CT-guided 125I seed implantation for the treatment of retroperitoneal malignant tumors：analysis of puncturing approaches / 介入放射学杂志

ABSTRACT

Objective To investigate the safety and feasibility of different puncturing approaches in the performance of CT-guided 125I seed implantation for the treatment of retroperitoneal malignant tumors. Methods The clinical data of twenty-five patients with retroperitoneal malignant tumors, who had underwent CT-guided 125I seed implantation, were retrospectively analyzed. The puncturing approaches included trans-hepatic route, trans-gastric route, trans-duodenal route, and through mesentery and through thoracolumbar iliocostalis. The malignant tumors included retroperitoneal lymph node metastases (n=21) and pancreatic cancer (n=4). Preoperative full bowel preparation was carried out in all patients, and treatment planning was formulated by using treatment planning system (TPS) before the procedure. Under CT guidance, proper puncturing approach was selected according to lesion's location. One to 3 needles were used to implant 125I seeds. Immediately after 125I seed implantation, CT scanning was performed to check the distribution of 125I seeds. Results CT-guided 125I seed implantation was successfully completed in all patients. The puncturing approaches used in this series included trans-hepatic route (n=21), trans-gastric route (n=9), trans-duodenal route (n=2), through mesentery (n=2) and through thoracolumbar iliocostalis (n=5). After the operation, no procedure-related complications such as bleeding, peritonitis, hematemesis or melena occurred in all patients. The postoperative 125I particle number, total activity and peripheral dose (D90) were not significantly different from the preoperative data. Conclusion The use of the five puncturing approaches mentioned above is clinically safe and feasible. Strict perioperative management measures should be carefully executed when through cavity organ implantation is employed.