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Objective To investigate the differences in the survival time and the occurrence of complications between esophageal cancer patients treated with fully-covered segmented esophageal internal irradiation stent and esophageal cancer patients treated with conventional esophageal internal irradiation stent.Methods The clinical data of 66 esophageal cancer patients,who had received esophageal internal irradiation stents placement,were retrospectively analyzed.The patients were divided into the study group (using fullycovered segmented esophageal internal irradiation stent,n=30) and the control group (using conventional esophageal internal irradiation stent,n=36).The postoperative complications,including restenosis,stent migration,chest pain,etc.,and the survival time of the two groups were recorded.The results were analyzed,and P＜0.05 was considered to be statistically significant.Results No statistically significant difference in the restenosis rate existed between the study group and the control group (20.0％ vs.30.6％,P=0.403);although the median time of restenosis in the study group was longer than that in the control group (161.5 d vs.138 d,P=0.025).The stent migration rate in the study group was higher than that in the control group (33.3％ vs.8.3％,P=0.014).The difference in the median time of stent migration between the two groups was not statistically significant (91.5 d vs.166 d,P=0.236).No statistically significant difference in the median survival time existed between the two groups (186 d vs.178 d,P=0.486).No statistically significantly differences in the incidence of other stent-related complications existed between the two groups.Conclusion Fully-covered segmented esophageal internal irradiation stent can delay the occurrence of restenosis,although it can increase the stent migration rate to a certain degree.
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Objective To evaluate the efficacy of 125Ⅰ brachytherapy alone for the treatment of recurrent parotid gland carcinoma.Methods Recurrent parotid gland carcinoma patients (n =24) treated by 125Ⅰ brachytherapy alone between 2006 and 2013 at Peking University Hospital of Stomatology were enrolled in this retrospective study.All patients underwent surgery or radiotherapy.The local control rate,survival rate,and side effects were evaluated.Results The median follow-up time was 21 months (range,4-59 months).Among the 24 patients,6 had local failure and 10 died during the follow-up period.The 1-and 3-year overall survival rates,progression-free survival rates,local control rates were 74.8％ and 39.3％,74.8％ and 31.5％,82.0％ and 69.4％,respectively.No grade 3 or over radiation injury was found.Conclusions 125Ⅰ seed brachytherapy alone could provide an ahernative treatment method for inoperable recurrent parotid gland carcinoma patients.
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Objective To explore the feasibility, safety and preliminary efficacy of radioactive gastric tube of 125Ⅰ seeds in the treatment of advanced esophageal carcinoma. Methods For 10 cases with advanced esophageal carcinoma, the tumor target area was outlined in the TPS system according to preoperative CT images. Prescription dose was 60 Gy with 125Ⅰ seed radioactivity of 2. 22 × 107 Bq. Accordingly, the 125Ⅰ seeds number and the appropriate gastric tube was decided. Then, depending on the location of the tumor and certain rules, 125Ⅰ seeds were fixed in the tube wall to make the radioactive 125Ⅰ seeds gastric tube. Under the C-arm X-ray fluoroscopy, the radioactive 125Ⅰ seeds gastric tubes were placed into esophageal carcinoma site of the patients. Results The radioactive 125Ⅰ seeds gastric tubes of 10 patients were successfully placed, without esophageal perforation, bleeding complications and so on. In one month after operation, all patients with dysphagia′s Stooler classification score were 2 -3 level,of which one case died of other basic diseases in three months after operation, and six cases achieved 0 -1 level while the other three cases achieved 1 -2 level in four months after operation. There were no cases of postoperative chest pain, bleeding, pneumonia and other related complications. Conclusions The radioactive 125Ⅰ seeds gastric tube could not only help to solve nutrition problems, but also the intracavitary brachytherapy inhibit the growth of tumor, which is safe and feasible in clinical use. It can be used as a palliative treatment for patients with advanced esophageal carcinoma.
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Objective To study the dosimetry distribution of 125Ⅰ seed chains with different radians in different curvatures of bile ducts. Methods The outlines were drawn on the papers, which are the seed chain models with different radians. Radians formula (radian length=2πr × angle/360) was used to calculate the corresponding 0°, 30°, 60°, 90°, 120°, 150° and 180° models with a radian length at 45 mm, for the total length of seed chain model was 45 mm, and the seeds, had no interval or linear arrangements. The image was transmitted to the Brachytherapy planning system for seeds implantation( TPS) to simulate the seed chains with different radians. Using TPS to delineate the tumor target area, of which the activity was set as 1. 85 × 107 Bq, and the prescription dose was 60 Gy. It was prescribed to simulate the bile duct ( diameter at 8 mm) . TPS were used to calculate the D90 and V100 of the simulated bile duct with the diameter at 8 mm, and explore dosimetry of the points at the centripetal and centrifugal sides with 5 mm vertical distance which from two endpoints and center of seed chains with different radians. Results When the radian of seed chain was 30°, the D90and the V100 were the highest (the D90 was 132 Gy; the V100 was 100%). While the radian was 60°, the D90 and the V100 were the lowest (the D90 was 45 Gy, the V100 was 68%). As the radian was 30°, the highest dose was in the center ( dose in the centripetal side was 165 Gy, and centrifugal side dose was 142 Gy) . The center has the lowest dose as the radian up to 180°(dose in the centripetal side was 90 Gy, and centrifugal side dose was 50 Gy) . Among all radians, dose in the centripetal side was always higher than centrifugal side in the center. Between two endpoints, dose in the centrifugal side was higher than centripetal. Conclusions Distribution of seed chain dosage also changed along with the change of radian. When the radian of seed chain was 30°, the D90 and the V100 were the highest. The centripetal dose was higher than that of the centrifugal side.
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Objective To explore the quality control and the short-term curative efficacy of 125Ⅰ radioactive seeds implantation in the treatment of spinal metastases by using co-planar template ( CPT ) assisted CT guidance. Methods Totally 12 cases of primary tumor were diagnosed by pathology, imaging changes for 16 lesions were consistent with the characteristics of spinal metastatic tumor. The prescription dose (PD) was 80 Gy, seed activity was 1. 48 × 107 -2. 59 × 107Bq(0. 4 -0. 7 mCi). According to preoperative plan, spinal metastases were treated with CPT assisted CT guided 125Ⅰ radioactive seeds implantation. The distribution of seeds was observed immediately after operation and the dose was assessed. Patients were followed up by CT to determine the change of tumor diameter and evaluate the efficacy. Follow-up time ranged from 3 to 29 months. And the improvement of pain was evaluated by pain grading. Results All of the 16 spinal metastases lesions were successfully implanted by the preoperative planning. After the implantation, quality verification showed the average dose of target region was (209. 21 ± 37. 16) Gy, D90 ( 115. 29 ± 7. 87 ) Gy, D100 ( 76. 59 ± 5. 53 ) Gy, V90 ( 99. 30 ± 0. 51 )%, V100 ( 98. 06 ± 1. 15 )%, conformal index (CI) 0. 981 ± 0. 012, external index (EI) 0. 012 ± 0. 007. And the average dose of the spinal cord was ( 30. 47 ± 4. 83 ) Gy. There was no significant difference in the mean dose between the target area and the spinal cord and the preoperative plan ( P>0. 05 ) . 3 months after surgery, among 16 spinal metastases lesions, complete response ( CR ) was 18. 8% ( 3/16 ) , PR ( partial response ) rate 62. 5% (10/16), PD(progressive disease) rate 6. 25%(1/16),SD(stable disease) rate 6. 25%(1/16), effective rate ( CR + PR ) 81. 3%. The were 3 cases in pain complete remission, 7 cases in partial remission, 2 cases in mild remission. The survival time range from 11 to 39 months. The median survival time was 24 months. No radiation damage of spinal cord was found. Conclusions CT guided CPT can be used to control the position and radiation dose of the seeds implantation before the operation, so as to achieve the objective of treating tumor with fewer complications and improvement of patients′tolerance.
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As a standard method for early stage prostate cancer, 125Ⅰ seed implantations are used widely in America. Although there are guidelines from American Brachytherapy Society and American Association of Physicists in Medicine, some hospitals still cannot implant the seeds properly according to the guidelines. Complications were observed inevitably. The medical events about seeds implantation in America from 2002 were investigated and the reasons were analyzed in this paper. Additionally, some solutions were given to avoid the medical events, so that the practitioners in China can learn from it and make sure the 125Ⅰ seeds implantation can be developed healthily and smoothly.
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Objective To explore the feasibility, safety and preliminary efficacy of radioactive gastric tube of 125Ⅰ seeds in the treatment of advanced esophageal carcinoma. Methods For 10 cases with advanced esophageal carcinoma, the tumor target area was outlined in the TPS system according to preoperative CT images. Prescription dose was 60 Gy with 125Ⅰ seed radioactivity of 2. 22 × 107 Bq. Accordingly, the 125Ⅰ seeds number and the appropriate gastric tube was decided. Then, depending on the location of the tumor and certain rules, 125Ⅰ seeds were fixed in the tube wall to make the radioactive 125Ⅰ seeds gastric tube. Under the C-arm X-ray fluoroscopy, the radioactive 125Ⅰ seeds gastric tubes were placed into esophageal carcinoma site of the patients. Results The radioactive 125Ⅰ seeds gastric tubes of 10 patients were successfully placed, without esophageal perforation, bleeding complications and so on. In one month after operation, all patients with dysphagia′s Stooler classification score were 2 -3 level,of which one case died of other basic diseases in three months after operation, and six cases achieved 0 -1 level while the other three cases achieved 1 -2 level in four months after operation. There were no cases of postoperative chest pain, bleeding, pneumonia and other related complications. Conclusions The radioactive 125Ⅰ seeds gastric tube could not only help to solve nutrition problems, but also the intracavitary brachytherapy inhibit the growth of tumor, which is safe and feasible in clinical use. It can be used as a palliative treatment for patients with advanced esophageal carcinoma.
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Objective To study the dosimetry distribution of 125Ⅰ seed chains with different radians in different curvatures of bile ducts. Methods The outlines were drawn on the papers, which are the seed chain models with different radians. Radians formula (radian length=2πr × angle/360) was used to calculate the corresponding 0°, 30°, 60°, 90°, 120°, 150° and 180° models with a radian length at 45 mm, for the total length of seed chain model was 45 mm, and the seeds, had no interval or linear arrangements. The image was transmitted to the Brachytherapy planning system for seeds implantation( TPS) to simulate the seed chains with different radians. Using TPS to delineate the tumor target area, of which the activity was set as 1. 85 × 107 Bq, and the prescription dose was 60 Gy. It was prescribed to simulate the bile duct ( diameter at 8 mm) . TPS were used to calculate the D90 and V100 of the simulated bile duct with the diameter at 8 mm, and explore dosimetry of the points at the centripetal and centrifugal sides with 5 mm vertical distance which from two endpoints and center of seed chains with different radians. Results When the radian of seed chain was 30°, the D90and the V100 were the highest (the D90 was 132 Gy; the V100 was 100%). While the radian was 60°, the D90 and the V100 were the lowest (the D90 was 45 Gy, the V100 was 68%). As the radian was 30°, the highest dose was in the center ( dose in the centripetal side was 165 Gy, and centrifugal side dose was 142 Gy) . The center has the lowest dose as the radian up to 180°(dose in the centripetal side was 90 Gy, and centrifugal side dose was 50 Gy) . Among all radians, dose in the centripetal side was always higher than centrifugal side in the center. Between two endpoints, dose in the centrifugal side was higher than centripetal. Conclusions Distribution of seed chain dosage also changed along with the change of radian. When the radian of seed chain was 30°, the D90 and the V100 were the highest. The centripetal dose was higher than that of the centrifugal side.
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Objective To explore the quality control and the short-term curative efficacy of 125Ⅰ radioactive seeds implantation in the treatment of spinal metastases by using co-planar template ( CPT ) assisted CT guidance. Methods Totally 12 cases of primary tumor were diagnosed by pathology, imaging changes for 16 lesions were consistent with the characteristics of spinal metastatic tumor. The prescription dose (PD) was 80 Gy, seed activity was 1. 48 × 107 -2. 59 × 107Bq(0. 4 -0. 7 mCi). According to preoperative plan, spinal metastases were treated with CPT assisted CT guided 125Ⅰ radioactive seeds implantation. The distribution of seeds was observed immediately after operation and the dose was assessed. Patients were followed up by CT to determine the change of tumor diameter and evaluate the efficacy. Follow-up time ranged from 3 to 29 months. And the improvement of pain was evaluated by pain grading. Results All of the 16 spinal metastases lesions were successfully implanted by the preoperative planning. After the implantation, quality verification showed the average dose of target region was (209. 21 ± 37. 16) Gy, D90 ( 115. 29 ± 7. 87 ) Gy, D100 ( 76. 59 ± 5. 53 ) Gy, V90 ( 99. 30 ± 0. 51 )%, V100 ( 98. 06 ± 1. 15 )%, conformal index (CI) 0. 981 ± 0. 012, external index (EI) 0. 012 ± 0. 007. And the average dose of the spinal cord was ( 30. 47 ± 4. 83 ) Gy. There was no significant difference in the mean dose between the target area and the spinal cord and the preoperative plan ( P>0. 05 ) . 3 months after surgery, among 16 spinal metastases lesions, complete response ( CR ) was 18. 8% ( 3/16 ) , PR ( partial response ) rate 62. 5% (10/16), PD(progressive disease) rate 6. 25%(1/16),SD(stable disease) rate 6. 25%(1/16), effective rate ( CR + PR ) 81. 3%. The were 3 cases in pain complete remission, 7 cases in partial remission, 2 cases in mild remission. The survival time range from 11 to 39 months. The median survival time was 24 months. No radiation damage of spinal cord was found. Conclusions CT guided CPT can be used to control the position and radiation dose of the seeds implantation before the operation, so as to achieve the objective of treating tumor with fewer complications and improvement of patients′tolerance.
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As a standard method for early stage prostate cancer, 125Ⅰ seed implantations are used widely in America. Although there are guidelines from American Brachytherapy Society and American Association of Physicists in Medicine, some hospitals still cannot implant the seeds properly according to the guidelines. Complications were observed inevitably. The medical events about seeds implantation in America from 2002 were investigated and the reasons were analyzed in this paper. Additionally, some solutions were given to avoid the medical events, so that the practitioners in China can learn from it and make sure the 125Ⅰ seeds implantation can be developed healthily and smoothly.
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Objective To study the effective dose and precaution time of the irradiation of the close contact from the radiators who underwent implantation of radioactive 125Ⅰ seeds so as to guide scientifically people how to avoid radiation damage.Methods Twenty patients with different types of cancer underwent implantation of radioactive 125Ⅰ seeds with the median value of implantation depth of 2.16 cm.Within 24hs after the operations the dose rates 30 cm and 100 cm from the skin were measured with pocket-size radiometer so as to imitate the situations of the close contacts.The effective doses and precaution times of different persons were calculated according to relevant formula.Results The dose rate a person received at the same time points (1,54,78,and 109 d,respectively) decreased along with the increase of the distance from the skin (t =5.962,5.961,5.961,5.962,P ＜ 0.05).and the dose rate a person received at the same distance from the skin decreased along with the extension of time (30 cm:t =6.236,6.236,6.235,P＜0.05;100 cm:t=7.310,7.315,7.314,P＜0.05).At different time points,the dose rates at 30 cm distance point were all significant higher than those at the 100 cm point (P ＜0.05).The adult living together,minors and pregnant women sharing the room,colleagues,adults who slept together with the patients began to reach the 50％ dose constraint values 0,54,78 and 109 days after the operation.Conclusions After their precaution time,it's safe to contact with the patients for the groups;otherwise,it's necessary to take some protect works within the precaution time.
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Objective To explore the method for measuring and calculating both absorbed dose and effective dose received in organ and tissues of occupational workers by using TLDs for the implantation of 125Ⅰ seed sources.Methods The experiments with 60Co γ-rays were carried out for the stability.A group of TLD chips was exposed to 125Ⅰ seed sources to establish standard dose curve for air kerma.During the 125Ⅰ seed implantation, the TLD chips were pasted to 13 locations like thyroid inside and outside the lead aprons worn by occupational workers to measure average absorbed dose and calculate the absorbed doses and effectives to organs and tissues.Results For 3 cases of prostate cancers with implantation of 125Ⅰ seeds, the worker's organs and tissues received the absorbed dose 0.02 -3.80 μ Gy and effective dose 0.06- 1.81 μSv outside lead aprons and the highest absorbed dose 2.35 μ Gy and effective 0.02 μSv inside lead aprons, respectively, with more than 65.9% of rays shielded.For 3 cases of brain cancers with implantation of 125Ⅰ seeds, the workers received the absorbed dose 0.23 - 11.31 μGy and effective dose 0.88 - 4.07 μSv outside lead aprons and the highest absorbed dose 2.22 μ Gy and effective dose 0.09 μSv inside lead aprons, respectively, with more than 54.5% of rays shielded.For 3 cases of lung cancers with implantation of 125Ⅰ seeds, the workers received the absorbed dose 0.03 - 14.78 μGy and effective dose 0.35 -7.59 μSv outside lead aprons and the highest absorbed dose 4.09 μGy and effective 0.22 μSv inside lead aprons, respectively, with more than 58.4% of rays shielded.For 2 cases of mediastinum cancers with implantation of 125Ⅰseeds, the workers received the absorbed dose 0.06 - 74.91 μGy and effective dose 0.83 - 17.96 μSv outside lead aprons and the highest absorbed dose 10.29 μGy and effective 0.5 μSv inside lead aprons, respectively, with more than 85% of rays shielded.For one case of ovary cancer with implantation of 125Ⅰ seeds, the worker received the absorbed dose 0.09 - 14.29 μGy and effective dose 2.40 - 4.50 μSv outside lead aprons and the highest absorbed dose 7.77 μGy and effective 0.12 μSv inside lead aprons, respectively, with more than 34% of rays shielded.For one case of eye cancer with implantation of 125Ⅰ seeds, the workers received the absorbed dose 2.2 -39.84 μGy and effective dose 4.48 - 10.06 μSv outside aprons and the highest absorbed dose 5.19 μGy and effective 0.16 μSv inside aprons, respectively, with more than 54.6 % of rays shielded.Conclusions The method of using TLDs to measure the doses to the occupational workers in the course of the implantation of 125Ⅰ seed sources is simple and easy to operate.It would be an effective approach to protecting medical workers in the case of brachytherapy.
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Objective To investigate the application value of early evaluation and monitoring of 125Ⅰ interstitial implantation in a pancreatic cancer xeuograft.Methods Xenograft models were created by subcutaneous injection of Sw 1990 human pancreatic cancer cell suspensions into the right hind limbs of the immunodeficient BABL/c nude mice.The tumors size were about 8-10 mm after two weeks.The mice were randomly divided into 3 groups,including control group (n = 4) ,empty seed implantation group (n = 4)and 125Ⅰ implantation group (n = 4).Before treatment and one week after treatment,18F-FDG Micro-PET/CT scan was performed and then maximum standardized uptake values (SUVmax),mean standardized uptake values (SUVmean),tumor size and necrosis rate were measured.HE staining and TK1 immunohistochemistry examination were carried out in the paraffin-embedded sample.Results Before treatment the SUVmax and SUVmean values of three groups did not reach statistical significance.One week after treatment the SUVmax and SUV values of three groups were 3.53 + 1.20 and 0.57±0.26 vs.3.83±2.13 and0.59 ±0.24vs.0.29±0.23 and0.016±0.001,respectively,with a significant difference (F =7.62,P =0.01 ; F = 10.34,P =0.005).The SUVmax and SUVmean values of 125Ⅰ implant group were significantly lower than empty seed implant group and control group and were significantly lower than before treatment.Before treatment,tumor necrosis rate of three groups were not significantly different.Immunohistochemical staining found the TK1 positive staining index of three groups were respectively (64.25±1.71) % ,(62.25±2.22) % and (38.25±1.71) % with statistically significant difference (F =233.67,P < 0.001).The TK1 positive staining index of 125Ⅰ implant group was significantly lower than empty seed implant group and control group.The SUVmax values had some positive correlation with TK1 positive staining index (r = 0.85,P = 0.001).Conclusions 18F-FDG Micro-PET/CT may be useful as a noninvasive imaging modality to assess early response to 125Ⅰ seed brachytherapy in a pancreatic cancer xenograft.
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ObjectiveTo investigate the effect of interstitial brachytherapy with 125Ⅰon human esophageal carcinoma implanted in nude mice. MethodsAnimal model simulating human esophageal carcinoma was established by subcutaneous implantation of cultured Eca-109 cell lines into nude mice.The mice were randomly divided into 3 groups,namely control group (saline plus empty seed),125Ⅰ seed group (22.2 MBq×1 seed),and DDP group (cisplatin at the dose of 1 mg/kg),to receive corresponding treatment.The growth rate and the pathological changes of esophageal carcinoma were observed.ResultsThe animals were sacrificed 16 days after irradiation.The average tumor weight in control group,125Ⅰ seed group,and DDP group were (0.20±0.06) g, (0.12±0.03) g and (0.12±0.05 ) g,respectively (P<0.05).Pathological findings included degeneration and necrosis of the tumor cells.Compared to the control group,the necrosis areas in 125Ⅰ seed group and DDP group were significantly larger than those in control (P<0.05).Conclusion125Ⅰ seed brachytherapy in esophageal carcinoma could cause degeneration and necrosis of the tumor cells and had inhibitory effect on tumor growth.
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Objective To evaluate the efficacy of percutaneous CT guided interstitial 125Ⅰ seeds implantation treatment for refractory pelvic malignant tumors and discuss the procedure of technique.Methods Twenty-three patients with refractory pelvic malignant tumors(25 lesions,diameter 3.5-7.0 cm,mean 4.5 cm) showing failure response to full chemotherapy and/or radical radiotherapy after tumors resection were undergone percutaneous CT guided intratumoral 125Ⅰseed implantation.Treatment plan system(TPS)was used to design the distribution and number of 125Ⅰ seeds according to matched peripheral dose(MPD)1-3 days before the procedure.Of which 6 cases received combined internal iliac arterial infusion chemotherapy before or after the 125Ⅰ seed implantation procedure.Results 9 ～ 75(mean 27)125Ⅰ seeds were implanted into a single tumor at first time including 6 patients with intraarterial chemotherapy for 14 cycles(mean 2.3 cycles),showed relief of clinical pain symptoms in 16 of 23 cases,72 h ～ 4 w after the seeds implantation;with the an effective rate of 69.6%.Follow up for 2-34 months(median,21 months),CT or MRI performed 2 months after the seeds implantation showed no CR,but PR in 18 cases,SD in 4 cases,and PD in 1 case,with overall response rate of 78%(18/23),and no serious complication.In addition,20 cases survived,with the longest one of 34 months and the other 3 died.Conclusions Intratumoral 125Ⅰ seeds implantation under CT guidance for pelvic refractory malignant tumors is safe,minimally invasive,and effective.
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0.05).Conclusion Multi-disciplinary techniques combined with 125Ⅰ seeds implantation is effective in the management of the malignant obstructive jaundice.No significant difference for relief and liver function were found between CT-guided and during operation interstitial 125Ⅰ seeds implantations,but it seems more quickly relief or recovery was achieved in the latter.