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Objective: To investigate the safety and efficacy of 125I radioactive seed implantation in the treatment of mediastinal lymph node metastasis. Methods: Records of 53 patients enrolled in Shaanxi Provincial Tumor Hospital from June 2014 to June 2018 with me-diastinal lymph node metastasis treated by computed tomography (CT)-guided 125I seed implantation were analyzed retrospectively. The preoperative treatment planning system was validated after the surgery. Intraoperative and post-operative complications were re-corded. The improvement in quality of life was observed. Chest CT follow-up was conducted 1 month, 3 months, 6 months, 1 year, and 2 years after treatment. The local focus control was evaluated. The median survival and total survival were recorded, and the survival prognosis and causes of death were analyzed. Results: The median survival time was 254 days (8.5 months), one-year survival rate was 48.67%, and complete and partial response rate was 83.02% (44/53). Multivariate Cox model analysis showed that the survival progno-sis was related to the Eastern Cooperative Oncology Group (ECOG) score, distant metastasis at the time of implantation, concurrent chemotherapy after implantation, and secondary seed implantation (P<0.05). The rates of developing pneumothorax and hemoptysis during and after the surgery were 20.75% (11/55) and 13.20% (7/55), respectively. No patients died. After implantation, the remission rate of cough, shortness of breath, pain, hoarseness, and superior vena cava syndrome was 60.00%-82.61%. Conclusions: CT-guid-ed 125I seed implantation in the treatment of mediastinal lymph node metastasis has the advantages of minimal trauma, remarkable cu-rative effect, safety, and feasibility. It has important application value and is worthy of further clinical application.
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Objective To investigate the value of CT-guided 125I particles implantation combined with gemcitabine plus S-1 (GS) regimen in the treatment of locally advanced pancreatic cancer.Methods 42 patients with unresectable local advanced pancreatic cancer were given with CT-guided 125I seed implantation.3-4 cycles of GS regimen was given based on the tolerance of patient s body within 3-7 d after implantation of particles.Review of blood,CA199,chest X-ray,CT scan + enhanced or MRI were performed at 2nd,4th,6th,12th month after surgery.Results 2nd,4th,6th month after surgery,tumor lesions were significantly reduced,ORRs were 59.5 ％ (25/42),66.7 ％ (28/42) and 73.8 ％ (31/42),respectively,DCRs were 83.3 ％ (35/42),78.6 ％ (33/42) and 76.2 ％ (32/42),respectively.No serious adverse reactions were observed,patient could tolerate these reactions.The 6th,12th,24th month survival rates were 100 ％ (42/42),47.6 ％ (20/42) and 11.9 ％ (5/42),respectively,mPFS was 8.27 months and mOS was 12.00 months.Conclusion CT-guided 125I particles implantation combined with GS regimen is convenient,safe,high efficacy in the treatment of locally advanced pancreatic cancer.
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Objective:To improve the therapeutic gain ratio from 125I seed implants by investigating the QA/QC strategies used in brachytherapy treatment of lung cancer. Methods:A total of 287 lung cancer and pulmonary metastases cases were studied. Among which, 184 are male and 103 are female with a mean age of 61.9 years. The NOA-NSCLC subgroup and pulmonary metastases were targeted on conventional CT positioning. Considering that COA-NSCL subgroup on the tumor target area is difficult to determine with CT, the coincidence circuit SPECT was used to assist in positioning. A dose-volume histogram was constructed to evaluate the quality of the TPS and optimization. Corrections on real-time positioning are necessary when using an image-guided implantation. The C-LC should be aligned with the FFB for CT-guided percutaneous puncture implantation. After implantation, dosimetry verification was con-ducted. Results:The NOA-NSCLC subgroup, comprising the risk organs such as heart, lung, and spinal column, received an average dose of 137, which was significantly lower than that of normal tissue dose tolerance. The NOA-NSCLC subgroup and lung metastases have matched peripheral dosages of 92.1 and 106.2 Gy with local-control efficiency rates of 91.97% (126/137) and 96.0% (48/50), 1-year survival rates of 91.24%and 83.4%(42/50), and 2-year survival rates of 50.36%(69/137) and 52.3%(26/50), respectively. The 35 COA-NSCL subgroup and 65 lung cancer group have local control efficiency rates of 91.43%(32/35) and 92.3%(60/65) and 1-year survival rates of 88.57%(31/35) and 80.30%(53/66), respectively. Conclusion:Proper radiation dosimetry as a QA/QC strategy was found to improve particle-implantation therapy gain and greatly reduce the risks of radiation pneumonia and pulmonary fibrosis.
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OBJECTIVE:To observe the clinical effects of interstitial implantation of 125 I particles together with5-FU slow-release particles for advanced pancreatic cancer.METHODS:A total of12patients with advanced pancreatic cancer whose tumors were unsuitable to be resected were implanted with5-FU slow-releasing particles and then 125 I particles.The intensity of radioactive 125 I particles was0.4mCi～0.5mCi,the matched peripheral dose was60Gy～100Gy,and an average of16 125 I particles and1000mg5-FU were used for each patient.RESULTS:Relief of pain was achieved in all the subjects,with the effective rates of odynolysis at91.7%.The tumor size in all the subjects was diminished to some degree,with local control rate at83.3%.1y survival rate was25%.CONCLUSION:Interstitial implantation of 125 I particles and5-FU slow-release particles for advanced pancreatic cancer is simple,safe and effective.
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Objective To observe the clinical effectiveness and adverse side effects of percutaneous embedding of ~(125)I particles in combination with chemotherapy for advanced non-small cell lung cancer(NSCLC).Methods Twenty-one patients with advanced NSCLC(IIIa-IIIb phase) received percutaneous embedding of ~(125)I particles in combination with concurrent chemotherapy.The chemotherapy was conducted in accordance with TP regime(paclitaxel at 135 mg/m~2 and cisplatin at 30 mg/m~2 were administered on day 1 and on day 2 to 4,respectively with 28 days as a cycle).12～75 ~(125)I particles were embedded with CT-guided percutaneous puncture one week after chemotherapy.The radioactivity quantum was 22～33 MBq per particle.The overall radioactivity quantum of embedded particles was 264-1650 MBq with one or more puncture points.Chemotherapy was then continued for two cycles.Results All the 21 patients completed the therapy,among whom,23.80% got complete response(CR),66.67% got partial response(PR) and 9.53% had stable or progressive disease(NC+PD) with an overall response(CR+PR) of 90.48%.The complications included hemopneumothorax(33.34%),hemorrhage(4.77%),particle migration(4.77%).The incidence rates of radiation esophagitis and radiation pneumonia with grade 1～2 were 4.77%(1/21) and 4.77%(1/21) respectively.No radiation esophagitis or radiation pneumonia with grade 3～4 was found.The incidence rate of grade 3～4 acute myelosuppression comprises 52.38% leucocytopenia,9.53% thrombocytopenia,28.58% decrease of hemoglobin,grade III-IV nausea and 42.86%vomiting,38.10% grade III-IV alopecia.The 1-year survival rate was 80.96%.The 12-month local control rate was 85.72%. Conclusion The results have shown that CT-guided percutaneous embedding of ~(125)I particles in combination with chemotherapy was effective and well-tolerable with few complications and good compliance.