Application of I125 Brachytherapy Combined Artificial Joint Prosthesis in Malignant Osteo- and Soft-Tissue Sarcoma

Permanent interstitial 125I seed implantation as a salvage therapy for pediatric recurrent or metastatic soft tissue sarcoma after multidisciplinary treatment

BACKGROUND

The management of pediatric recurrent or metastatic soft tissue sarcoma after multimodal treatment remains challenging. We investigated the feasibility, efficacy, and morbidity of permanent interstitial (125)I seed implantation under image guidance as a salvage treatment for pediatric patients with recurrent or metastatic soft tissue sarcoma.

METHODS

This was a retrospective study of 10 patients who underwent percutaneous ultrasound or computed tomography (CT) guided permanent (125)I seed implantation. Postoperative dosimetry was performed for all patients. Actuarial D90 was 121-187.1 Gy (median, 170.3 Gy). The number of (125)I seeds implanted was 6-158 (median, 34.5), with a median specific activity of 0.7 mCi per seed (range, 0.62-0.8 mCi); total activity was 4.2-113.76 mCi. Follow-up time was 6-107 months (median, 27.5 months); no patients were lost to follow-up.

RESULTS

The overall response rate (complete response + partial response) was 8/10 (80 %), including two patients with complete response (CR) (20 %) and five patients with partial response (PR) (60 %). Local control rates after 1 and 2 years were 70.1 and 62.3 %, respectively, with a mean local control time of 70.6 months (95 % confidence interval (CI) 45.1-96.0). Survival rates after 1 and 2 years were 68.6 and 57.1 %, respectively, with a mean survival time of 65.3 months (95 % CI 34.1-96.5). Three patients died from distant metastasis; one died from local recurrence 12 months after seed implantation. Three patients suffered a grade I skin reaction and one developed ulceration. No severe adverse neurologic sequelae or blood vessel damage occurred.

CONCLUSIONS

Image guided permanent interstitial (125)I seed implantation as a salvage treatment appears to have a satisfactory outcome in children with recurrent or metastatic soft tissue sarcoma.

Comprehensive treatment based on intra-arterial chemotherapy for distal femur neoplasms

To investigate the clinical efficacy of intra-arterial chemotherapy by subcutaneous implantable delivery system (SIDS) in the treatment of distal femur neoplasm. From March 2002 to December 2009, 51 patients were treated with SIDS intra-femoral artery chemotherapy, followed by customized prosthetic reconstruction, including 45 patients of osteosarcoma and 6 malignant fibrous histiocytoma in distal femur. The average follow-up period was 64 months (ranging between 24 and 116 months) to track on the efficacy of chemotherapy, which shows that 96.1 % of patients got pain relief, 70.6 % of patients had significant radiological change, and 82.4 % of paitents with medium to severe pathological variation responded to the chemotherapy. Local recurrence happened in 4 cases, 3 cases are alive with disease, 4 cases died because of pulmonary metastases and other 40 patients are free of local recurrence or distant metastasis. SIDS intra-femur artery chemotherapy can improve clinical outcome of DFN, and provide effective method for treatment of DFN when combined with customized prosthetic reconstruction.

Image-guided percutaneous (125)I seed implantation as a salvage treatment for recurrent soft tissue sarcomas after surgery and radiotherapy

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.