Analysis of the efficacy and safety of iodine-125 seeds implantation in the treatment of patients with inoperable early-stage non-small cell lung cancer

Efficacy and safety of iodine-125 seed implantations combined with chemotherapy and immunotherapy for patients with non-small cell lung cancer: protocol for a systematic review and meta-analysis

BACKGROUND

Non-small cell lung cancer (NSCLC) is a leading cause of cancer-related mortality worldwide, with conventional treatments often limited by radiation resistance, systemic toxicity and poor outcomes in advanced stages. Iodine-125 (I-125) seed implantation, combined with chemotherapy and immunotherapy, has emerged as a promising therapeutic strategy, but its efficacy and safety compared with conventional external beam radiotherapy combined with systemic therapies remain unclear. This systematic review and meta-analysis aims to synthesise the available evidence to evaluate the comparative benefits and risks of these treatment modalities.

METHODS AND ANALYSIS

Two reviewers will independently search seven databases-PubMed, Embase, Web of Science and the Cochrane Library-for randomised controlled trials (RCTs). These RCTs should compare the efficacy and safety of I-125 seed implantations combined with chemotherapy and immunotherapy against chemoradiotherapy combined with immunotherapy in patients with NSCLC. The risk of bias in the included studies will be evaluated using the Revised Cochrane risk-of-bias tool V.2. Data synthesis will be conducted using RevMan software. Trial sequential analysis will be applied to the primary outcomes. Additionally, subgroup and sensitivity analyses will be performed to assess the robustness of the findings.

ETHICS AND DISSEMINATION

Ethical approval is not required because this study is a secondary analysis of existing data. We will disseminate the findings through peer-reviewed publications.

PROSPERO REGISTRATION NUMBER

CRD42024591684.

Bronchial arterial chemoembolization/infusion combined with iodine-125 brachytherapy in advanced non-small cell lung cancer: a promising salvage therapy after standard treatment failure

OBJECTIVES

To evaluate the efficacy, safety and optimal intervention timing of bronchial arterial chemoembolization/infusion combined with iodine-125 brachytherapy for advanced non-small cell lung cancer after standard treatment failure.

MATERIALS AND METHODS

From January 2019 to April 2024, the eligible patients with advanced non-small cell lung cancer after standard treatment failure received bronchial arterial chemoembolization/infusion combined with iodine-125 brachytherapy, were included in this retrospective study. Objective response rate, disease control rate, progression-free survival, overall survival and adverse events served as the main indicators of assessment. According to the intervention timing of intervention for this combination therapy, they were divided into the early intervention subgroup and the late intervention subgroup. Statistical analyses were performed using R software (version 3.5.3).

RESULTS

A total of 45 patients with the median age 66 years (11 women) were enrolled in this study. The objective response rate of three months after the combination therapy was 71.11% and disease control rate was 95.56%. The median progression-free survival of this cohort was 12 months and the median overall survival was 20 months. The progression-free survival (15.5 vs. 9 months, P = 0.007) and overall survival (27.5 vs. 15 months, P < 0.001) in the early intervention subgroup was significantly better than that in the late intervention subgroup. No severe complications occurred.

CONCLUSION

For advanced non-small cell lung cancer after standard treatment failure, the combination of bronchial arterial chemoembolization/infusion and iodine-125 brachytherapy is a promising salvage therapy with good efficacy and safety.

3D‑printed template‑guided iodine‑125 seed implantation to treat complete occlusion of the superior vena cava in pulmonary sarcomatoid carcinoma: A case report

Pulmonary sarcomatoid carcinoma (PSC), which is a type of non-small-cell lung carcinoma (NSCLC), is characterized by a high degree of malignancy, poor differentiation and a high incidence of pulmonary malignancy. In addition, PSC has a stronger invasive ability than other types of NSCLC and is not sensitive to radiation or chemotherapy. Furthermore, 90% of PSC cases exhibit vascular invasion; therefore, there is a risk of multiple metastases to the lung, bone, adrenal glands and brain, and consequently a poor prognosis, in the early stage. Targeted therapy and immunotherapy currently offer a new treatment direction; however, there have not been any significant advances in localized treatment in recent years. Thus, there is an urgent need for new localized treatment strategies. The present study describes the case of a 65-year-old man with recurrence of PSC after multi-line treatment with chemotherapy, radiotherapy, gamma knife and argon-helium knife treatment. In addition, the patient developed superior vena cava syndrome, and exhibited severe compression of the superior vena cava, chest discomfort, dyspnea and severe facial edema after chemotherapy, local gamma knife therapy (35 Gy, delivered through 14 2.5-Gy doses), argon-helium knife therapy and radiation therapy (28 Gy, delivered through seven 4-Gy doses). Partial remission was achieved after local implantation of iodine-125 (I125) seed under the guidance of a 3D-printed template, with progression-free survival observed up to 8 months afterwards. In conclusion, in patients with PSC who develop superior vena cava blockage after numerous treatment regimens, salvage I125 brachytherapy with a 3D-printed template may be suitable, and may improve local control and symptoms.

Recent progress in radioactive seed implantation brachytherapy of non-small cell lung cancer: a narrative review

Background and Objective

Brachytherapy, a new form of radiation therapy, has been used to treat lung cancer and consists of two main forms of treatment: endobronchial brachytherapy and radioactive seed implantation brachytherapy (RSI-BT), the latter of which is used to treat non-small cell lung cancer (NSCLC). The use of RSI-BT in the treatment of NSCLC at our centre has yielded some positive results.

Methods

To more fully consider the context of this application, we conducted a search of PubMed from 2018 to March 5, 2023. The search included a combination of the MeSH terms: "brachytherapy" and "lung neoplasm".

Key Content and Findings

The majority of NSCLC patients who received RSI-BT achieved positive benefits. Most patients had a progression-free survival (PFS) of between 12 and 18 months. Additionally, radioactive particle stent implantation as a specific RSI-BT has shown therapeutic potential in the treatment of malignant airway obstruction. With the application of new technologies, RSI-BT will become more precise, efficient and inexpensive.

Conclusions

This review demonstrates that RSI-BT can be therapeutic in the treatment of both early and advanced NSCLC with manageable complications. There have also been reports on the combination of RSI-BT with other therapies, but more research is needed on the combination of RSI-BT with them.

Covalent organic frameworks: linkage types, synthetic methods and bio-related applications

Covalent organic frameworks (COFs) are composed of small organic molecules linked via covalent bonds, which have tunable mesoporous structure, good biocompatibility and functional diversities. These excellent properties make COFs a promising candidate for constructing biomedical nanoplatforms and provide ample opportunities for nanomedicine development. A systematic review of the linkage types and synthesis methods of COFs is of indispensable value for their biomedical applications. In this review, we first summarize the types of various linkages of COFs and their corresponding properties. Then, we highlight the reaction temperature, solvent and reaction time required by different synthesis methods and show the most suitable synthesis method by comparing the merits and demerits of various methods. To appreciate the cutting-edge research on COFs in bioscience technology, we also summarize the bio-related applications of COFs, including drug delivery, tumor therapy, bioimaging, biosensing and antimicrobial applications. We hope to provide insight into the interdisciplinary research on COFs and promote the development of COF nanomaterials for biomedical applications and their future clinical translations.

Effect of I-125 Seed Implantation on Lung Cancer and Its Environmental Impact

ABSTRACT

This paper compares the efficacy and adverse effects of iodine-125 ( 125 I) seed implantation and external beam radiotherapy (EBRT) in the treatment of lung cancer as well as impact of the 125 I radiation on the environment around the patients. A total of 40 patients who were admitted with lung cancer to our hospital from October 2017 to October 2018 were enrolled into this study. The patients were randomly assigned into study groups treated with 125 I seed implantation (20 patients) and a control group treated with EBRT (20 patients). The patients were followed up for 6 mo by CT scanning of the tumor size as well as measuring serum carcinoembryonic antigen (CEA), cytokeratin fragment (CYRA21-1), and neurospecific enolase (NSE) levels. The dose rate of 125 I at various distances and times after implantation was also measured. The local tumor control rate was higher in the study group than in the control group. CEA, NSE and CYFRA21-1 significantly decreased from the pre-treatment baseline in both groups (p < 0.05). Side effects of pneumothorax, hemoptysis, chest pain, and leukopenia occurred in the patients treated with 125 I seed implantation. Radiation of the 125 I isotope, which was correlated with the number of implanted 125 I seeds, decreased rapidly in a time- and distance-dependent manner. A lead apron could significantly block radiation of 125 I. Compared to EBRT, brachytherapy with 125 I seed implantation in the lung cancer had a better therapeutic outcome with fewer complications. A lead apron could protect members of patient's family as well as public from 125 I radiation.

CT-guided iodine-125 brachytherapy as salvage therapy for local-regional recurrent breast cancer

Background

The treatment of local-regional recurrent breast cancer (BC) after external beam radiotherapy is challenging. We aim to evaluate the effectiveness and safety of computed tomography (CT)-guided percutaneous iodine-125 brachytherapy for local recurrent BC.

Methods

We retrospectively analyzed 15 patients with local recurrent BC treated with CT-guided interstitial implantation of iodine-125 seeds. Regular contrast-enhanced CT was conducted to evaluate the tumor response. Follow-up survival, quality of life, and adverse events were analyzed.

Results

Among the 15 patients, five were elderly patients (older than 80 years) and six were complicated with chronic underlying diseases. The median number of 125I seeds implantation was 33 (range: 20-130) with median dose 90 (D90, the minimum dose covering 90% of the target volume) of 108 Gy (range: 60-120 Gy). There was no significant difference in D90, V100 (the volume of the target receiving 100% of the prescription dose), and V150 (the volume of the target receiving 150% of the prescription dose) before and after operation (p > 0.05). The median follow-up was 14 months (range: 6-18 months). Six months after operation, the ORR was 66.7% (10/15) and the LCR was 93.3% (14/15). The 6- and 12-month survival rates were 100 and 41.6%, respectively, and the median survival time was 12.5 months. PS score decreased from 1.53 ± 0.81 to 0.53 ± 0.49. The pain score decreased from 2.87 ± 1.67 before operation to 1.07 ± 1.18 after operation, and the differences were statistically significant (p< 0.05). No severe complications occurred.

Conclusions

CT-guided iodine-125 brachytherapy provided a safe and effective choice for recurrent BC with significant local therapeutic effects and minor complications, especially for elderly patients with chronic underlying disease and those who were not eligible for surgical resection and had failed to benefit from systemic therapy.

Innovative Invasive Loco-Regional Techniques for the Treatment of Lung Cancer

Surgical resection is still the standard treatment for early-stage lung cancer. A multimodal treatment consisting of chemotherapy, radiotherapy and/or immunotherapy is advised for more advanced disease stages (stages IIb, III and IV). The role of surgery in these stages is limited to very specific indications. Regional treatment techniques are being introduced at a high speed because of improved technology and their possible advantages over traditional surgery. This review includes an overview of established and promising innovative invasive loco-regional techniques stratified based on the route of administration, including endobronchial, endovascular and transthoracic routes, a discussion of the results for each method, and an overview of their implementation and effectiveness.

Iodine-125 seed brachytherapy combined with pembrolizumab for advanced non-small-cell lung cancer after failure of first-line chemotherapy: A report of two cases and literature review

Although immunotherapy regimens for advanced non-small-cell lung cancer (NSCLC) improve survival in selected sub-populations, their efficacy remains far from ideal due to underlying resistance; therefore, multimodal combination strategies are needed to optimize their efficacy. In our report, two patients with advanced NSCLC with negative targetable mutations, who had failed first-line chemotherapy were treated with combined therapy of computed tomography (CT)-guided percutaneous iodine-125 seed implantation and pembrolizumab. After combination treatment, both patients achieved partial response (PR), and sustained a long progression-free survival (PFS) without obvious therapy-related adverse reactions. Iodine-125 seeds bring no long-term adverse events and effectively amplify anti-tumor immune response induced by immunotherapy; thus, this combined therapy might be a promising alternative for NSCLC.

Prognostic Evaluation of CT Imaging Big Data-Assisted Arterial Chemoembolization Combined with 125I Seed Implantation for Non-Small-Cell Lung Cancer

Objective

To investigate the prognostic impact of computed tomography (CT) imaging big data-assisted arterial chemoembolization combined with iodine 125 (¹²⁵I) seed implantation on patients with non-small-cell lung cancer (NSCLC).

Methods

A total of 116 patients with intermediate and advanced NSCLC hospitalized in our hospital from August 2019 to August 2020 were selected and divided into a control group and an experiment group (58 cases in each group) by random number table method for the study. The patients in the experiment group were treated with CT imaging big data-assisted arterial chemoembolization combined with ¹²⁵I seed implantation, while the patients in the control group were treated with arterial chemoembolization alone, with the use of gemcitabine combined with cisplatin (GP) in chemotherapy. The prognostic impact was determined by analyzing recent efficacy; the incidence of adverse effects; tumor size and CT perfusion parameters including blood volume (BV), blood flow (BF), and permeability surface (PS); frailty state and quality of life; and the levels of serum tumor markers including carcinoembryonic antigen (CEA), glycoconjugate antigen 125 (CA125), cytokeratin 19 fragment antigen 21-1 (CYFRA21-1), microRNA- (miRNA-) 137, and miR-379-5p. In addition, frailty status was evaluated using the Fried frailty phenotype (FP) scale, and quality of life was determined according to Karnofsky Performance Status (KPS) score. Kaplan-Meyer (KM) method was used to analyze the survival rate of NSCLC patients after a 12-month follow-up.

Results

The remission rate in the experiment group (77.59%) was higher than that in the control group (56.90%) (P < 0.05). Tumor size, BV, BF, PS, serum CEA and CA125 levels, and FP value in both groups were dramatically reduced after treatment compared with before treatment, especially in the experiment group after 1 and 3 months of treatment (P < 0.05). Meanwhile, the serum miR-137 and miR-379-5p levels and KPS scores in both groups were higher after treatment than before treatment, especially in the experiment group after 1 and 3 months of treatment (P < 0.05). However, there was no significant difference in the incidence of nausea and vomiting, alopecia, diarrhea, myelosuppression, and hemoptysis of NSCLC patients in both groups after treatment (P > 0.05). Further, the 12-month survival rate of NSCLC patients was higher in the experiment group (84.21%) than in the control group (64.29%) (P < 0.05).

Conclusion

CT imaging big data-assisted arterial chemoembolization combined with ¹²⁵I seed implantation for NSCLC can improve recent efficacy and the prognosis of NSCLC patients by inhibiting tumor progression with a certain degree of safety.