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Zhang M, Zhang M, Yu M, Song Y, Wang Y. A study on short-term efficacy and safety of Iodine-125 brachytherapy coupled with preoperative arterial chemoembolization for hypervascular spinal metastasis. Brachytherapy 2024; 23:207-213. [PMID: 38044181 DOI: 10.1016/j.brachy.2023.10.001] [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: 06/13/2023] [Revised: 09/05/2023] [Accepted: 10/05/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE Hypervascular spinal metastatic malignancies can cause severe pain and intraoperative bleeding and selection of appropriate treatment can be challenging. This study aimed to observe the short-term efficacy and safety of Iodine-125 brachytherapy (125I BT) combined with preoperative transcatheter arterial chemoembolization (TACE) for hypervascular spinal metastasis. METHODS This study included a total of 33 patients (39 lesions) with hypervascular spinal metastasis. All of them carried out a regimen of TACE followed by 125I BT under CT guidance. A brachytherapy planning system has been utilized for the purpose of designing treatment plans and optimizing dose distribution. Pain relief was evaluated using a numeric rating scale (NRS) and intraoperative bleeding was recorded. Follow-up was conducted for 6 months to observe the local control rate and clinical complications. RESULTS All patients tolerated combined treatment well and intraoperative blood loss of every patient was not more than 10 ml. The 2- and 6- month local disease control rates were 92.3% and 83.8%. The NRS scores for thirty-three tumor patients before surgery and after one week, two, and six months of surgery were recorded as 7.33 ± 1.80, 7.39 ± 1.89, 3.15 ± 2.35, and 4.16 ± 2.15, respectively. The NRS score 2 months after treatment was found considerably lower in comparison to the NRS score before operation (p < 0.05). CONCLUSIONS According to our findings, 125I BT as well as preoperative TACE leads to perioperative hemostasis, pain alleviation, and reduced tumor burden, indicating that this combined treatment could be effective and promising for hypervascular spinal metastases.
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Affiliation(s)
- Menglong Zhang
- Department of Minimally Invasive Intervention, Ganzhou People's Hospital, Zhanggong District, Ganzhou, Jiangxi, China.
| | - Menglin Zhang
- Chengyang District People's Hospital of Qingdao, Shandong, China
| | - Miaoshen Yu
- Department of Minimally Invasive Intervention, Ganzhou People's Hospital, Zhanggong District, Ganzhou, Jiangxi, China
| | - Yusheng Song
- Department of Minimally Invasive Intervention, Ganzhou People's Hospital, Zhanggong District, Ganzhou, Jiangxi, China
| | - Yan Wang
- Department of Minimally Invasive Intervention, Ganzhou People's Hospital, Zhanggong District, Ganzhou, Jiangxi, China
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Wu L, Zhao X, Tian S, Zhang K, He C, Feng Y, Zhou J, Guo W, Ji Z, He X, Chen G, Wang J. Efficacy and toxicity of Iodine-125 seed implantation for lymph node recurrence secondary to esophageal cancer after radiotherapy: a multicenter retrospective study. Radiat Oncol 2023; 18:18. [PMID: 36698157 PMCID: PMC9878769 DOI: 10.1186/s13014-022-02196-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/30/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND/OBJECTIVE This multicenter study aimed to explore the efficacy and toxicity of radioactive Iodine-125 seed implantation for lymph node recurrence in patients with esophageal cancer after external radiotherapy. METHODS Clinical data of eligible patients from 5 centers in China were retrospectively reviewed. A total of 126 patients between January 2016 and March 2019 were included. The median interval between previous radiotherapy and radioactive Iodine-125 seed implantation was calculated. The target volume was 2.1-128.1 cm3 (median, 22.2 cm3) and the median postoperative D90 is 120.6 Gy (range, 101.7-192). Short-term efficacy of tumor response, the long-term efficacy of local progression-free survival (LRFS) and overall survival (OS), and treatment-related toxicity were reported. RESULTS For tumor response, 37 (29.4%), 51 (40.5%), 14 (11.1%), and 24 (19.0%) patients achieved complete response, partial response, stable disease and progressive disease, respectively. The 1-, 2- and 3-year LPFS and OS rates were 48.8%, 23.0% and 15.9%, and 80.2%, 38.8%, and 24.5%, respectively. Multivariate analysis identified Karnofsky performance status (P = 0.041) and tumor response (P = 0.049) as independent prognostic factors for LPFS; initial tumor stage (P = 0.034), lesion volume (P = 0.017), and tumor response (P = 0.004) as independent prognostic factors for OS. In total, 77 (61.1%) patients suffered from skin reactions and the incidence of grade 3-5 skin toxicity was 5.6% (7/126). CONCLUSION Radioactive Iodine-125 seed implantation seems efficient with acceptable toxicity for the treatment of lymph node recurrence secondary to esophageal cancer. A head-to-head study is needed to further evaluate the survival benefit.
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Affiliation(s)
- Lirong Wu
- grid.89957.3a0000 0000 9255 8984Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009 China
| | - Xinxin Zhao
- Department of Radiation Oncology, The First People’s Hospital of Kerqin District, No. 328 Kerqin Street, Tongliao, 028000 China
| | - Suqing Tian
- grid.411642.40000 0004 0605 3760Department of Radiation Oncology, Beijing University Third Hospital, Beijing, 100191 China
| | - Kaixian Zhang
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, Tengzhou, 277599 China
| | - Chuang He
- grid.416208.90000 0004 1757 2259Center of Minimally Invasive Intervention, Southwest Hospital of Army Medical University (The First Hospital Affiliated to AMU), Chongqin, 400038 China
| | - Yong Feng
- grid.89957.3a0000 0000 9255 8984Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009 China
| | - Jiawei Zhou
- grid.89957.3a0000 0000 9255 8984Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009 China
| | - Wenjie Guo
- grid.89957.3a0000 0000 9255 8984Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009 China
| | - Zhe Ji
- grid.411642.40000 0004 0605 3760Department of Radiation Oncology, Beijing University Third Hospital, Beijing, 100191 China
| | - Xia He
- grid.89957.3a0000 0000 9255 8984Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009 China
| | - Guanglie Chen
- Department of Radiation Oncology, The First People’s Hospital of Kerqin District, No. 328 Kerqin Street, Tongliao, 028000 China
| | - Junjie Wang
- grid.411642.40000 0004 0605 3760Department of Radiation Oncology, Beijing University Third Hospital, Beijing, 100191 China
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Hao L, Chen X, Chen Q, Xu Y, Zhang B, Yang Z, Zhong J, Zhou Q. Application and Development of Minimally Invasive Techniques in the Treatment of Spinal Metastases. Technol Cancer Res Treat 2022; 21:15330338221142160. [PMID: 36476013 PMCID: PMC9742696 DOI: 10.1177/15330338221142160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
With the improvement of medical technology, the quality of life and prognosis of patients with malignant tumors have been greatly improved, and surgical treatment strategies for patients with spinal metastatic tumors have received extensive attention. Traditional open surgery for spinal metastases has problems such as large trauma, slow recovery, and influence on subsequent systemic treatment. Minimally invasive spine surgery has similar clinical outcomes to traditional open surgery, but minimally invasive spine surgery is less invasive and has a shorter recovery time. Minimally invasive spine surgery was initially applied to non-neoplastic diseases such as spinal degeneration and trauma, and was gradually applied to the treatment of spinal metastatic tumors and spinal deformities. For patients with spinal metastases, a shorter recovery time is helpful for early postoperative radiotherapy, thereby achieving a more satisfactory tumor control effect. This review discusses the application of minimally invasive spine surgery in the treatment of spinal metastatic tumors from the concept, surgical purpose, indications, and surgical selection, so as to provide reference for clinical practice.
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Affiliation(s)
- Lu Hao
- Science and Education Department, Shenzhen Baoan Shiyan People's Hospital, Shenzhen, China
| | - Xi Chen
- Central Laboratory, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Qiuyan Chen
- Science and Education Department, Shenzhen Baoan Shiyan People's Hospital, Shenzhen, China
| | - Yuzhong Xu
- Department of Clinical Laboratory, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Baozhu Zhang
- Department of Radiotherapy, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Zhe Yang
- The First Clinical Medical School, Southern Medical University, Guangzhou, China
| | - Junxin Zhong
- The Second Clinical Medical School, Southern Medical University, Guangzhou, China
| | - Qing Zhou
- Central Laboratory, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen, China,Qing Zhou, Central Laboratory, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen, China.
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Wu L, Wang L, Yang J, Jia W, Xu Y. Clinical Features, Treatments, and Prognosis of Intramedullary Spinal Cord Metastases From Lung Cancer: A Case Series and Systematic Review. Neurospine 2022; 19:65-76. [PMID: 35130420 PMCID: PMC8987539 DOI: 10.14245/ns.2142910.455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/14/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Intramedullary spinal cord metastasis from lung cancer (ISCM-LC) are increasing in prevalence. We aim to investigate its clinical features, treatments and prognosis.
Methods We reported 6 ISCM-LC cases and conducted a systematic review. Descriptive summarization, survival analysis, and multivariate Cox regression analysis were performed to comprehensively study the disease.
Results All 6 patients had surgery. One used chemotherapy and the other had targeted drugs. Two patients died of ISCM-LC, 1 died of pulmonary embolism, 1 was alive, and 2 were lost to follow-up. We identified 197 ISCM-LC cases in literature with a mean age of 58 years and male preponderance. Small cell lung cancer accounted for 39.1%. The median interval from lung cancer to ISCM-LC was 7 months. Limb weakness was the most common symptom, and 45% cases progressed rapidly. Concomitant brain, leptomeningeal, and vertebral metastasis occurred to 55.8%, 20%, and 19.5%, respectively. Peritumoral edema appeared in 83.3%. Through survival analysis, we found sex, extraspinal metastasis, pathology, and improved symptoms affected the overall survival. Additionally, gross total resection (GTR) shared similar effectiveness with non-GTR, and other treatments following surgery hardly added extra effect. Surgery, improved symptoms, and sex were 3 independent prognostic factors after adjusting for confounding. The estimated median survival time was 5 months.
Conclusion The overall survival of ISCM-LC remains poor. Surgery is an independent protective factor for survival. Surgery should be considered once tolerated, and GTR might not be necessary. In addition, female patients with improved symptoms after intervention might have better overall survival.
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Affiliation(s)
- Liang Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li'ao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenqing Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yulun Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Corresponding Author Yulun Xu https://orcid.org/0000-0001-8365-1930 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 Nansihuan Xilu, Fengtai District, Beijing 100070, China
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Li P, Fan J, Zhang K, Wang J, Hu M, Yang S, Xing C, Yuan Q. Interstitial 125I Brachytherapy as a Salvage Treatment for Refractory Cervical Lymph Node Metastasis of Thoracic Esophageal Squamous Cell Carcinoma After External Irradiation With a CT-Guided Coplanar Template-Assisted Technique: A Retrospective Study. Technol Cancer Res Treat 2022; 21:15330338221103102. [PMID: 35656785 PMCID: PMC9168871 DOI: 10.1177/15330338221103102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose: To analyze the outcome and prognosis of patients with
refractory cervical lymph node metastasis of thoracic esophageal squamous cell
carcinoma after external irradiation, who underwent interstitial 125I
brachytherapy as a salvage treatment with a CT-guided coplanar template-assisted
technique. We also want to compare the dosimetry of 3D printed coplanar
template-assisted interstitial 125I brachytherapy preoperative and
postoperative, and to explore the accuracy of this technology. Material
and methods: We retrospectively collected and analyzed the results of
32 patients with refractory cervical lymph node metastasis of thoracic
esophageal squamous cell carcinoma after external irradiation, who underwent
interstitial 125I brachytherapy as a salvage treatment with a
CT-guided coplanar template-assisted technique from January 2012 to December
2017. Results: The actual D90 were 114 to 240 Gy, and the median
postoperative dosimetry assessment was 177.5 Gy. The local control rates at 3,
6, 9, and 12 months were 87.5%, 59.38%, 40.63%, and 31.25%, respectively. The
median local control time was 7.5 months. The median overall survival time was
10.5 months (95% CI, 8.9-13.4), and the survival rates of 1- and 2-year,
respectively, were 43.75% and 9.38%. There were 36 lesions in 32 patients. By
performing a paired t-test analysis, there was no significant
difference in D90, D100, V100, V150, V200, GTV volume, CI, EI, and HI between
preoperative and postoperative (P > .05).
Conclusions: Interstitial 125I brachytherapy can be
used as a salvage treatment for patients with refractory cervical lymph node
metastasis of thoracic esophageal squamous cell carcinoma after external
irradiation. With the auxiliary function of 3D printed coplanar template, the
main dosimetry parameters verified after the operation can meet the requirements
of the preoperative plan with good treatment accuracy.
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Affiliation(s)
- Peishun Li
- Department of Oncology, Tengzhou Central People’s Hospital,
Shandong, China
| | - Jing Fan
- Department of Oncology, Tengzhou Central People’s Hospital,
Shandong, China
| | - Kaixian Zhang
- Department of Oncology, Tengzhou Central People’s Hospital,
Shandong, China
- Kaixian Zhang, Department of Oncology,
Tengzhou Central People's Hospital, Tengzhou, Shandong 277599, China.
| | - Junjie Wang
- Department of Radiation Oncology, Peking University 3rd
Hospital, Beijing, P. R. China
- Junjie Wang, Department of Radiation
Oncology, Peking University 3rd Hospital, Beijing 100191, P. R. China.
| | - Miaomiao Hu
- Department of Oncology, Tengzhou Central People’s Hospital,
Shandong, China
| | - Sen Yang
- Department of Oncology, Tengzhou Central People’s Hospital,
Shandong, China
| | - Chao Xing
- Department of Oncology, Tengzhou Central People’s Hospital,
Shandong, China
| | - Qianqian Yuan
- Department of Oncology, Tengzhou Central People’s Hospital,
Shandong, 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: 15] [Impact Index Per Article: 5.0] [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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Chen Y, Dai J, Jiang Y, Ji Z, Jiang P, Sun H, Xu F, Wang J. Long-Term Outcomes of Personalized Stereotactic Ablative Brachytherapy for Recurrent Head and Neck Adenoid Cystic Carcinoma after Surgery or External Beam Radiotherapy: A 9-Year Study. J Pers Med 2021; 11:jpm11090839. [PMID: 34575616 PMCID: PMC8467951 DOI: 10.3390/jpm11090839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/21/2021] [Accepted: 08/22/2021] [Indexed: 12/12/2022] Open
Abstract
The management of recurrent head and neck adenoid cystic carcinoma (HNACC) remains a problematic challenge. This study aims to evaluate the long-term outcomes of personalized stereotactic ablative brachytherapy (SABT) as a salvage treatment for recurrent HNACC after surgery or external beam radiotherapy (EBRT). 21 patients with recurrent HNACC after surgery or EBRT successfully underwent iodine-125 (I-125) seed SABT from May 2011 to November 2019. The objective response rate (ORR), disease control rate (DCR), local control time (LCT), overall survival (OS), symptomatic relief and adverse events (AEs) were analyzed. Following SABT, the ORR and DCR were 85.7% and 100%, respectively. The 3-, and 5-year LCT rates were 68.8% and 55.1%, respectively, and the 3- and 5-year OS rates were 85.9% and 66.2%, respectively. Furthermore, univariate analyses showed that higher D90 (>137.1 Gy) was a strong positive prognostic factor of LCT (p < 0.05). The pain disappeared in one patient 3 months after SABT and partial pain improvement was observed in nine patients 1 to 6 months after SABT. Additionally, dyspnea was relieved in one patient with the tumor involving the trachea. The major AEs were mild intraoperative hemorrhage and skin/mucosal toxicities which were generally graded ≤2 and well-tolerated. Personalized SABT was an effective and safe alternative option for recurrent HNACC after the previous failure of surgery or EBRT. The parameter of D90 may influence the local control.
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Affiliation(s)
- Yi Chen
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (Y.C.); (Y.J.); (Z.J.); (P.J.); (H.S.); (F.X.)
| | - Jinzhao Dai
- Department of Nuclear Medicine, Qingdao Central Hospital, Qingdao 266300, China;
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (Y.C.); (Y.J.); (Z.J.); (P.J.); (H.S.); (F.X.)
| | - Zhe Ji
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (Y.C.); (Y.J.); (Z.J.); (P.J.); (H.S.); (F.X.)
| | - Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (Y.C.); (Y.J.); (Z.J.); (P.J.); (H.S.); (F.X.)
| | - Haitao Sun
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (Y.C.); (Y.J.); (Z.J.); (P.J.); (H.S.); (F.X.)
| | - Fei Xu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (Y.C.); (Y.J.); (Z.J.); (P.J.); (H.S.); (F.X.)
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (Y.C.); (Y.J.); (Z.J.); (P.J.); (H.S.); (F.X.)
- Correspondence: ; Tel.: +86-137-0107-6310; Fax: +86-010-8226-5968
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The effectiveness and prognostic factors of radioactive iodine-125 seed implantation for the treatment of cervical lymph node recurrence of esophageal squamous cell carcinoma after external beam radiation therapy. J Contemp Brachytherapy 2020; 12:579-585. [PMID: 33437306 PMCID: PMC7787212 DOI: 10.5114/jcb.2020.101691] [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: 07/21/2020] [Accepted: 10/17/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To analyze factors influencing the efficacy of 125I seed implantation in the treatment of in-field cervical lymph node recurrence of esophageal squamous cell carcinoma (ESCC) after external beam radiation therapy. Material and methods We conducted a retrospective review of 36 patients with in-field cervical metastatic lymph nodes recurrence of esophageal squamous cell carcinoma (CML-ESCC) after external beam radiation therapy treatment, who underwent 125I seed implantation in our department from 2013 to 2019. Previous cumulative external irradiation dose ranged from 20 to 66 Gy (median, 60 Gy). The post-implant efficacy was evaluated by response evaluation criteria in solid tumors (RECIST) version 1.1, and an adverse event was evaluated by the Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer Late Radiation Morbidity Score (EORTC). COX proportional hazards model was used to analyze risk factors affecting effectiveness. Results Among 36 patients, 31 patients (86.1%) received fluorouracil-based chemotherapy (1-6 cycles) after 125I seed implantation. Local control rates at 3, 6, 12, and 24 months after implantation were 51%, 30%, 30%, and 18%, respectively, with a median of 9 months (95% CI: 6.106-11.894); survival rates after 3, 6, 12, and 24 months were 55%, 41%, 22%, and 22%, respectively, with a median of 8 months (95% CI: 5.753-10.247). Multivariate analysis showed that D90 and short-term efficacy were independent factors related to local control and survival rate (p = 0.005, < 0.001, 0.010, < 0.001). There were 2 cases (5.6%) with grade 1 skin toxicity, 1 case (2.8%) with grade 4 skin toxicity, 3 cases (8.3%) with grade 1 mucosal ulcer, and 3 cases (8.3%) with grade 1 xerostomia. Conclusions 125I seed implantation as an effective salvage treatment shows definite efficacy and safety for patients with in-field cervical lymph node recurrence of ESCC after external beam radiation therapy.
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9
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Chen Y, Jiang Y, Ji Z, Jiang P, Xu F, Zhang Y, Zhang P, Guo F, Li X, Sun H, Lei R, Fan J, Li W, Huang Y, Wang J. Dosimetry, efficacy, and safety of three-dimensional printing noncoplanar template-assisted and CT-guided 125I seed implantation for recurrent retroperitoneal lymphatic metastasis after external beam radiotherapy. Brachytherapy 2020; 19:380-388. [PMID: 32249183 DOI: 10.1016/j.brachy.2020.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the dosimetry, efficacy, and safety of radioactive 125I seed implantation (RISI) assisted by three-dimensional printing noncoplanar template (3D-PNCT) and CT for recurrent retroperitoneal lymphatic metastasis (RRLM) after previous external beam radiotherapy. METHODS AND MATERIALS From June 2016 to August 2018, 32 patients with RRLM successfully underwent 3D-PNCT-assisted and CT-guided RISI. The dosimetry, pain relief rate, performance improvement rate, overall response rate, disease control rate, local control time (LCT), overall survival (OS), and safety profiles were evaluated. RESULTS Dosimetric results showed that the D90, D100, V100, V150, V200, and homogeneity index were consistent in preoperation and postoperation (p > 0.05), except for the external index and conformal index (p = 0.048, p = 0.034). After RISI, 81.3% of the patients achieved pain relief, and 71.9% achieved an improvement of performance. The overall response rate and disease control rate were 85.3% and 94.1%, respectively. The LCT rates reached 66.2% and 43.2% in 1 year and two years, respectively, with a median LCT of 15.8 months. The OS rates were 74.1% and 28.1% in 1 year and two year, respectively, with a median OS reaching 17.6 months. Univariate analysis showed that when D90 > 130 Gy or D100 > 63 Gy or tumor size ≤49.8 cm3, LCT was extended significantly, but not for OS. Except for two patients developing Grade 1 retroperitoneal hematomas, no other severe adverse events were observed. CONCLUSIONS 3D-PNCT and CT guidance provide excellent accuracy for RISI, which can be an effective and safe alternative for RRLM after external beam radiotherapy. Radiation dose and tumor size seem to significantly influence the local control.
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Affiliation(s)
- Yi Chen
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Zhe Ji
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Fei Xu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Yibao Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiotherapy, Peking University Cancer Hospital & Institute, Beijing, China
| | - Pu Zhang
- Department of Radiation Oncology, Liaocheng People's Hospital, Liaocheng, Shandong Province, China
| | - Fuxing Guo
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Xuemin Li
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Runhong Lei
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Jinghong Fan
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Weiyan Li
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Yuliang Huang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiotherapy, Peking University Cancer Hospital & Institute, Beijing, China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China.
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Niu Y, Ding Z, Deng X, Guo B, Kang J, Wu B, Fan Y. A Novel Multimodal Therapy for Anaplastic Thyroid Carcinoma: 125 I Seed Implantation Plus Apatinib After Surgery. Front Endocrinol (Lausanne) 2020; 11:207. [PMID: 32390940 PMCID: PMC7188788 DOI: 10.3389/fendo.2020.00207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/24/2020] [Indexed: 01/08/2023] Open
Abstract
Anaplastic thyroid cancer is known to be the most lethal malignancy among endocrine tumors for its extremely limited survival rate after diagnosis. As a result of this poor survival prognosis, multimodal therapy is currently under investigation to address this global concern. In this reported case, the 125I seed implantation and vascular endothelial growth factor receptor-2 (VEGFR-2) inhibitor apatinib were co-applied to treat a 49-year-old woman with anaplastic thyroid cancer. After the patient began apatinib administration and underwent 125I seed implantation twice, the tumor size shrank successfully. After a follow-up of 13 months since the initial diagnosis of anaplastic thyroid cancer, the patient survived with a stable disease pathology. In conclusion, this study supports 125I seed implantation and apatinib as effective therapeutic alternatives for inoperable anaplastic thyroid cancer patients.
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Affiliation(s)
- Yiqi Niu
- Department of Thyroid-breast-hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zheng Ding
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xianzhao Deng
- Department of Thyroid-breast-hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Bomin Guo
- Department of Thyroid-breast-hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jie Kang
- Department of Thyroid-breast-hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Bo Wu
- Department of Thyroid-breast-hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Youben Fan
- Department of Thyroid-breast-hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- *Correspondence: Youben Fan
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Cao X, Fang L, Cui CY, Gao S, Wang TW. DTI and pathological changes in a rabbit model of radiation injury to the spinal cord after 125I radioactive seed implantation. Neural Regen Res 2018; 13:528-535. [PMID: 29623940 PMCID: PMC5900518 DOI: 10.4103/1673-5374.228758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Excessive radiation exposure may lead to edema of the spinal cord and deterioration of the nervous system. Magnetic resonance imaging can be used to judge and assess the extent of edema and to evaluate pathological changes and thus may be used for the evaluation of spinal cord injuries caused by radiation therapy. Radioactive 125I seeds to irradiate 90% of the spinal cord tissue at doses of 40–100 Gy (D90) were implanted in rabbits at T10 to induce radiation injury, and we evaluated their safety for use in the spinal cord. Diffusion tensor imaging showed that with increased D90, the apparent diffusion coefficient and fractional anisotropy values were increased. Moreover, pathological damage of neurons and microvessels in the gray matter and white matter was aggravated. At 2 months after implantation, obvious pathological injury was visible in the spinal cords of each group. Magnetic resonance diffusion tensor imaging revealed the radiation injury to the spinal cord, and we quantified the degree of spinal cord injury through apparent diffusion coefficient and fractional anisotropy.
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Affiliation(s)
- Xia Cao
- School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin Province, China
| | - Le Fang
- First Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Chuan-Yu Cui
- Department of MRI, Fourth Hospital, Jilin University, Changchun, Jilin Province, China
| | - Shi Gao
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Tian-Wei Wang
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
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Zhao N, Yang R, Ren L, Fan Y, Li J, Zhang J. Dosimetric characterization of GMS BT-125-1 125 I radioactive seed with Monte Carlo simulations and experimental measurement. J Appl Clin Med Phys 2017; 18:49-57. [PMID: 28905514 PMCID: PMC5689916 DOI: 10.1002/acm2.12173] [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: 12/12/2016] [Revised: 07/10/2017] [Accepted: 07/26/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose To investigate the dosimetric characteristics of the new GMS BT‐125‐1 125I radioactive seed, including dose rate constant, radial dose functions, and anisotropy functions. Methods Dosimetric parameters of GMS BT‐125‐1 125I seed including dose rate constant, radial dose functions, and anisotropy functions were calculated using the Monte Carlo code of MCNP5, and measured with thermoluminescent dosimeters (TLDs). The results were compared with those of PharmaSeed BT‐125‐1, PharmaSeed BT‐125‐2 125I, and model 6711 125I seeds. Results The dose rate constant of GMS BT‐125‐1 125I seed was 0.959 cGy·h−1·U−1, with the difference of 0.94%, 0.83%, and 0.73% compared with the PharmaSeed BT‐125‐1 125I seed, PharmaSeed BT‐125‐2 125I seed, and Model 6711 125I seed, respectively. For radial dose function, the differences between the Monte Carlo and the experimental g(r) results were mostly within 10%. Monte Carlo results of g(r) for GMS BT‐125‐1 125I seed were found in agreement (within 3.3%) with corresponding results for the PharmaSeed BT‐125‐2 125I seed. The largest differences were 8.1% and 6.2% compared with PharmaSeed BT‐125‐1 125I seed and model 6711 125I seed, respectively. For anisotropy function, the difference between GMS BT‐125‐1 125I seed and PharmaSeed BT‐125‐2 125I seed was typically <10%. Conclusions The measured dose rate constant, radial dose functions, and two‐dimensional anisotropy functions for the GMS BT‐125‐1 125I seed showed good agreement with the Monte Carlo results. The dose rate constant of the GMS BT‐125‐1 125I seed is similar to that of the PharmaSeed BT‐125‐1 125I seed, the PharmaSeed BT‐125‐2 125I seed, and the model 6711 125I seed. For radial dose functions and two‐dimensional anisotropy functions, the GMS BT‐125‐1 125I seed is similar to the PharmaSeed BT‐125‐2 125I seed but different from the PharmaSeed BT‐125‐1 125I seed and the model 6711 125I seed.
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Affiliation(s)
- Nan Zhao
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Ruijie Yang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Li Ren
- Key Laboratory of High Energy Radiation Imaging Fundamental Science, Key Laboratory of Particle & Radiation Imaging (Tsinghua University), Ministry of Education, Department of Engineering Physics, Tsinghua University, Beijing, China
| | - Yi Fan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Junli Li
- Key Laboratory of High Energy Radiation Imaging Fundamental Science, Key Laboratory of Particle & Radiation Imaging (Tsinghua University), Ministry of Education, Department of Engineering Physics, Tsinghua University, Beijing, China
| | - Jianguo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
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Tong L, Liu P, Huo B, Guo Z, Ni H. CT-guided 125I interstitial brachytherapy for pelvic recurrent cervical carcinoma after radiotherapy. Onco Targets Ther 2017; 10:4081-4088. [PMID: 28860816 PMCID: PMC5566505 DOI: 10.2147/ott.s139571] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective This retrospective study aimed to evaluate the feasibility, safety, and clinical efficacy of computed tomography (CT)-guided 125I seed interstitial brachytherapy for pelvic recurrent cervical cancer in patients with a history of pelvic radiotherapy. Methods From March 2011 to December 2015, 35 pelvic recurrent lesions (33 patients) were reirradiated using this type of salvage therapy. The medical history, dose–volume histogram parameters, complications, local control, overall survival (OS), and affected factors were analyzed. Results All patients were followed-up until expiration, and the median duration of follow-up was 16 months. The 1-, 3-, 6-, 12-, and 18-month local control rates were 84.5%, 74.2%, 60.0%, 55.5%, and 33.3%, respectively. The symptoms significantly improved after implantation. The median local tumor progression-free survival (LTPFS) and OS times were 7 months (range, 1–19 months) and 12 months (range, 2–42 months), respectively. The 1- and 2-year OS rates were 65.5% and 43.6%, respectively. In univariate analysis, a good performance status, a tumor diameter <4 cm, an interval time from last radiotherapy to seed implantation longer than 6 months and D90 (dose delivered to 90% of the target volume) ≥130 Gy were prognostic factors for LTPFS. Cox proportional hazards regression analysis revealed that tumor size and D90 were independent factors affecting LTPFS (P=0.033, hazard ratio [HR] =3.357, 95% CI =1.105, 10.212; P=0.035, HR =2.766, 95% CI =1.072, 10.212). Good performance status was identified as an independent factor affecting OS (P=0.001, HR =0.086, 95% CI =0.019, 0.387). Two patients showed grade 3–4 toxicity – 1 patient had rectovaginal fistula and 1 patient had incomplete intestinal obstruction – and 3 cases showed seed migration in our analysis. No grade 5 events occurred. Conclusion Reirradiation with CT-guided 125I seed interstitial brachytherapy is a safe, effective, and minimally invasive method to treat patients with recurrent cervical cancer after radiotherapy.
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Affiliation(s)
- Lina Tong
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Ping Liu
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Bin Huo
- Department of Oncology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhi Guo
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Hong Ni
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Bian C, Chen N, Li XL, Zhou XG, Lin H, Jiang LB, Liu WM, Chen Q, Dong J. Surgery Combined with Radiotherapy to Treat Spinal Tumors: A Review of Published Reports. Orthop Surg 2017; 8:97-104. [PMID: 27384717 DOI: 10.1111/os.12230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/07/2016] [Indexed: 12/11/2022] Open
Abstract
Spinal tumors result in high morbidity and a high rate of lower limb paralysis. Both surgical therapy and radiation therapy (RT) are used to treat spinal tumors; however, how best to combine these two therapies to maximize the benefits and minimize the risks is still being debated. It is also difficult to decide the optimal timing, course and dose of RT, especially in pregnant women and children. The aim of this review is to assist surgeons who are dealing with spinal tumors by providing comprehensive information about advanced techniques for administering RT with greater precision and safety, and about the impact of various ways of combining surgery and RT on therapeutic outcomes. We here review published reports about treating spinal tumors with a combination of these two forms of therapy and attempt to draw appropriate conclusions concerning selection of optimal treatment protocols. Our conclusion is that postoperative radiotherapy, especially with high-precision, low-dose and multiple fractions, and brachytherapy are promising therapies to combined with surgery.
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Affiliation(s)
- Chong Bian
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Nong Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital Qingpu Branch, Fudan University, Shanghai, China
| | - Xi-Lei Li
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao-Gang Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Lin
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li-Bo Jiang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wang-Mi Liu
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qian Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Dong
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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CT-Guided 125I Seed Interstitial Brachytherapy as a Salvage Treatment for Recurrent Spinal Metastases after External Beam Radiotherapy. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8265907. [PMID: 28105434 PMCID: PMC5220449 DOI: 10.1155/2016/8265907] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 10/30/2016] [Accepted: 11/29/2016] [Indexed: 11/17/2022]
Abstract
The aim of this study is to evaluate the feasibility, safety, and clinical efficacy of CT-guided 125I seed interstitial brachytherapy in patients with recurrent spinal metastases after external beam radiotherapy (EBRT). Between August 2003 and September 2015, 26 spinal metastatic lesions (24 patients) were reirradiated by this salvage therapy modality. Treatment for all patients was preplanned using a three-dimensional treatment planning system 3-5 days before 125I seed interstitial brachytherapy; dosimetry verification was performed immediately after seed implantation. Median actual D90 was 99 Gy (range, 90-176), and spinal cord median Dmax was 39 Gy (range, 6-110). Median local control (LC) was 12 months (95% CI: 7.0-17.0). The 6- and 12-month LC rates were 52% and 40%, respectively. Median overall survival (OS) was 11 months (95% CI: 7.7-14.3); 6-month and 1-, 2-, and 3-year OS rates were 65%, 37%, 14%, and 9%, respectively. Pain-free survival ranged from 2 to 42 months (median, 6; 95% CI: 4.6-7.4). Treatment was well-tolerated, with no radiation-induced vertebral compression fractures or myelopathy reported. Reirradiation with CT-guided 125I seed interstitial brachytherapy appears to be feasible, safe, and effective as pain relief or salvage treatment for patients with recurrent spinal metastases after EBRT.
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Ma X, Wei S, Yang C, Hua Y, Shen J, Cai Z. Gelfoam embolization or 125I seed implantation may be a more effective treatment than surgical treatment for giant benign sacral neurogenic tumors. World J Surg Oncol 2015; 13:247. [PMID: 26271355 PMCID: PMC4536730 DOI: 10.1186/s12957-015-0662-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 07/28/2015] [Indexed: 11/15/2022] Open
Abstract
Background The goal of the present study was to assess the effects of computed tomography (CT)-guided iodine-125 (125I) seed implantation or gelatin sponge particle (GSP) embolization on patients with giant benign sacral neurogenic tumors. Methods A total of 24 cases with giant sacral neurogenic tumor were performed in a retrospective study between 2000 and 2012. Nineteen cases received surgical resection, and five cases received non-surgical treatment. In surgical group, patients with type III sacral tumor had received a combined anterior-posterior approach and patients with type IV were treated with simple anterior approach. In non-surgical group, CT-guided 125I seed implantation or GSP embolization was applied to occlude vessels. Besides, CT scanning or magnetic resonance imaging was used to assess the size and development of tumors. Results Two of the five patients were treated three times with GSP embolization, one had received GSP embolization combined with CT-guided 125I seed implantation, one case did not receive any treatment, and one patient was lost to follow-up. Patients in non-surgical group were followed up for 2–8 years. Conclusions Our study suggested that CT-guided 125I seed implantation or GSP embolization treatment is very useful to slow down the development of giant benign sacral neurogenic tumors.
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Affiliation(s)
- Xiaojun Ma
- Department of Orthopedics, Tongji University, Shanghai Tenth People's Hospital, 301 Yanchang Rd, Shanghai, 200072, China. .,Department of Orthopedics, Shanghai Jiao Tong University, Shanghai First People's Hospital, No.100 Haining road, Hongkou district, Shanghai, 200080, China.
| | - Sun Wei
- Department of Orthopedics, Shanghai Jiao Tong University, Shanghai First People's Hospital, No.100 Haining road, Hongkou district, Shanghai, 200080, China.
| | - Chunxi Yang
- Department of Orthopedics, Tongji University, Shanghai Tenth People's Hospital, 301 Yanchang Rd, Shanghai, 200072, China.
| | - Yingqi Hua
- Department of Orthopedics, Shanghai Jiao Tong University, Shanghai First People's Hospital, No.100 Haining road, Hongkou district, Shanghai, 200080, China.
| | - Jiakang Shen
- Department of Orthopedics, Shanghai Jiao Tong University, Shanghai First People's Hospital, No.100 Haining road, Hongkou district, Shanghai, 200080, China.
| | - Zhengdong Cai
- Department of Orthopedics, Shanghai Jiao Tong University, Shanghai First People's Hospital, No.100 Haining road, Hongkou district, Shanghai, 200080, China.
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Cao Q, Wang H, Meng N, Jiang Y, Jiang P, Gao Y, Tian S, Liu C, Yang R, Wang J, Zhang K. CT-guidance interstitial (125)Iodine seed brachytherapy as a salvage therapy for recurrent spinal primary tumors. Radiat Oncol 2014; 9:301. [PMID: 25534142 PMCID: PMC4299295 DOI: 10.1186/s13014-014-0301-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/14/2014] [Indexed: 01/09/2023] Open
Abstract
Background Management of spinal neoplasms has relied on open surgery and external beam radiotherapy (EBRT). Although primary spinal tumors are rare, their treatment remains a pervasive problem. This analysis sought to evaluate the safety and efficacy of CT-guided 125I seed brachytherapy for recurrent paraspinous and vertebral primary tumors. Methods From November 2002 to June 2014, 17 patients who met the inclusion criteria were retrospectively reviewed. 14 (82.4%) had previously undergone surgery, 15 (88.2%) had received conventional EBRT and 3 (17.6%) had chosen chemotherapy. The number of 125I seeds implanted ranged from 7 to 122 (median 79) with specific activity of 0.5-0.8 mCi (median 0.7 mCi). The post-plan showed that the actuarial D90 of 125I seeds were 90–183 Gy (median 137 Gy). The follow-up period ranged from 2 to 69 months (median 19 months). The local control rate was calculated by the Kaplan-Meier method. Results For 5 Chondrosarcomas, the 1-, 2-, 3-year local control rates were 75%, 37.5%, and 37.5%, respectively, with a median of 34 months (range, 4–39 months). For 4 chordomas, the local control rate was 50% with a median follow-up of 13 months (range, 3–17 months). For 3 fibromatosis, all of them were survival without local recurrence at the end of follow-up. During the follow-up period, 35.3% (6/17) died from metastases, 17.6% (3/17) developed local recurrence by 8, 14 and 34 months while 64.7% (11/17) remained alive. 100% experienced pain relief and normal or improved ambulation, without more than Frankel grade 3 radiation myelopathy. Conclusions Percutaneous 125I seed implantation can be an alternative or retreatment for recurrent spinal primary tumors.
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Affiliation(s)
- Qianqian Cao
- Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Hao Wang
- Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Na Meng
- Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Yuliang Jiang
- Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Ping Jiang
- Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Yang Gao
- Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Suqing Tian
- Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Chen Liu
- Department of Radiology, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Ruijie Yang
- Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Junjie Wang
- Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Kaixian Zhang
- Cancer Center, Tengzhou Central People's Hospital, Tengzhou city, Shangdong Province, 277500, China.
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Ren C, Shi R, Min L, Zhang W, Tu C, Duan H, Zhang B, Xiong Y. Experience of Interstitial Permanent I125 Brachytherapy for Extremity Soft Tissue Sarcomas. Clin Oncol (R Coll Radiol) 2014; 26:230-5. [DOI: 10.1016/j.clon.2014.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 10/31/2013] [Accepted: 12/03/2013] [Indexed: 11/24/2022]
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Yu DS, Chang H, Sommer CM, Qu WL, Xu WJ, Yang RJ, Zhao P. Efficacy and safety of percutaneous microwave coagulation therapy followed by 125I seed brachytherapy for VX2 hepatic tumors in a rabbit model. Exp Ther Med 2013; 6:159-163. [PMID: 23935738 PMCID: PMC3735553 DOI: 10.3892/etm.2013.1088] [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: 01/27/2013] [Accepted: 04/04/2013] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to evaluate the efficacy and safety of percutaneous microwave coagulation therapy (PMCT) followed by 125I seed brachytherapy for VX2 liver cancer in rabbits. Eighty New Zealand rabbits were injected with suspensions of VX2 tumor cells to create an animal model. The rabbits were randomly divided into 4 groups (n=20); the control, PMCT, 125I seed brachytherapy and combination groups. Group A was treated with PMCT at 40 W for 120 sec, group B was treated with 125I seed brachytherapy and group C was treated with PMCT followed by 125I seed brachytherapy. Group D were not treated and served as the control group. At 21 days after treatment, the rabbits were sacrificed for pathological assessment. The complete tumor necrosis rate was 19 out of 20 tumors (95%) in group C, 6 (30%) in group A, 0 (0%) in group B and 0 (0%) in the control group. The complete tumor necrosis rate was observed to be significantly different between groups C and A, and between groups C and B (P<0.01). No intraheptic metastasis occurred in group C, compared with an incidence of 7 (35%) in group A, 2 (10%) in group B and 20 (100%) in the control group. Between groups C and A, and between groups C and D, the intraheptic metastasis rate was statistically significant (P<0.01). PMCT followed by 125I seed brachytherapy increased the rate of carcinoma necrosis and decreased carcinoma metastasis in the VX2 rabbit model. This combined treatment is a safe, effective and minimally invasive therapeutic option for liver cancer.
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Affiliation(s)
- Dong-Sheng Yu
- Departments of Interventional Medicine, Qingdao University, Qingdao, Shandong 266003, P.R. China
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Zhang F, Wu K, Gao F, Zhang W, Shi F, Li C. Refractory Nasopharyngeal Carcinoma. Otolaryngol Head Neck Surg 2013; 149:417-23. [DOI: 10.1177/0194599813491221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective To evaluate the feasibility of positron emission tomography combined with computed tomography (PET-CT)–guided 125I seed implantation in the treatment of patients with refractory nasopharyngeal carcinoma after repeated traditional radiochemotherapy. Study Design Case series with chart review. Setting University medical center. Subjects and Methods A total of 26 patients (18 men, 8 women; mean age, 51.3 ± 10.8 years; totaling 53 lesions with an average diameter of 2.86 ± 1.61 cm) were treated by PET-CT–guided 125I seed implantation. All of the patients received a PET-CT scan 2 months after the treatment. Follow-up was conducted for ~2 to 43 months (median, 28.2 months) to observe the local control rate, overall survival rate, and clinical complications. Results The local control rates of refractory nasopharyngeal carcinoma after repeated traditional radiochemotherapy after 3, 6, 12, 24, and 36 months were 90.6% (48/53), 79.3% (42/53), 71.7% (38/53), 62.3% (33/53), and 56.6% (30/53), respectively. The overall 1-, 2-, and 3-year survival rates were 87.2%, 71.3%, and 56.5%, respectively, with a median survival time of 28.2 months. Of all patients, 19.2% (5/26) died of local recurrence and 15.4% (4/26) died of metastases. One patient died of hypertensive cerebral hemorrhage, and another patient died from cachexia and infection. The long-term complications included hyperpigmentation at operative sites (n = 5), insensible feeling on the lateral cheek (n = 2), dryness of the oral cavity (n = 1), and headache (n = 1). Conclusion PET-CT–guided 125I seed implantation is an acceptable and feasible method for treating refractory nasopharyngeal carcinoma with minimal damage and few complications.
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Affiliation(s)
- Fujun Zhang
- Department of Medical Imaging & Interventional Radiology, Cancer Center and State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, P.R. China
| | - Ketong Wu
- Department of Medical Imaging & Interventional Radiology, Cancer Center and State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, 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, 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, P.R. China
| | - Feng Shi
- Department of Medical Imaging & Interventional Radiology, Cancer Center and State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, P.R. China
| | - Chuanxing Li
- Department of Medical Imaging & Interventional Radiology, Cancer Center and State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, P.R. China
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Wang Z, Lu J, Liu L, Liu T, Chen K, Liu F, Huang G. Clinical application of CT-guided (125)I seed interstitial implantation for local recurrent rectal carcinoma. Radiat Oncol 2011; 6:138. [PMID: 22004599 PMCID: PMC3214185 DOI: 10.1186/1748-717x-6-138] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Accepted: 10/18/2011] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The present study aimed to explore the safety profile and clinical efficacy of CT-guided radioactive seed implantation in treating local recurrent rectal carcinoma. MATERIALS AND METHODS CT-guided ¹²⁵I seed implantation was carried out in 20 patients with locally recurrent rectal carcinoma. 14 of the 20 patient had prior adjuvant external-beam radiation therapy (EBRT). The treatment planning system (TPS) was used preoperatively to reconstruct three dimensional images of the tumor and to calculate the estimated seed number and distribution. The median matched peripheral dose (MPD) was 120 Gy (range, 100-160 Gy). RESULTS Of the 20 patients, 12 were male, 8 were female, and ages ranged from 38 to 78, with a median age of 62. Duration of follow-up was 3-34 months. The response rate of pain relief was 85% (17/20). Repeat CT scan 2 months following the procedure revealed complete response (CR) of the tumor in 2 patients, partial response (PR) in 13 patients, stable disease (SD) in 3 patients, and progressive disease (PD) in 2 patients. 75% of patients had either CR or PR. Median survival time was 18.8 months (95% CI: 3.5-22.4 months). 1 and 2 year survival rates were 75% and 25%, respectively. 4 patients died of recurrent tumor; 4 patients died of distant metastases; 9 patients died of recurrent tumor and distant metastases. 3 patients survived after 2 year follow up. Two patients were found to have mild hematochezia, which was reversible with symptomatic management. CONCLUSION CT-guided ¹²⁵I seed implantation appeared to be a safe, useful and less complicated interventional treatment option for local recurrent rectal carcinoma.
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Affiliation(s)
- Zhongmin Wang
- Department of Nuclear Medicine, Renji hospital, Shanghai Jiaotong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China
- Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, 200020, China
| | - Jian Lu
- Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, 200020, China
| | - Lin Liu
- Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, 200020, China
| | - Tao Liu
- Department of General Surgery, Shanghai Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, 200020, China
| | - Kemin Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Fenju Liu
- School of Radiation Medicine and Public Health, Soochow University, Suzhou, 215123, China
| | - Gang Huang
- Department of Nuclear Medicine, Renji hospital, Shanghai Jiaotong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China
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Li J, Wang J, Meng N, Qu A, Yuan H, Liu C, Ran W, Jiang Y. Image-guided percutaneous (125)I seed implantation as a salvage treatment for recurrent soft tissue sarcomas after surgery and radiotherapy. Cancer Biother Radiopharm 2011; 26:113-20. [PMID: 21355782 DOI: 10.1089/cbr.2010.0847] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The purpose of this study was to evaluate the safety and efficacy of percutaneous iodine-125 ((125)I) seed implantation using computed tomography (CT) or ultrasound guidance in the treatment of recurrent soft tissue malignancies after surgery and radiotherapy. From February 2002 to September 2009, 18 patients with recurrent soft tissue sarcomas were treated under ultrasound or CT guidance. The actuarial median number of (125)I seeds implanted was 35 (range, 6-129), and the actuarial D90 of the implanted (125)I seeds ranged from 107.9 to 204.4 Gy (median, 147.1 Gy). The activity of the seeds ranged from 0.4 to 0.8 mCi (median, 0.7 mCi). Follow-up times ranged from 4 to 78 months (median, 20 months). The median local control was 41 months (95% CI, 15.9-66.1 months). The 1-, 2-, 3-, 4-, and 5-year local controls were 78.8%, 78.8%, 78.8%, 26.3%, and 0%, respectively. The median survival was 32 months (95% CI, 16-48 months). The actuarial 1-, 2-, 3-, 4-, and 5-year survivals were 76.6%, 61.3%, 39.4%, 39.4%, and 39.4%, respectively. Seven (7) patients (38.9%) experienced recurrence after seed implantation. Six (6) patients (33.3%) died of distant metastases and 1 died of stroke. Two (2) patients developed ulceration, 1 case caused by recurrence and another by a reaction of the skin to radiation. Percutaneous (125)I seed implantation for recurrent soft tissue malignancies under CT or ultrasound guidance is safe and is associated with high efficacy and low morbidity.
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Affiliation(s)
- Jinna Li
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, China
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