Wang J. Radioactive Iodine-125 in Tumor Therapy: Advances and Future Directions. Front Oncol 2021; 11:717180. [PMID: 34660280 PMCID: PMC8514864 DOI: 10.3389/fonc.2021.717180] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022] Open
Abstract
Radioactive iodine-125 (I-125) is the most widely used radioactive sealed source for interstitial permanent brachytherapy (BT). BT has the exceptional ability to deliver extremely high doses that external beam radiotherapy (EBRT) could never achieve within treated lesions, with the added benefit that doses drop off rapidly outside the target lesion by minimizing the exposure of uninvolved surrounding normal tissue. Spurred by multiple biological and technological advances, BT application has experienced substantial alteration over the past few decades. The procedure of I-125 radioactive seed implantation evolved from ultrasound guidance to computed tomography guidance. Compellingly, the creative introduction of 3D-printed individual templates, BT treatment planning systems, and artificial intelligence navigator systems remarkably increased the accuracy of I-125 BT and individualized I-125 ablative radiotherapy. Of note, utilizing I-125 to treat carcinoma in hollow cavity organs was enabled by the utility of self-expandable metal stents (SEMSs). Initially, I-125 BT was only used in the treatment of rare tumors. However, an increasing number of clinical trials upheld the efficacy and safety of I-125 BT in almost all tumors. Therefore, this study aims to summarize the recent advances of I-125 BT in cancer therapy, which cover experimental research to clinical investigations, including the development of novel techniques. This review also raises unanswered questions that may prompt future clinical trials and experimental work.
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Affiliation(s)
- Shuhua Wei
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Chunxiao Li
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Mengyuan Li
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Yan Xiong
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Bin Qiu
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | | | - Junjie Wang
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
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Xiang Z, Zhong Z, Mu L, Li G, Zhou C, Wang H, Huang M. The Clinical Value of Computed Tomography (CT)-Guided 125I Brachytherapy for Locally Advanced Non-Small Cell Lung Cancer After Progression of Concurrent Radiochemotherapy. Cancer Manag Res 2021; 13:5297-5307. [PMID: 34262339 PMCID: PMC8275038 DOI: 10.2147/cmar.s313438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/12/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose To further evaluate the efficacy and safety of computed tomography (CT)-guided iodine 125 (125I) brachytherapy to treat locally advanced non-small cell lung cancer (NSCLC) after progression of concurrent radiochemotherapy (CCRT). Methods This study obtained written consent from all patients and was approved by our institution. From January 2006 to June 2018, 210 NSCLC patients (progression of first-line CCRT) were retrospectively recruited and then divided into two groups. A total of 116 patients were given CT-guided 125I brachytherapy and second-line chemotherapy (group A), and 94 were treated with second-line chemotherapy alone (group B). Results In group A, local response rate (LRR) within 3 years was significantly better (P<0.05). Mean survival time [progression-free survival time (PFST) and overall survival (OS)] was 15.1±1.4 months and 21.2±1.6 months in group A compared with 10.0±1.4 months and 16.2±1.7 months in group B (PFST: P<0.01, HR=1.472, 95% CI 1.097–1.975; OS: P = 0.036, HR=1.342, 95% CI 1.005–1.791). Tumor size and No. of first cycle chemotherapy were independent factors that affected survival, ≤3cm largest tumor diameter and more than 4 first cycles of chemotherapy showed longer PFST and OS (P<0.05). Tumor-related clinical symptoms were relieved in group A (P<0.01). No serious complications occurred in the two groups. Conclusion 125I brachytherapy is effective and safe in locally advanced NSCLC after progression of CCRT.
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Affiliation(s)
- Zhanwang Xiang
- Interventional Radiology Program, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, People's Republic of China; Guangdong Provincial Key Lab of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, People's Republic of China
| | - Zhihui Zhong
- Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Luwen Mu
- Interventional Radiology Program, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, People's Republic of China; Guangdong Provincial Key Lab of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, People's Republic of China
| | - Guohong Li
- Department of Radiology, Guangdong Second Provincial General Hospital, Guangdong Provincial Emergency Hospital, Guangzhou, 510000, People's Republic of China
| | - Churen Zhou
- Interventional Radiology Program, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, People's Republic of China; Guangdong Provincial Key Lab of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, People's Republic of China
| | - Haofan Wang
- Interventional Radiology Program, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, People's Republic of China; Guangdong Provincial Key Lab of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, People's Republic of China
| | - Mingsheng Huang
- Interventional Radiology Program, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, People's Republic of China; Guangdong Provincial Key Lab of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, People's Republic of China
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Yue TH, Xing W. 125I Seed Brachytherapy Combined with Single-Agent Chemotherapy in the Treatment of Non-Small-Cell Lung Cancer in the Elderly: A Valuable Solution. Onco Targets Ther 2020; 13:10581-10591. [PMID: 33116636 PMCID: PMC7584506 DOI: 10.2147/ott.s272898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose The aim of this study was to compare the effectiveness and safety of CT-guided 125I seed brachytherapy combined with single-agent chemotherapy versus combined chemotherapy in the treatment of elderly NSCLC. Materials and Methods We retrospectively analyzed 110 patients (64 men and 46 women; mean age=71.25±7.14 years) who were diagnosed with NSCLC without distant metastases between January 2015 and May 2020. A total of 50 patients received 125I brachytherapy combined with single-agent chemotherapy (group A), whereas 60 patients received combined chemotherapy (group B). The response to therapy and adverse effect were compared between groups. The local response rate was evaluated by CT. Progression-free survival (PFS) and overall survival (OS) data were obtained through clinical follow-up. Results All patients had been treated and were followed-up for 3-60 months. The median OS and PFS were 23.71±1.41 months (95% CI=20.95-26.47) vs 16.12±0.93 months (95% CI=14.31-17.93) (P<0.05) and 15.08±0.85 months (95% CI=13.42-16.74) vs 10.03±0.53 months (95% CI=9.01-11.06) (P<0.05) in group A and group B, respectively. The local response rate and clinical symptoms of patients in group A were significantly relieved when compared with group B. Severe complications were not observed in either group. Conclusion CT-guided 125I seed brachytherapy combined with single-agent chemotherapy is an effective and safe therapy and shows promising results compared to combined chemotherapy alone for NSCLC in the elderly. A randomized study will be needed to assess the superiority of this combined modality treatment.
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Affiliation(s)
- Tian-Hua Yue
- Medical Imaging Department, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213000, People's Republic of China.,Department of Interventional Radiology, The Affiliated Jianhu Hospital of Nantong University, Jiangsu, Jianhu 224700, People's Republic of China
| | - Wei Xing
- Medical Imaging Department, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213000, People's Republic of China
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Yang DY, Lin YP, Xue C, Fan JM, Wang Y, Cai C, Song DH, Zeng YM. CT-guided percutaneous implantation of 125I particles in treatment of early lung cancer. J Thorac Dis 2020; 12:5996-6009. [PMID: 33209432 PMCID: PMC7656391 DOI: 10.21037/jtd-20-2666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background To analyze the efficacy of computed tomography (CT)-guided implantation of 125I radioactive particles in treatment of early lung cancer. Methods Six 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). Results There 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. Conclusions The preliminary clinical observation showed that 125I radioactive particle implantation was a safe, reliable and effective therapeutic method for early lung cancer.
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Affiliation(s)
- Dong-Yong Yang
- Respiratory Medicine Center of Fujian Province, Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yan-Ping Lin
- Intensive Care Unit, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Cheng Xue
- Respiratory Medicine Center of Fujian Province, Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Ji-Min Fan
- Respiratory Medicine Center of Fujian Province, Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yi Wang
- CT Examination Room, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Chi Cai
- CT Examination Room, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Duan-Hong Song
- Respiratory Medicine Center of Fujian Province, Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yi-Ming Zeng
- Respiratory Medicine Center of Fujian Province, Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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Wu H, Li L, Yang J, Yang ZM. Radioactive seeds insertion with chemotherapy for advanced non-small-cell lung cancer: A meta-analysis. CLINICAL RESPIRATORY JOURNAL 2020; 15:187-195. [PMID: 32981198 DOI: 10.1111/crj.13283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/08/2020] [Accepted: 09/21/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Non-small-cell lung cancers (NSCLCs) are only eligible to undergo curative surgical resection in <20% of patients. In patients with inoperable NSCLC, computed tomography (CT)-guided radioactive seed insertion (RSI) is a common treatment practice. OBJECTIVES To assess the relative efficacy of chemotherapy alone versus chemotherapy in combination with CT-guided RSI in patients with advanced NSCLC. METHODS We searched the Pubmed, Embase, and Cochrane Library databases for relevant articles published as of July 2020. Complete and total response rates (CR and TR, respectively) served as the primary endpoints for this meta-analysis, with disease control (DC) rate, myelosuppression rate, progression-free survival (PFS), overall survival (OS), and CT-guided RSI-related pneumothorax serving as secondary endpoints. RESULTS In total, eight studies incorporating 281 patients that underwent combination treatment and 297 patients that underwent chemotherapy along were included in this meta-analysis. The CR (21.5% vs. 4.0%, P < 0.00001), TR (73.8% vs. 42.6%, P < 0.00001), and DC (94.1% vs. 78.2%, P < 0.00001) rates were significantly higher for patients in the combined treatment group relative to patients in the chemotherapy only group. Furthermore, pooled PFS (P < 0.00001) and OS (P = 0.0006) were significantly longer for patients in the combined treatment group, whereas no differences in pooled myelosuppression rates were observed between groups (34.3% vs. 30.7%, P = 0.47). The pooled rate of CT-guided RSI-related pneumothorax was 15%. CONCLUSIONS Combination chemotherapy and CT-guided RSI can significantly improve clinical response and prolong survival in advanced-stage NSCLC patients without inducing other significant toxic side effects.
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Affiliation(s)
- Hong Wu
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, China
| | - Lei Li
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, China
| | - Jing Yang
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, China
| | - Zhi-Min Yang
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, China
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Implantation of 125I radioactive seeds via c-TBNA combined with chemotherapy in an advanced non-small-cell lung carcinoma patient. BMC Pulm Med 2019; 19:205. [PMID: 31703663 PMCID: PMC6842247 DOI: 10.1186/s12890-019-0974-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/28/2019] [Indexed: 01/03/2023] Open
Abstract
Background The 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 presentation A 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. Conclusion We 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.
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Jin F, Li Q, Bai C, Wang H, Li S, Song Y, Zeng Y, Zhou R, Li W, Hu C, Zhang J, Zhou H, Zhang H. Chinese Expert Recommendation for Diagnosis and Treatment of Massive Hemoptysis. Respiration 2019; 99:83-92. [PMID: 31509823 DOI: 10.1159/000502156] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 07/16/2019] [Indexed: 11/19/2022] Open
Abstract
Massive hemoptysis is one of emergency and critical diseases of the respiratory system. The definition of massive hemoptysis has always been different in the literature, which often depends on the quantitative estimation of the amount of hemoptysis, such as the amount of hemoptysis being in the range of 300-600 mL within 24 h, or hemoptysis more than 3 times within 1 week. Each amount of hemoptysis that is greater than 100 mL can be considered as massive hemoptysis, but the amount of hemoptysis is difficult to accurately estimate. Therefore, massive hemoptysis can be defined as any life-threatening hemoptysis and any hemoptysis that may cause airway obstruction and asphyxia. Massive hemoptysis accounts for approximately 5% of all hemoptysis cases and usually indicates the presence of a potentially severe respiratory or systemic disease. The mortality rate of massive hemoptysis is about 6.5-38%. The cause of death is generally shock caused by airway obstruction or excessive bleeding, and asphyxia is the main cause of death. At present, due to insufficient understanding of massive hemoptysis, there are limited technical means in the etiological diagnosis and untimely or improper treatment, resulting in high mortality of massive hemoptysis. Therefore, the diagnosis and treatment of massive hemoptysis needs to be standardized.
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Affiliation(s)
- Faguang Jin
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, China,
| | - Qiang Li
- Department of Respiratory and Critical Care Medicine, Dongfang Hospital, Tongji University, Shanghai, China
| | - Chong Bai
- Department of Respiratory Medicine, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hongwu Wang
- Department of Respiratory Medicine, Meitan General Hospital, Beijing, China
| | - Shiyue Li
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Yiming Zeng
- Department of Respiratory Pulmonary and Critical Care Medicine, The Second Hospital of Fujian Medical University, Quanzhou, China
| | - Rui Zhou
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wangping Li
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Chengping Hu
- Department of Respiration, Central South University Xiangya Hospital, Changsha, China
| | - Jie Zhang
- Department of Respiration, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongmei Zhou
- Department of Respiration, Affiliated Zhongshan Hospital of Guangdong Medical University, Guangzhou, China
| | - Haitao Zhang
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, China
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Li C, Wang J, Shao JB, Zhu LM, Sun ZG, Zhang N. Microwave ablation combined with chemotherapy improved progression free survival of IV stage lung adenocarcinoma patients compared with chemotherapy alone. Thorac Cancer 2019; 10:1628-1635. [PMID: 31243894 PMCID: PMC6610256 DOI: 10.1111/1759-7714.13129] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 12/30/2022] Open
Abstract
Background Microwave ablation (MWA) has recently become an established treatment option for topical therapy of lung cancer patients. In this study, we evaluated whether MWA combined with chemotherapy could improve progression‐free survival (PFS) of patients with stage IV lung adenocarcinoma compared with chemotherapy alone. Methods A total of 49 patients were enrolled into the study; 21 patients accepted MWA therapy combined with chemotherapy, 28 patients accepted only chemotherapy. Enumeration data were analyzed using χ2 test or Fisher's exact probability test and univariate analysis was analyzed using Kaplan–Meier survival curves. Multivariate analysis was carried out with the Cox proportional hazard model. Results The treatment regimen was not correlated with clinical features of the patients, which included gender, age, smoking history, tumor site, tumor size and Eastern Cooperative Oncology Group (ECOG). The patients’ 3‐year overall survival (OS) was 12.5%, and median survival time was 19.3 months. The median PFS was 6.1 months and the 1‐year PFS was 0.0%. The PFS was significantly associated with tumor size (P < 0.05), ECOG (P < 0.01) and treatment regimen (P < 0.01). The median time to local progression (TTLP) was 8.4 months and the 3‐year TTLP was 2.0%. The TTLP was significantly associated with tumor size (P < 0.05) and treatment regimen (P < 0.01). Cox multivariate regression demonstrated that MWA combined with chemotherapy was the independent factor for both the PFS and TTLP. Conclusion MWA, as a topical treatment method, when combined with chemotherapy improved the PFS and TTLP of patients with stage IV lung adenocarcinoma.
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Affiliation(s)
- Chunhai Li
- Department of Radiology, Qilu Hospital of Shandong University, Shandong Province, Jinan 250012, P.R. China
| | - Jie Wang
- Department of General Surgery, Jinan Central Hospital Affiliated to Shandong University, Shandong Province, Jinan 250013, P.R. China
| | - Jing-Bo Shao
- Department of Thoracic Surgery, Jinan Central Hospital Affiliated to Shandong University, Shandong Province, Jinan 250013, P.R. China
| | - Liang-Ming Zhu
- Department of Thoracic Surgery, Jinan Central Hospital Affiliated to Shandong University, Shandong Province, Jinan 250013, P.R. China
| | - Zhi-Gang Sun
- Department of Thoracic Surgery, Jinan Central Hospital Affiliated to Shandong University, Shandong Province, Jinan 250013, P.R. China
| | - Nan Zhang
- Department of Oncology, Jinan Central Hospital Affiliated to Shandong University, Shandong Province, Jinan 250013, P.R. China
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Zhang W, Li J, Li R, Zhang Y, Han M, Ma W. Efficacy and safety of iodine-125 radioactive seeds brachytherapy for advanced non–small cell lung cancer—A meta-analysis. Brachytherapy 2018; 17:439-448. [DOI: 10.1016/j.brachy.2017.11.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/23/2017] [Accepted: 11/24/2017] [Indexed: 12/18/2022]
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Lin J, Yang W, Jiang N, Zheng Q, Huang J, Huang N, Li A, Jiang H. Incidence and prediction of seed migration to the chest after iodine-125 brachytherapy for hepatocellular carcinoma. Brachytherapy 2017; 16:1252-1256. [DOI: 10.1016/j.brachy.2017.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/30/2017] [Accepted: 07/11/2017] [Indexed: 01/09/2023]
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Mao Y, Yang X, Li M, Guo W, Zhang W. Treating cancerous large airway stenosis with staging radioactive particle implantation guided by computed tomography and fiber bronchoscopy: a clinical study. World J Surg Oncol 2017; 15:149. [PMID: 28774331 PMCID: PMC5543595 DOI: 10.1186/s12957-017-1216-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 07/25/2017] [Indexed: 01/19/2023] Open
Abstract
Background The purpose of this study is to investigate the clinical effectiveness of staging radioactive particle implantation guided by computed tomography (CT) and fiber–optic bronchoscopy in treating cancerous large airway stenosis. Methods A total of 102 patients were included; 57 had undergone staging radioactive particle implantation guided by CT and fiber bronchoscopy and 45 did not. Patients were evaluated by CT and fiber–optic bronchoscopy to determine the feasibility of the implantation of radioactive seeds for the treatment of cancerous large airway stenosis. The treatment planning system (TPS) was used to plan the doses. Radioactive seeds were implanted using fiber–optic bronchoscopy. One week later, CT-guided implantation of radioactive seeds was performed. Results The clinical evaluation showed complete, partial, slight, and non-response in 38, 14, 5, and 0 patients, respectively. None of the patients were found with serious complications. The diameter of the affected airway, Karnofsky score, dyspnea index, survival, and quality of life of the patients in both groups was significantly higher and significantly different after the treatment (P < 0.05). The dyspnea index was significantly lower in the treatment group as compared with the control group (P < 0.001). Conclusion CT- and fiber bronchoscopy-guided staging radioactive particle implantation has definite treatment effectiveness in treating cancerous large airway stenosis. It should be widely used in clinical practices.
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Affiliation(s)
- Yu Mao
- Department of Thoracic Surgery, The First People's Hospital of Hohhot, Hohhot, Inner Mongolia, 010020, China.
| | - Xiuyan Yang
- Department of Thoracic Surgery, The First People's Hospital of Hohhot, Hohhot, Inner Mongolia, 010020, China
| | - Ming Li
- Department of Thoracic Surgery, The First People's Hospital of Hohhot, Hohhot, Inner Mongolia, 010020, China
| | - Wei Guo
- Department of Thoracic Surgery, The First People's Hospital of Hohhot, Hohhot, Inner Mongolia, 010020, China
| | - Wenhua Zhang
- Department of Thoracic Surgery, The First People's Hospital of Hohhot, Hohhot, Inner Mongolia, 010020, China
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Wang Y, Guo JH, Zhu GY, Zhu HD, Chen L, Lu J, Wang C, Teng GJ. A Novel Self-Expandable, Radioactive Airway Stent Loaded with 125I Seeds: A Feasibility and Safety Study in Healthy Beagle Dog. Cardiovasc Intervent Radiol 2017; 40:1086-1093. [DOI: 10.1007/s00270-017-1639-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/22/2017] [Indexed: 12/11/2022]
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Song J, Fan X, Zhao Z, Chen M, Chen W, Wu F, Zhang D, Chen L, Tu J, Ji J. 125I brachytherapy of locally advanced non-small-cell lung cancer after one cycle of first-line chemotherapy: a comparison with best supportive care. Onco Targets Ther 2017; 10:1345-1352. [PMID: 28280369 PMCID: PMC5338930 DOI: 10.2147/ott.s129903] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The objective of this study was to assess the efficacy of computed tomography (CT)-guided 125I brachytherapy alone in improving the survival and quality of life of patients with unresectable locally advanced non-small-cell lung cancer (NSCLC) after one cycle of first-line chemotherapy. PATIENTS AND METHODS Sixteen patients with locally advanced NSCLC were treated with CT-guided 125I brachytherapy after one cycle of first-line chemotherapy (group A). Sixteen patients who received only best supportive care (group B) were matched up with the patients in group A. Primary end point included survival, and secondary end point included assessment of safety, effectiveness of CT-guided 125I brachytherapy, and improvement in the quality of life. RESULTS The two groups were well balanced in terms of age, disease histology, tumor stage, tumor location, and performance status (P>0.05). The median follow-up time was 16 months (range, 3-30). The total tumor response rate was 75.0% in group A, which was significantly higher than that in group B (0.0%) (P<0.01). The median progression-free survival time was 4.80 months for patients in group A and 1.35 months for patients in group B (P<0.001). Kaplan-Meier survival analysis showed that the median survival time of group A was 9.4±0.3 months versus 8.4±0.1 months in group B (P=0.013). Tumor-related symptoms of patients were significantly relieved, and the quality of life was markedly improved in group A than in group B. CONCLUSION CT-guided 125I brachytherapy improved the survival of patients with locally advanced NSCLC and quality of life after one cycle of first-line chemotherapy compared with best supportive care.
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Affiliation(s)
- Jingjing Song
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China
| | - Xiaoxi Fan
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China
| | - Zhongwei Zhao
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China
| | - Minjiang Chen
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China
| | - Weiqian Chen
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China
| | - Fazong Wu
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China
| | - Dengke Zhang
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China
| | - Li Chen
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China
| | - Jianfei Tu
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China
| | - Jiansong Ji
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China
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CT-guided 125I brachytherapy in the treatment of distant metastases in the oral cavity and maxillofacial region. Transl Oncol 2016; 10:90-98. [PMID: 27992832 PMCID: PMC5175989 DOI: 10.1016/j.tranon.2016.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We aimed to evaluate the feasibility and clinical effectiveness of CT-guided 125I brachytherapy for distant oral and maxillofacial metastases. MATERIALS AND METHODS We retrospectively analyzed 65 patients with 84 distant oral and maxillofacial metastases. Thirty-one patients with 38 lesions received 125I brachytherapy (group A) and 34 with 46 lesions received external beam radiotherapy (EBRT; group B). RESULTS Median follow-up time was 16 months. The 3-, 6-, 12-, 18-, and 24-month local control rates for group A were 83.9%, 75.9%, 66.7%, 38.4%, and 25.0%, respectively; for group B they were 76.5%, 62.5%, 43.8%, 25.0%, and 0.0%, respectively (P<.05); the median local tumor progression-free survival times were 14 and 9 months, respectively. Group A had a better local tumor progression-free survival (LTPFS) relative to group B (P<.001; HR, 6.961 [95%CI, 2.109, 9.356]). Cox proportional hazards regression analysis indicated that 125I brachytherapy, tumor size, and primary pathological type were the independent factors affecting LTPFS. Additionally, 125I brachytherapy showed better performance in relieving patient clinical symptoms relative to EBRT (P<.05). Group A also had fewer complications than group B, especially regarding grade 3/4 complications according to Radiation Therapy Oncology Group grading criteria. Mean overall survival times in groups A and B were 17.1 and 14.8 months, respectively. CONCLUSION CT-guided 125I brachytherapy is feasible and safe for distant oral and maxillofacial metastases; it achieved a better local control rate, longer LTPFS and fewer complications without compromising overall survival compared with EBRT.
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Li W, Dan G, Jiang J, Zheng Y, Zheng X, Deng D. Repeated iodine-125 seed implantations combined with external beam radiotherapy for the treatment of locally recurrent or metastatic stage III/IV non-small cell lung cancer: a retrospective study. Radiat Oncol 2016; 11:119. [PMID: 27623620 PMCID: PMC5022153 DOI: 10.1186/s13014-016-0688-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/19/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Recurrent or metastatic lung cancer is difficult to manage. This retrospective study aimed to assess the efficacy of repeated iodine-125 seed implantations combined with external beam radiotherapy (EBRT) for locally recurrent or metastatic stage-III/IV non-small cell lung cancer (NSCLC). METHODS Eighteen previously treated stage-III/IV NSCLC patients with local or metastatic recurrences underwent 1-to-3 iodine-125 implantations. Six of these patients received palliative EBRT and six patients received combined chemotherapy using gemcitabine and cisplatin. Near-term treatment efficacy was evaluated 3 months after seed implantation by comparing changes in tumor size on computed tomography images; the evaluated outcomes were complete response, partial response, stable disease, and local tumor control rate. Long-term efficacy was assessed based on 1- and 2-year survival rates. RESULTS Patients were followed up for 6 to 50 months. The overall (i.e., complete + partial) response rate was 87.4 %. The local control rates after the first, second, and third years were 94.1, 58.8 and 41.2 %, respectively. CONCLUSIONS The results of this study demonstrated that repeated implantation of radioactive particles combined with EBRT is a safe treatment that effectively controlled local recurrence and metastasis of stage III/IV NSCLC.
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Affiliation(s)
- Wei Li
- Department of Thoracic Surgery, PLA Chengdu Military General Hospital, Chengdu, 610083 People’s Republic of China
| | - Gang Dan
- Department of Thoracic Surgery, PLA Chengdu Military General Hospital, Chengdu, 610083 People’s Republic of China
| | - Jianqing Jiang
- Department of Thoracic Surgery, PLA Chengdu Military General Hospital, Chengdu, 610083 People’s Republic of China
| | - Yifeng Zheng
- Department of Thoracic Surgery, PLA Chengdu Military General Hospital, Chengdu, 610083 People’s Republic of China
| | - Xiushan Zheng
- Department of Thoracic Surgery, PLA Chengdu Military General Hospital, Chengdu, 610083 People’s Republic of China
| | - Dan Deng
- Department of Thoracic Surgery, PLA Chengdu Military General Hospital, Chengdu, 610083 People’s Republic of China
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Liu J, Wang W, Zhao X, Shen Z, Shao W, Wang X, Li L, Wang B. The value of spectral imaging to reduce artefacts in the body after 125 I seed implantation. J Med Imaging Radiat Oncol 2016; 60:643-649. [PMID: 27612002 DOI: 10.1111/1754-9485.12504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 07/07/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To explore the value of gemstone spectral imaging (GSI) and metal artefact reduction sequence (MARs) to reduce the artefacts of metal seeds. METHODS Thirty-five patients with 125 I seed implantation in their abdomens underwent GSI CT. Six types of monochromatic images and the corresponding MARs images at 60-110 keV (interval of 10 keV) were reconstructed. The differences in the quality of the images of three imaging methods were subjectively assessed by three radiologists. Length of artefacts, the CT value and noise value of tissue adjacent to 125 I seeds, contrast-to-noise ratio (CNR), and artefact index (AI) were recorded. RESULTS The differences in subjective scoring were statistically significant (t = 10.87, P < 0.001). Images at 70 keV showed the best CNR (0.84 ± 0.17) of tissues adjacent to 125 I seeds, and received the highest subjective score (2.82 ± 0.18). Images at 80 keV had the lowest AI (70.67 ± 19.17). Images at 110 keV had the shortest artefact lengths. High-density metal artefacts in the MARs spectral images were reduced. The length of metal artefacts in images at 110 keV was shorter than that of the polychromatic images and MARs spectral images (t = 3.35, 3.89, P < 0.05). The difference in CNR between MARs spectral images and polychromatic images, and images at 70 keV was statistically significant (t = 3.57, 4.16, P < 0.01). CONCLUSIONS Gemstone spectral imaging technique can reduce metal artefacts of 125 I seeds effectively in CT images, and improve the quality of images, and improve the display of tissues adjacent to 125 I seeds after implantation. MARs technique cannot reduce the artefacts caused by radioactive seeds effectively.
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Affiliation(s)
- Jingang Liu
- Imaging Center of Affiliated Hospital, Weifang Medical University, Weifang, China
| | - Wenjuan Wang
- Department of Radiology, Weifang People's Hospital, Weifang, China
| | - Xingsheng Zhao
- Imaging Center of Affiliated Hospital, Weifang Medical University, Weifang, China
| | - Zhen Shen
- Imaging Center of Affiliated Hospital, Weifang Medical University, Weifang, China
| | - Weiguang Shao
- Imaging Center of Affiliated Hospital, Weifang Medical University, Weifang, China
| | - Xizhen Wang
- Imaging Center of Affiliated Hospital, Weifang Medical University, Weifang, China.
| | - Lixin Li
- Imaging Center of Affiliated Hospital, Weifang Medical University, Weifang, China
| | - Bin Wang
- Imaging Center of Affiliated Hospital, Weifang Medical University, Weifang, China. .,Department of Medical Imaging, Medical Imaging Research Institute, Binzhou Medical University, Yantai, China.
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Implantation of radioactive (125)I seeds improves the prognosis of locally advanced pancreatic cancer patients: A retrospective study. ACTA ACUST UNITED AC 2016; 36:205-210. [PMID: 27072963 DOI: 10.1007/s11596-016-1567-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/16/2016] [Indexed: 12/18/2022]
Abstract
Locally advanced pancreatic cancer is associated with a very poor prognosis. This study was performed to evaluate whether patients with locally advanced pancreatic cancer benefit from (125)I seed implantation. This retrospective study included 224 patients with locally advanced pancreatic cancer, with 137 patients (61.2%) in the implantation (IP) group and 87 (38.9%) in the non-implantation (NIP) group. The survival status, complications and objective curative effects were compared between the groups. The average operative time in the IP group was significantly longer than that in the NIP group (243±51 vs. 214±77 min). The tumor response rates were 9.5% and 0 at the 2nd month after surgery in the IP and NIP groups, respectively (P<0.05). The IP group exhibited a trend toward pain relief at the 6th month after surgery. The global health status scores of the IP group were higher than those of the NIP group at the 3rd and 6th month after surgery. The median survival time in the IP group was significantly longer than that in the NIP group. In conclusion, patients with locally advanced pancreatic cancer can benefit from (125)I seed implantation in terms of local tumor control, survival time, pain relief and quality of life.
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Computed tomography-guided 125I seed interstitial implantation for head and neck cancer patients with unmanageable cervical lymph node metastases. World J Surg Oncol 2015. [DOI: 10.1186/s12957-015-0443-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Xiang Z, Li G, Liu Z, Huang J, Zhong Z, Sun L, Li C, Zhang F. 125I Brachytherapy in Locally Advanced Nonsmall Cell Lung Cancer After Progression of Concurrent Radiochemotherapy. Medicine (Baltimore) 2015; 94:e2249. [PMID: 26656370 PMCID: PMC5008515 DOI: 10.1097/md.0000000000002249] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To investigate the safety and effectiveness of computed tomography (CT)-guided I seed implantation for locally advanced nonsmall cell lung cancer (NSCLC) after progression of concurrent radiochemotherapy (CCRT).We reviewed 78 locally advanced NSCLC patients who had each one cycle of first-line CCRT but had progressive disease identified from January 2006 to February 2015 at our institution. A total of 37 patients with 44 lesions received CT-guided percutaneous I seed implantation and second-line chemotherapy (group A), while 41 with 41 lesions received second-line chemotherapy (group B).Patients in group A and B received a total of 37 and 41 first cycle of CCRT treatment. The median follow-up was 19 (range 3-36) months. After the second treatment, the total response rate (RR) in tumor response accounted for 63.6% in group A, which was significantly higher than that of group B (41.5%) (P = 0.033). The median progression-free survival time (PFST) was 8.00 ± 1.09 months and 5.00 ± 0.64 months in groups A and B (P = 0.011). The 1-, 2-, and 3-year overall survival (OS) rates for group A were 56.8%, 16.2%, and 2.7%, respectively. For group B, OS rates were 36.6%, 9.8%, and 2.4%, respectively. The median OS time was 14.00 ± 1.82 months and 10.00 ± 1.37 months for groups A and B, respectively (P = 0.059). Similar toxicity reactions were found in both groups. Tumor-related clinical symptoms were significantly reduced and the patients' quality of life was obviously improved.CT-guided I seed implantation proved to be potentially beneficial in treating localized advanced NSCLC; it achieved good local control rates and relieved clinical symptoms without increasing side effects.
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Affiliation(s)
- Zhanwang Xiang
- From the State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center (ZX, GL, JH, ZZ, LS, CL, FZ), and Guangzhou Women and Children Health Care Center, Guangzhou, China (ZL)
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Lu M, Pu D, Zhang W, Liao J, Zhang T, Yang G, Liu Z, Singh S, Gao F, Zhang F. Trans-bronchoscopy with implantation of 125I radioactive seeds in patients with pulmonary atelectasis induced by lung cancer. Oncol Lett 2015; 10:216-222. [PMID: 26171002 DOI: 10.3892/ol.2015.3204] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 04/14/2015] [Indexed: 12/19/2022] Open
Abstract
To evaluate the role of low-dose-rate interstitial brachytherapy using trans-bronchoscope 125I radioactive seeds implantation in patients with pulmonary atelectasis induced by lung cancer, in terms of feasibility, safety, quality of life (QOL), and survival time. Between April 2008 and June 2011, 15 patients from two medical institutions that had obstructive pulmonary atelectasis caused by inoperable lung cancer were assigned to receive 125I implantation endoluminal brachytherapy by bronchoscopy. Subsequent to the implantation of 125I seeds, the outcomes were measured in terms of procedure success rate, reopening of atelectasis, complications associated with the procedure, Karnofsky performance status (KPS) scores and survival time. The surgical procedure was successfully performed in all 15 patients. No procedure-associated mortality occurred and the complications were mild and considered acceptable. Irritable cough and temporary increase of hemoptysis occurred in 11 (73.3%) and 10 (66.7%) patients respectively, and were the most common complications. The pulmonary atelectasis reopening rate subsequent to the procedure was 86.7, 76.9, 80.0, 75.0 and 50.0% at 2, 6, 12, 18 and 24 months, respectively. The KPS score significantly improved following the implantation of 125I seeds and the duration of improvement ranged between 3 and 27 months. The median and mean survival times were 15.6 and 16 months, respectively. Actuarial survival rates at 6, 12 and 24 months after the procedure were 86.7, 66.7 and 13.3%, respectively. In patients with advanced lung cancer and those presenting with obstructive pulmonary atelectasis, treatment with intraluminal implantation of 125I seeds is a safe and effective therapy option with easy accessibility.
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Affiliation(s)
- Mingjian Lu
- Department of Medical Imaging & Interventional Radiology, Cancer Center and State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Deli Pu
- Department of Oncology, Guizhou Astronautics Hospital, Zunyi, Guizhou 563003, P.R. China
| | - Weidong Zhang
- Department of Medical Imaging & Interventional Radiology, Cancer Center and State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Jiangrong Liao
- Department of Oncology, Guizhou Astronautics Hospital, Zunyi, Guizhou 563003, P.R. China
| | - Tao Zhang
- Department of Medical Imaging & Interventional Radiology, Cancer Center and State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Guang Yang
- Department of Medical Imaging & Interventional Radiology, Cancer Center and State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Zhenyin Liu
- Department of Medical Imaging & Interventional Radiology, Cancer Center and State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Sristi Singh
- Department of Medical Imaging & Interventional Radiology, Cancer Center and State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Fei Gao
- Department of Medical Imaging & Interventional Radiology, Cancer Center and State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Fujun Zhang
- Department of Medical Imaging & Interventional Radiology, Cancer Center and State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
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Wei Z, Ye X, Yang X, Huang G, Li W, Wang J, Han X. Microwave ablation plus chemotherapy improved progression-free survival of advanced non-small cell lung cancer compared to chemotherapy alone. Med Oncol 2015; 32:464. [PMID: 25572816 DOI: 10.1007/s12032-014-0464-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/16/2014] [Indexed: 01/13/2023]
Abstract
The aim of the study was to determine survival benefit of the microwave ablation (MWA)/chemotherapy combination compared with chemotherapy alone. Patients with untreated, stage IIIB or IV NSCLC and at least one additional measurable site other than the ablative site were enrolled. They were divided into MWA/chemotherapy group and chemotherapy group. The primary endpoint was progression-free survival (PFS); secondary endpoints included response, time to local progression (TTLP), overall survival (OS), and adverse events (AEs). Forty-six and twenty-eight patients were enrolled in the MWA/chemotherapy group and chemotherapy group, respectively. Complete ablation was observed in 84.8 % patients in the MWA/chemotherapy group. Median TTLP was 27.0 months. Objective response rate and disease control rate in MWA/chemotherapy group were 21.7 and 76.1 %, and in the chemotherapy group were 32.1 % (p = 0.320) and 75.0 % (p = 0.916), respectively. MWA/chemotherapy combination prolonged PFS [MWA/chemotherapy group 10.9 (95 % CI 5.1-16.7) ms vs. chemotherapy group 4.8 (95 % CI 3.9-5.8) ms, p = 0.001] and tended to improve OS [MWA/chemotherapy group 23.9 (95 % CI 15.2-32.6) ms vs. chemotherapy group 17.3 (95 % CI 15.2-19.3) ms, p = 0.140]. Multivariate analyses showed that MWA was an independent prognostic factor of PFS and primary tumor size was an independent prognostic factor of OS. AEs of MWA were observed in 67.4 % patients. Chemotherapy-associated AEs were observed in 39.1 and 53.6 % of patients in the MWA/chemotherapy and chemotherapy group, respectively. MWA/chemotherapy combination improved PFS of advanced NSCLC compared to chemotherapy alone, and the combination did not increase the adverse events of chemotherapy.
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Affiliation(s)
- Zhigang Wei
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, 250021, Shandong Province, China,
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Qu A, Wang H, Li J, Wang J, Liu J, Hou Y, Huang L, Zhao Y. Biological effects of (125)i seeds radiation on A549 lung cancer cells: G2/M arrest and enhanced cell death. Cancer Invest 2014; 32:209-17. [PMID: 24745612 DOI: 10.3109/07357907.2014.905585] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
External beam radiation (EBRT) and (125)I seeds continuous low dose rate radiation (CLDR) were used to treat patients with lung cancer. We herein investigated the biological effects of EBRT and CLDR on lung cancer cells. A549 human lung cancer cell line was thus exposed to different doses of EBRT and CLDR. CLDR was more efficient to inhibit cell growth than EBRT. CLDR induced increased DNA damage as evidenced by long-lasting p-H2AX activity. The enhanced inhibitory effects of CLDR on lung cancer cell growth may be, at least in part, due to the increased Bax/Bcl2 ratio and cyclin B1-mediated G2/M arrest.
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Affiliation(s)
- Ang Qu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P.R. China,1
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Huang Q, Chen J, Chen Q, Lai Q, Cai S, Luo K, Lin Z. Computed tomographic-guided iodine-125 interstitial implants for malignant thoracic tumors. Eur J Radiol 2013; 82:2061-6. [PMID: 23830205 DOI: 10.1016/j.ejrad.2013.05.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 05/19/2013] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the feasibility and efficacy of percutaneous interstitial brachytherapy using iodine-125 ((125)I) radioactive seeds under computed tomographic (CT) guidance for malignant thoracic tumors. MATERIALS AND METHODS Forty-one patients (34 males, 7 females; 18-90 years; mean, 63.7 years) with 77 lesions (3 in the mediastinum, 7 in the chest wall, 67 in the lung) underwent percutaneous interstitial implantation of (125)I radioactive seeds under CT guidance. A treatment planning system (TPS) was employed to calculate the number and distribution of seeds preoperatively. An 18-G needle was inserted into the lesions under CT guidance and send the seeds according to TPS. Two patients with mediastinal lesions undergoing seed implantation received an artificial pneumothorax. One patient with lung carcinoma adjacent to the anterior mediastinum underwent seed implantation through the sternum. Follow-up CT was done every 2 months postoperatively. RESULTS The procedure was successful in all patients. No major procedure-associated death occurred. The mean duration of follow-up was 19.4 ± 1.3 months (3-49 months). A complete response (CR) was seen in 49 lesions (63.6%), partial response (PR) in 9 lesions (11.7%), stable disease (SD) in 12 lesions (12.8%), and progressive disease (PD) in 7 lesions (7.4%). The overall response rate (CR+PR) was 75.3%; the local control rate (CR+PR+SD) was 90.9%. The 1-, 2- and 3-year progression-free rates for local tumors were 91%, 88% and 88%, respectively. The 1-, 2- and 3-year survival rates were 87%, 74% and 68%, respectively. CONCLUSION Implantation of CT-guided (125)I seeds is feasible and effective for patients with malignant thoracic tumors.
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Affiliation(s)
- Qiming Huang
- The Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou 350005, China; The Department of Radiology, Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan Bei Road, Quanzhou 362000, China
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