Permanent Iodine-125 Seed Implantation for the Treatment of Nonresectable Retroperitoneal Malignant Tumors.

PURPOSE: This study aimed to investigate the outcomes of permanent Iodine-125 (125I) radiotherapy for patients with unresectable retroperitoneal malignant tumor. METHODS: Twenty-six patients with retroperitoneal malignant tumors were implanted with 125I seeds under ultrasound guidance from June 2012 to June 2015. The patients were then followed up for 3 to 36 months after the implantation. During the follow-up, pain relief, control of tumor growth, over survival rate, and complications were evaluated. RESULTS: Most of the patients (90%, 24/26) suffered from mild to severe pain before 125I seed treatment. After 1-month treatment, 16 patients had 100% pain relief, 4 patients had at least 50% pain relief, and 4 patients had no response, showing 83.3% of pain relief response. Results of computed tomography scan after 2-month 125I treatment indicated that 3 patients had complete remission in the tumor size, 20 patients had partial remission in tumor size, 2 patients were stable, and 1 patient had progressive disease, accounting for 88.4% response in tumor size remission. The median survival of the 26 patients was 11 months. The 1-year and 2-year overall survival rates were 46% and 27%, respectively. The median survival of the 5 patients with pancreatic cancer was 9.4 months. None of the patients had any severe complications. CONCLUSIONS: 125I implantation could effectively relieve the pain in the patients with advanced primary or metastatic retroperitoneal malignant tumors and suppress local tumor progress.

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

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.