~(125)Iodine seed interstitial implantation combined with external radiotherapy and systemic chemotherapy for recurrent rectal cancers / 中国微创外科杂志

ABSTRACT

Objective To investigate the feasibility, short-term efficacy and adverse effects of 125 I seed implantation guided by ultrasonography or CT in the treatment of recurrent rectal cancers. Methods A total of 15 patients (4 women and 11 men) with recurrent rectal cancer entered the study. Uneer epidural anesthesia, the patients were treated with 125 I seed implantation under the guidance of either transvaginal ultrasonography or CT scans. The prescribed matched peripheral dose (MPD) was 90~110 Gy, with an activity per seed of 0.50~0.70 mCi and the total number of sources implanted of 33~70. Chest and pelvic X-ray examinations were performed within 24~48 hours after implantation to determine whether or not seed misplacement or migration existed. An additional three-dimensional conformal radiation therapy with a 4~6 fields technique was required in 6 patients 4 weeks postoperatively, with 200~300 cGy/fx, 5 fx/week, up to a total dose of 4500~5 000 cGy. Additional chemotherapy with oxaliplatin, 5-fluorouracil and tetrahydrofolic acid for one treatment course was given in 2 patients. The patients were followed for 3~15 months and the tumors were evaluated by CT findings. Results Relief from pain was achieved at a mean of 7 days after procedure, offering a complete relief in 12 patients, a partial relief in 2, and no change in 1, the effective rate being 93%(14/15). Nine patients showed a complete remission, 2 showed a partial remission, 4 showed a progressive disease, the local control rate being 73%(11/15). Two patients died of the dissemination to lungs. In 1 patient 1 seed had migrated to the pelvic side-wall and did not cause any clinical morbidity in a follow-up of 12 months. Conclusion 125 I implantation in recurrence of rectum cancer guided by ultrasonography or CT was safety, minimally invasion, low morbidity and high efficacy, it was worth of development and promotion.