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Objective:To explore the value of digital information line mark coplanar template (also referred to as the line mark template) in 125I radioactive seed implantation for the treatment of lung cancers. Methods:A retrospective analysis was conducted for 58 cases of lung cancers who were treated with template-assisted seed implantation in Oncology Department of the Second Hospital of Tianjin Medical University from Aug 2017 to May 2019.Line mark templates were adopted for 30 cases (the line mark template group) and general standard coplanar templates (also referred to as the general template) were used for 28 cases (the general template group). Pre-plan and post-implant parameters were compared, including the minimum prescription dose delivered to 90% of target volume ( D90), minimum peripheral dose (MPD), mean percentages of volume receiving 100%, 150% and 200% of the prescription doses ( V100, V150 and V200), external index (EI), conformity index (CI), and homogeneity index (HI) of target volume.The operation duration was also compared between the two groups. Results:There was no statistical difference between pre-plan and post-implant D90, MPD, V100, V150 and V200 in the line mark template group ( P>0.05). There was also no statistical difference between pre-plan and post-implant D90, MPD, V100, V150 and V200 of the general template group ( P>0.05). The operation duration of the line mark template group and the general template group was (44.3±12.4) and (60.0±12.8) min, respectively ( t=-3.03, P<0.05). Conclusions:The use of template-assisted seed implantation can accurately achieve preoperative planning, while the line mark template shortens the operation duration and thus improves the tolerance of patients.
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Objective:To evaluate the pre- and post-implantation dosimetric consistency and efficacy of CT-guided 125I radioactive seed implantation for the treatment of the local recurrence of lung cancers under the assistance of a universal coplanar template (also referred to as the universal template). Methods:This study involved 38 patients with a local recurrence of non-small cell lung cancers who received universal template-assisted 125I radioactive seed implantation in the Second Hospital of Tianjin Medical University from Jan 2009 to Dec 2015.Preoperative planning was carried out before implantation, and the prescription dose was 110 Gy.The paired T-test was adopted for cooperation between intraoperative verification result and pre-plan values of the dosimetric parameters including minimum peripheral dose (MPD), the minimum prescription doses delivered to 90% and 100% of the target volume ( D90 and D100), conformity index (CI), external index (EI), and homogeneity index (HI). The efficacy was evaluated at the 6th month after implantation according to the RECIST 1.1 (Response Evaluation Criteria in Solid Tumors). Results:All patients successively received the seed implantation.The pre-plan and post-implant dosimetric parameters were as follows: MPD (222.7±26.2), (227.74±29.8) Gy; D90(130.8±13.6), (134.8±12.8) Gy; D100 (106.4±10.6), (110.7±11.8) Gy, CI ( 0.75±0.06), (0.74±0.04), EI(22.7±5.8)%, (24.3±4.8)%; HI(36.8±4.7)%, (37.2±5.3)%, the mean irradiation dose of hearts (19.3±7.2), (21.3±6.8) Gy( P> 0.05). The median follow-up period was 22.5 months (8-98 months). The median survival was 21 months (95% CI, 7.4-34.6), and the 2-year overall survival (OS), progression-free survival (PFS), and local control (LC) rate were 47.4%, 39.5%, and 83.5%, respectively. Conclusions:The universal template-assisted and CT-guided 125I radioactive seed implantation in the treatment of postoperative local recurrence of non-small cell lung cancers can achieve the goal of the preoperative TPS planning during the operation and achieve good efficacy.It is a minimally invasive, accurate, safe and effective therapy.
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Objective:To investigate the feasibility, efficacy, and safety of CT- and bronchoscopy-guided 125I seed implantation in the treatment of central lung cancer complicated with atelectasis. Methods:Retrospective analysis was conducted on twenty-nine patients who were treated from May 2016 to Oct 2019 in the Second Hospital of Tianjin Medical University for central non-small-cell lung carcinoma complicated with pulmonary atelectasis that was inoperable due to medical reasons. 125I seeds were implanted into the trachea under the guidance of bronchoscopy first.The 125I seeds were then implanted into the hilum of the lungs by percutaneous puncture under the guidance of the CT and template.The seed activity was 18.5-29.6 MBq, and the prescription dose was 120 Gy.TPS planning and quality verification were performed before and after the operations.The rate of atelectasis recanalization, the satisfactory rate of dose verification, the improvement of dyspnea index, the survival time, and the adverse events during and after operation were observed. Results:All 29 patients with lung cancer complicated with atelectasis successfully completed the seed implantation, and the satisfactory rate of quality verification was 93.1%.The rate of atelectasis recanalization at 2, 6, 12, 18, and 24 months was 93.1%, 89.7%, 78.6%, 76.2%, and 60%, respectively.Their dyspnea and anoxia symptoms were significantly relieved in 5-28 months after treatment.The results showed that the patients′ dyspnea index was 2.8-0.8 before treatment and 1.4-0.9 after treatment.The median follow-up period was 20 months and median survival was 21 months.Adverse events associated with the radiation therapy included pneumothorax, hemoptysis, cough, fever, and particle displacement.No level-3 or more serious adverse events occurred.Conclusions:The CT- and bronchoscopy-guided 125I seed implantation is a safe and effective therapy option for the treatment of central non-small-cell lung carcinoma associated with atelectasis.It contributes to a high rate of local recanalization, and can rapidly improve clinical conditions and quality of life of the patients with few adverse reactions.
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Objective To evaluate the clinical efficacy and prognostic factors of limited-stage small cell lung cancer ( LS-SCLC) treated with 125 I radioactive seed implantation guided by CT combined with systemic chemotherapy. Methods A total of 128 limited-stage small cell lung cancer patients were treated with 125 I radioactive seed implantation combined with chemotherapy from Jun 2008 to Jun 2012 in Tianjin Medical University Second Hospital. Theχ2 test was used to analyze the influencing factors of short-term efficacy. Survival rate was calculated by Kaplan-Meier method, single factor analysis was performed by Log-rank, and multivariate analysis was performed by Cox proportional hazard model. Results Totally 128 patients finished the treatment. The overall response rate was 86.7％ ( 111/128 ) after 6 months of treatment. The 1-, 2-and 3-year overall survival rate was 77.9％, 39.8％and 28.0％, respectively, and the median survival time was 21.0 months. The univariate analysis showed that the following factors were main prognostic factors:age, performance status ( PS) , hemoglobin≥120 g/L before treatment, smoking index, the maximum diameter of tumor, neuron-specific enolase before treatment, subscribe for prophylactic cranial irradiation ( PCI) , number of chemotherapy cycle, chemotherapy response, prescribed dose ( PD ) , postoperation dose covering 100％ volume ( D100 ) , remedial model. multivariate analysis revealed that age, PS, hemoglobin≥120 g/L before treatment and PD, the maximum diameter of tumor, number of chemotherapy cycle, chemotherapy response, and remedial model were the independent prognostic factors for survival. 29 patients of 128 suffered from aerothorax and the incidence rate of aerothorax was 27.7％. Totally 16 patients occurred hemoptysis and theincidence rate was 12.5％. Conclusions 125 I radioactive seed implantation therapy showed good effecacy in the treatment of LS-SCLC. Age, PS, hemoglobin≥120 g/L before treatment, the maximum diameter of tumor, number of chemotherapy cycle, chemotherapy response, and remedial model might be the main prognostic factors for LS-SCLC patients.
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Objective To investigate whether quality assurance and quality control using multimodal image guidance and radiation dosimetry optimization could ensure and improve the targeting of 125I seeds brachytherapy.Methods A total of 287 patients (184 males,103 females,average age 61.9 years) with non-small-cell lung cancer (NSCLC) and 122 patients (average age 65.5 years) with prostate cancer who were diagnosed by pathology or imaging methods (coincidence imaging,CT,flexible fiberoptic bronchoscopy,ultrasonography) from October 2002 to October 2016 were retrospectively enrolled.All imaging methods were used to locate the target area.Optimization of radiation dosimetry was made according to treatment planning system (TPS) and evaluated by dose-volume histogram (DVH).125I seeds implantation was performed under the imaging guidance,followed by real-time location verification,dosimetric verification.Therapeutic efficacy was evaluated.Paired t test was used to analyze the data.Results The prescribed dose (PD) of planning target volume (PTV) was above 140 Gy.Immediate dosimetric verification was performed in 59 patients with NSCLC and 31 patients with pulmonary metastases.The radiation dose before and after the implantation was coincident in 93.2％ (55/59) of NSCLC and 93.5％ (29/31) of pulmonary metastases.The coincident rate of patients with dose delivered to 90％ GTV (D90)＞matched peripheral dose (MPD) was 93.2％ (55/59) and 87.1％ (27/31) respectively in NSCLC and pulmonary metastases.There was no significant difference in MPD,D90 and conformity index (CI) before and after implantation (t values:2.11-9.71,all P＞0.05).The average dose of the risk organs was significantly lower than the tolerance dose of the normal tissue.The incidence of radiation pneumonitis was 1.05％ (3/287).No other serious complications were found.Conclusion Targeted diagnosis and therapy of multimodal image guidance could be optimized to improve the effect of targeting and therapeutic gain ratio of 125I seeds brachytherapy.
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As an interstitial brachytherapy,radioactive seed implantation could provide high doses in the local site and minimal doses at surrounding normal tissues.It has become one of the best choice for early stage prostate carcinoma.Radioactive seeds were implanted under the guidance by ultrasound,CT and MRI,featured with surgical and interventional treatment.Based on dosimetry for target and organs at risk,radioactive seed implantation is multiple disciplinary.In order to acquire the accurate and high quality seed implantation,it is necessary to set up a team including surgeons,radiation oncologists,interventional doctors and nuclear medicine doctors.The content of the consensus is as follows:radiation physics and dosimetry,indications,side-effects and 3 D-printing template work-follow.Despite the benefit of radioactive seed implantation for solid carcinoma,there still a compelling need for prospective randomized and stage Ⅲ clinical trials from multiple centers,so as to upgrade the evidencebased level,above all confirm the role of radioactive seed implantation in the comprehensive treatment of tumors.
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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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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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Objective To explore the therapeutic effect of radioactive 125I seeds combined with chemotherapy on the treatment of inoperative pancoast tumor by CT-guided percutaneous implantation of treatment planning system (TPS).Methods From December 2002 to December 2010,36 patients with pancoast tumor were confirmed by imaging and pathology.Among them,26 cases suffered from squamous cell carcinoma and 10 cases with adenocarcinoma.At 1 week after radioactive 125I implantation,chemotherapy was administered as intravenous 1 000 mg / m2 gemcitabine at 1 and 8 d and intravenous cisplatin 75 mg/ m2 at 1 d for 4 consecutive cycles.The prescribed dose (PD) was 120 Gy,and the median activity of the seeds was 0.7 mCi (2.59 × 107 Bq) with the range of 0.68-0.82 mCi (2.52 × 107-3.03 × 107 Bq).The patients were followed-up and the median follow-up time was 48 months.The survival rate was observed.Results The mPD of the target tumor was (118.7 ± 7.2) Gy,D90(126 ± 4.7) Gy,D90 ＞ mPD.The rate of CR (11 cases) was 63.6％,and the effective rate (CR + PR) was 83.4％.The follow-up last till December 1st,2016.1-,3-and 5-year local control rates were 92％,83％,and 67％,respectively.1-,3-and 5-year cumulative survival rate were 84.1％,56.7％,and 36.8％,respectively.Median survival was 38 months.Conclusions Chemotherapy combined with tissue radioactive 125I seed implantation is a minimally invasive and effective method for the treatment of pancoast tumor.
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Objective To evaluate the dosimetry accuracy and clinical efficacy of 125I radioactive seed implantation using coplanar template (CPT) in the treatment of metastatic or recurrent chest wall tumor.Methods Thirty-one patients with metastasis or recurrence of chest wall tumor,who had been diagnosed with pathology between July 2005 and July 2015,were retrospectively studied.All patients underwent CPT-assisted 125I radioactive seed implantation.Brachytherapy radiation treatment planning system (BTPS) was used to make preoperative plans,and the prescribed dose (PD) was 110 Gy.CPT was used to assist CT guided 125I radioactive seeds implantation.Dose evaluation was performed immediately after implantation.The difference of dose parameters was compared between preoperation and postoperation,including Dg0,D100,V90,V100 and the numbers of seeds.Postoperative chest CT was conducted regularly to assess the treatment efficacy based on the response evaluation criteria in solid tumors (RECIST Version 1.1).The patients were followed up till July 2016.Results All patients went through implantation procedure successfully and there was no significant statistical difference between preoperative and postoperative dose parameters (P ＞ 0.05).The conformal index (CI) was 0.951 ± 0.13,external index(EI) was 6.5％ ±0.9％.Six months after implantation,CR,PR,SD and PD were 25.8％ (8/31),51.6％ (16/31),6.5％ (2/31) and 16.1％ (5/31),respectively.The effective rate was 77.4％,and local control rate was 83.9％ (26/31).Skin pigmentation occurred in 13 patients during the follow-up period,without any special treatment.Conclusions The auxiliary of CPT in the treatment of metastatic or recurrent chest wall tumor under the guiding of CT could achieve quality control,safety and effectiveness.
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Objective To compare the planned radiation dose and the actual dose received after 125I radioactive seeds implantation supported by coplanar template (CPT) in lung cancer patients with mediastinal node metastases 4R,and to evaluate the clinical efficacy.Methods Totally 32 patients with lung cancer with mediastinal lymph node metastases 4R who had been diagnosed via cellular pathology studies were selected from January 2008 to December 2014.The mediastinal lymph node metastases were treated by CPT-assisted 125I radioactive seed implantation.Digital imaging and communications in medicine (DICOM) data were acquired by chest CT scan before implantation,brachytherapy radiation treatment planning system (BTPS) was introduced to carry out the plan,and the prescribed dose(PD) was 120 Gy.CPT was used to control the precision of needle penetration and implantation of radioactive seeds.Computer tomography (CT) was used to ensure the correct position of needles and radioactive seeds.Dose evaluation was performed immediately after implantation and was compared with planned dose using paired t-test.The 6-months postoperative chest CT was conducted to evaluate treatment efficacy according to response evaluation criteria in solid tumors(RECIST Version 1.1).Results All patients went through implantation procedure successfully.Dose evaluation after implantation was as followed.The average dose received (231.9 ±29.6)Gy,the dose received by 90％ of the target(D90) (150.8 ± 16.6) Gy,the dose received by 100％ of the target(D100) (100.4 ± 12.6)Gy,the volume of 100％PD covering the target(V100)(94.1 ± 2.6) ％,the volume of 200％ PD covering the target(V200) (33.0 ± 5.7) ％,the conformal index (CI) 0.75 ±0.06,the external index(EI) (22.7 ± 5.8)％,the average dose received by the superior vena cava (19.3 ± 7.2)Gy,and the average dose received by aorta (12.1 ± 5.1)Gy.Efficacy was followed for 6 months after implantation and the effective rate was 84.37％.There was no serious complications (such as radioactive lung injury,major vascular injury,bleeding,and et al.) occurred in follow-up period.Conclusions CPT assisted CT guided 125I radioactive seed imnplantation in treating mediastinal node metastases 4R can achieve preoperative BTPS,minimize major vascular or organ injury.It is an accurate,effective and safe treatment approach and may be of great value to standardize the procedure of radioactive seed implantation in mediastinal metastases.
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Objective To evaluate the curative effect of CT guided percutaneous puncture of radioactive 125I seeds in treatment of salivary gland carcinoma with lung metastasis.Methods 18 patients with 42 salivary gland carcinoma of the lung metastases,received CT-guided percutaneous puncture of 125I radioactive particles.No other treatment was given.The prescription dose was 80 Gy.Results After six months,CT showed that the tumor complete remission (CR) rate was 28.6％,(12/42),partial response (PR) 57.1％ (24/42),stable disease (SD)9.5％ (4/42),progressive disease(PD)4.8％ (2/42),and the total effective rate 85.7％ (36/42).16 cases survived within 1 year (88.9％),12 cases in 2 years (66.7％),and 9 cases in 3 years (50％).Conclusion CT guided percutaneous puncture of radioactive 125I particles has recent efficacy in treatment of salivary gland carcinoma with lung metastasis in the future.
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Objective:This study aimed to observe the clinical efficacy of implanting radioactive 125I seeds to treat non-small cell lung cancer (NSCLC) on the basis of the recent changes in serum tumor markers (including CEA, CA125, SCC-Ag, and CYFRA21-1). Methods:We selected 72 patients who were pathologically confirmed with NSCLC and received CT-guided percutaneous implantation of radioactive 125I seeds from January 2009 to June 2012. The concentration of the serum tumor markers was detected 3 d before implan-tation and 1, 2, 3, and 6 months after implantation. Result:All of the operations were successfully completed. One month after implan-tation, a significant change was observed in the concentration of serum tumor markers (CEA, CA125, SCC-Ag, and CYFRA21-1) com-pared with their preoperative levels (P<0.01). No significant difference was observed between the different time points after implanta-tion. Conclusion:The treatment of NSCLC by implanting radioactive 125I seeds can effectively reduce the level of tumor markers. A sig-nificant difference was observed in the level of tumor markers between patients with different efficacy classifications.
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Objective To evaluate the effect of CT guided permanent 125I seeds implant brachytherapy on early non-small cell lung cancer (NSCLC) that is not suitable for operation.Methods 18 patients with early stage of NSCLC (stage Ⅰ and Ⅱ) were treated with CT guided permanent seeds 125I implantation from December 2002 to December 2006.The prescribed dose (PD)was 110 Gy,the median activity of 125I seed source was 0.7 mCi.The chest CT detection was performed at 1,2,6 months and 1 year after treatment.The tumor size and the clinical effect were compared before and after treatment.Results The minimum PD in target tumor was (107.7±5.3)Gy,D90 was (113±3.7) Gy,and D9o was more than mPD.The chest CT showed that complete relief (CR) was achieved in 7 patients (38.9％),partial relief (PR) was in 9 patients (50％),stable disease (SD) was in 2 patients (11.1％),no progress disease (PD) was found.The effective rate (CR rate + PR rate) was 92.9％ (16 cases),and local control rate was 88.9％ (16 cases) within one year.During the follow-up to December 2011,the 1,3 and 5 years cumulatively survival rate was 94.4 ％ (17 cases),72.2％ (13 cases),66.7％ (12 cases),56.8％ (10 cases) respectively.Median survival time was 58 months.Conclusions CT-guided permanent 125I seeds implant brachtherapy is effective in the treatment of early non-small cell lung cancer that is not suitable for operation.
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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 evaluate the curative effect of computed tomography (CT)-guided percutaneous implantation of 125I radioactive seeds on inoperable early-stage non-small cell lung cancer (NSCLC). Methods:From January 2003 to December 2012, we selected 48 patients who had pathologically confirmed early-stage NSCLC (stageⅠ, 18 cases;stageⅡ, 30 cases with N0). We treated the nidus by CT-guided percutaneous implantation of 125I radioactive seeds. Six months after implantation, the chest CT-scan was reviewed, and the effect of the treatment was evaluated according to the international standards. Final follow-up was performed in December 2013. Results:All operations were successfully completed. The target tumor matched peripheral doses (MPDs) were 215.8±14.3 Gy (D100), 106.8±11.6 Gy (D90), and 148.6± 17.3 Gy (D90>MPD). Six months after implantation, chest CT was reviewed, and treatment effects were evaluated. The percentages of stage I patients achieving complete relief (CR), partial relief (PR), stable disease (SD), and progressive disease (PD) were 27.8%(5 cases), 72.2%(13 cases), 0%, and 0%, respectively. Among stageⅡpatients, CR, PR, SD, and PD percentages were 0%(3 cases), 73.3%(22 cases), 13.3%(4 cases), and 3.3%(1 case), respectively. The effective rate was 89.6%. The 1-year local control rate was 85%. Until December 2013, the 1-, 2-, and 5-year cumulative survival rates up to the end of the interval were 95.8%(46/48), 81.3%(39/48), and 56.3%(27/48), respectively. Conclusion:CT-guided percutaneous implantation of 125I radioactive seeds is an effective micro-invasive method for treating inoperable early-stage NSCLC.
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Objective To explore the clinical value of the thin-section CT scanning in all the steps of non-small cell lung cancer (NSCLC) therapy through 125I seed implantation. Methods In the 137 patients who were diagnosed with non-small cell cancer (NSCLC), the preoperative targets were delineated by CT scan, and the implantation plan was accom-plished according to treatment planning system (TPS); Intraoperative 125I seeds were implanted under the guidance of CT, then their positions were confirmed and corrected by CT scan layer-by-layer in real time;Post implantation dosimetry was validated also under the help of CT scan. If necessary, distribution and number of seeds should be adjusted to conform dose distribution under the principle of effectivity and micro-invasion;Follow-up and periodic evaluation should also be accom-plished by CT scan. Results Dose-volume histograms (DVHs) showed that the dose in line with the targets meet the re-quirement of prescription dose while the surrounding organs at risk were within the scope of their tolerance dose. Among 137 patients, implanted seeds number was the same with seeds number of TPS plan in 129 patients, and the coincidence rate was 94%. CT scan showed the local control efficient rate was 91.9%after 6 months. The 1-year and 2-year survival rates were 91.2%and 50.4%respectively. No serious operation-led complication was found during treatment. Conclusion The thin-section CT could be applied in all key steps of 125I seed implantation in NSCLC therapy, especially it is clinical significant and irreplaceable in quality assurance and control of seed implantation therapy.
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Objective To observe the pulmonary protective effect of large and small doses of mucosolvan in elderly patients with lung cancer undergoing radioactive seed implantation.Methods 93 patients with non-small cell lung cancer undergoing radioactive seed implantation guided by CT were selected and randomly divided into 3 groups:the high-dose group,the low-dose group and control group (n-31,each).All patients received the mucosolvan treatment with routine immunization and nutrition support after implantation.Patients was given mucosolvan 990 mg/d and 300 mg/d by continuous intravenous pumping in high-dose and small-dose groups respectively.Patients in the control group was given saline.The incidence of pneumothorax and plasma levels of C reactive protein (CRP),tumor necrosis factor alpha (TNF alpha),neutrophils (ANC) were compared between the three groups at 1 d,3 d and 5 d after implantation.Results There was no statistically significant difference in plasm levels of CRP,TNF alpha and ANC between the three groups at 1 d and 3 d after implantation (all P＞0.05).Plasma levels of CRP,TNF alpha and ANC were lower in highdose group than in low-dose group and control group at 5 d after implantation (F=3.596,3.555,3.406,respectively,all P＜0.05).The incidence of pneumothorax was lower in high dose group than in control group (x2 =4.31,P ＜ 0.05).Conclusions Perioperative application of high-dose mucosolvan can relieve lung inflammatory reaction rapidly and reduce the incidence of pneumothorax in elderly lung cancer patients undergoing radioactive seed implantation.
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Objective To evaluate the clinical effects of CT-guided 125I radioactive seed implantation in treatment of stage Ⅲ non-small cell lung cancer ( NSCLC ) and the influential factors of prognosis.Methods 247 patients of stage Ⅲa/Ⅲb NSCLC underwent CT-guided 125I radioactive seed implantation.The clinical effects and the factors affecting prognosis were analyzed by univariate and multivariate analyses.Results The 1-,3-,and 5- year overall survival rates were 82.8％,23.8％,and 11.5 ％,respectively.The median survival time was 24.8 months,and the local control rate was 92.2 ％,63.8％,and 25.7％,respectively.The 5- year overall survival rate was 14.7％,and the median survival time was 29.7 months of the stage Ⅲ,patients.And the 5- year overall survival rate was 11.2％,and the median survival time was 24.0 months at the stage Ⅲb.Univariate analysis showed that age,course of disease,hemoglobin before treatment,clinical stage,maximum diameter of tumor,prescribed dose (PD),post-operational mean dose,post-operational dose covering 100％ volume (D100),remedial model were the main prognostic factors; however,multivariate analysis revealed that hemoglobin ≥ 120 g/L before treatment,post-operational dose covering 100％ volume (D100) and maximum diameter of tumor were the independent risk factors for predicting the survival.Aerothorax was observed in 37 patients with an incidence rate of 14.9％,and hemothorax was observed in 22 patients with an incidence rate of 9％.Conclusions 125I radioactive seed implantation therapy is effective in the treatment of stage Ⅲ NSCLC.Hemoglobin level before treatment,post-operational dose covering 100％ volume (D100 ),and maximum diameter of tumor are the main prognostic factors for the NSCLC patients treated with radiotherapy for NSCLC.
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Objective To investigate the short-term clinical efficacy of CT-guided percutaneous implantation of 125I radioactive seeds in treating the postoperative lung metastases of malignant fibrous histiocytoma(MFH).Methods Eight patients with lung metastases after MFH surgery received CT-guided percutaneous implantation of 125I radioactive seeds.There are 28 metastasis lesions in total.Prescribed dose (PD) was 80 Gy and radioactivity was 0.7 mCi(2.59 × 107 Bq).Six months after implantation,chest CT-scan was performed and the changes were reviewed according to the international standards.ResultsAverage dose received by tumor was ( 172.9 ± 39.9 ) Gy,D100 ( 77.7 ± 10.2 ) Gy and D90 ( 97.2 ± 6.8 ) Gy.The overall response rate was 82.1％.Patients' survival period was 10.0 - 26.0 ( 14.6 ± 3.5 ) months with the median survival time of 13 months.ConclusionIn the treatment of postoperative lung metastases of MFH,implantation of 125I radioactive seeds produces a good short-term clinical efficacy.