ABSTRACT
Objective To investigate the technique and effect of CT-guided implantation of ~(125)I seeds for patients with brain glioma.Methods A total of 60 cases of brain glioma,that had been diagnosed by CT,MRI,or enhanced MRI,were enrolled in this study.Among the patients,20 were primary cases,and 40 were recurrent cases after surgical treatment (23) or radiotherapy (17).Before implanting the ~(125)I seeds,we pathologically comfirmed the diagnosis by using CT-guided percutaneous puncture. According to the pathological results,we determined the number and distribution of ~(125)I seeds,matched peripheral dose (MPD),and PTV;and then implanted the seeds (4 to 46 seeds per patient) under the guidance of CT.The radioactivity per seed was set at 26, 30,or 33 Mbp,thus the total radioactivity ranged from 132 to 1196 Mbp.The distance between the seeds was 0.5 to 1.0 cm.And the MPD ranged from 80 to 119 Gy.In each patient,percutaneous puncture was performed at one or two sites,and the direction of the needle was changed for 2 to 5 times at each punctural site.The outcomes of the implantation was confirmed by CT scan immediately after the procedure.The patients were followed up by using CT.Results The criteria of curative effect recommended by WHO was adopted.According to these criteria,the effective rate of the procedure was 48.3% (29/60),55.0% (33/60),67.3%(37/55), and 70.0% (35/50) in 1,2,3,and 6 months after the operation,and the rate of hydrocephalus relief was 55.0% (33/60),65.0% (39/60),76.4%(42/55),and 78.0% (39/50) respectively.The patients achieved 1-and 2-years rates of 63.8%(30/47) and 55.2% (16/29) during the follow-up.The median survival time was 18 months in this series (28 months in the patients withⅠanⅡgrades glioma,and 16 months forⅢtoⅣgrades).The total 1-and 2-year survival rate was 78.3% (47/60) and 48.3% (29/60) in our patients,among whichⅠandⅡgrades glioma cases achieved 90.0% (27/30) and 80.0% (24/30),respectively,while those who hadⅢandⅣgrades tumor had lower survival rates [66.7% (20/30) and 16.7% (5/30)].Four patients developed puncture site bleeding,3 had replacement of the particles,and 6 suffered from local necrosis of the brain tissues.No surgery-related death occurred in the patients.Conclusions CT-guided implantation of ~(125)I seeds is effective for the local control of brain glioma.By using the procedure,the brain edema and other symptoms can be relieved,and the survival rate can be increased.