CT引导下~(125)I放射性粒子治疗胰腺癌的疗效观察

目的 探讨CT引导下~(125)I放射性粒子植入治疗胰腺癌技术的可行性和疗效.方法 对40例不能手术切除的晚期胰腺癌患者作CT引导下植入~(125)I粒子治疗.术前采用治疗计划系统(TPS)重建胰腺肿瘤的三维立体图像,计算出植入的~(125)I粒子数目、空间分布和剂量分布率,在CT引导下将~(125)I粒子植入胰腺肿瘤内,采用~(125)I粒子活度为0.5～0.8 mCi/颗,相隔1.0 cm植入,避开血管和胰管等周围重要脏器.放射性粒子的肿瘤匹配周边剂量(matched peripheral dose,MPD)为60～140 Gy.中位植入粒子36颗(18～68颗),术后即刻行CT扫描进行粒子质量验证.术后1周10例患者给予吉西他滨和5-Fu动脉灌注化疗,3～4个疗程.结果 全组肿瘤平均直径为4.9 cm.治疗后随访2～28个月,术后患者顽固性疼痛症状明显缓解(P<0.05),Karnofsky评分显著提高(P<0.05).平均术后2～5 d疼痛开始缓解.术后2个月CT随访,肿瘤完全缓解(CR)3例,部分缓解(PR)20例,无变化(NC)14例,进展(PD)3例.总有效率(CR+PR)为57.5%.全组中位生存时间为10.2个月.Ⅱ、Ⅲ、Ⅳ期粒子植入术后中位生存期分别为14.7、10.9及7.1个月;6个月和12个月累计生存率分别为100%、88%、62%和70%、41%、0.其中5例合并肝转移患者,则同时行动脉栓塞治疗.3例患者术后随访发现4颗粒子迁移到肝脏内.在随访过程中未见上消化道出血、胰腺炎、胰瘘及放射性肠炎等并发症.结论 CT引导下植入~(125)I放射性粒子治疗胰腺癌,近期疗效确切,具有良好的止痛效果,是一种安全、有效、并发症发生率低的微创治疗方法,粒子治疗后联合化疗药物动脉灌注治疗,有望提高疗效,远期疗效尚待进一步随访和观察.     

CT导引下植入125I粒子治疗19例晚期胰腺癌的疗效观察

目的探讨CT引导下^125I放射性粒子植入治疗晚期胰腺癌前后血清肿瘤标志物的动态变化和疗效。方法对19例手术不能切除的晚期胰腺癌施行CT引导下经皮植入^125I放射性粒子。采用治疗计划系统（TPS）重建胰腺肿瘤的三维立体图像,计算出^125I粒子植入的数量和剂量分布率,在CT引导下将^125I粒子植入胰腺肿瘤内。并用放射免疫方法测定^125I放射性粒子植入治疗胰腺癌前后的血清肿瘤标志物CEA、CA19-9、CA50的浓度。结果治疗后平均2～5d疼痛开始缓解。治疗后1个月CT随访,总有效13例,有效率68.4%;术后3个月CT随访,总有效率为63.2%（12例）。^125I粒子植入1个月后,胰腺癌患者血清中CEA、CA19-9、CA50等肿瘤标志物水平与植入前比较明显降低（P〈0.05）。在CA19-9检测中,植入前、CR、PR、SD、PD各组间差别有统计学意义（H=15.349,P〈0.05）。结论 CT引导下植入^125I放射性粒子治疗胰腺癌,临床近期疗效确切,具有很好的姑息止痛疗效,是一种安全、有效、并发症少的介入治疗方法 ;且能有效降低多项肿瘤标志物水平,肿瘤标志物水平对临床疗效有一定的提示作用。     

125I粒子植入治疗胰腺癌的疗效及治疗前后血清肿瘤标志物的动态变化

目的 观察CT引导下125I 放射性粒子植入治疗胰腺癌的临床疗效及125I粒子植入前后血清肿瘤标志物的动态水平.方法 对21例不能手术切除的晚期胰腺癌患者施行CT引导下植入125I 放射性粒子.采用治疗计划系统(treatment planning system,TPS)重建胰腺肿瘤的三维立体图像,计算出125I粒子植入的数量和剂量分布率,在CT引导下经皮穿刺,将125I粒子植入胰腺肿瘤内.并用放射免疫方法 测定125I 放射性粒子植入治疗胰腺癌前后的患者血清肿瘤标志物CEA、CA19-9、CA50的浓度.结果治疗后随访1~24个月.全组中位生存时间10个月.125I 粒子植入1月后,胰腺癌患者血清中CEA、CA19-9、CA50等肿瘤标志物水平与植入前比较有明显变化(P＜0.05).在CA19-9测定结果中,病情进展与植入前,病情完全缓解,部分缓解及病情稳定比较有统计学差异(P＜0.05).结论 CT引导下植入125I 放射性粒子治疗胰腺癌,临床近期疗效确切,是一种安全、有效、并发症少的介入治疗方法.     

CT引导下植入125I 放射性粒子治疗后腹膜转移淋巴结的临床应用

目的 探讨CT引导下125I 放射性粒子植入治疗后腹膜转移淋巴结的临床疗效. 方法对25例后腹膜淋巴结转移的患者做了CT引导下植入125I 放射性粒子治疗.采用计算机治疗系统(treatment planning system,TPS)重建肿瘤的三维立体图像,计算出125I粒子植入的数量和剂量分布率.结果 全组25例治疗后随访2～30个月,中位生存时间为19个月,术后患者顽固性疼痛症状明显缓解(P<0.05),Karnofsky评分显著提高(P<0.05).平均术后2～5 d疼痛开始缓解.术后2个月CT随访,肿瘤完全缓解(CR)7例,部分缓解(PR)13例,无变化(NC)4例,进展(PD)1例.总有效率(CR+PR)为80%.中位生存时间为25.5个月,1、2年生存率分别为92%和36%.5例患者死亡因全身衰竭或其他部位转移,与已治疗的淋巴结转移灶无确切关系.所有患者随访过程中未见放射性粒子移位,2例患者术后1周显示局部皮肤红肿,对症处理后好转.结论 CT引导下植入125I 放射性粒子治疗后腹膜转移淋巴结,近期疗效确切,具有很好的姑息止痛疗效.     

CT引导下125I放射性粒子植入治疗胰腺癌的疗效评价

目的探讨CT引导下~(125)I放射性粒子植入治疗胰腺癌的近期疗效。方法15例胰腺癌患者均有典型的CT特征并经穿刺活检后病理证实。采用CT引导下经皮穿刺将~(125)I放射性粒子均匀置入肿瘤内进行组织间放疗。结果粒子植入后1个月CT复查:完全缓解(CR)5例,部分缓解(PR)6例,稳定(SD) 2例,进展(PD)2例,总有效率86.7%;3个月:CR 5例,PR 5例,SD 2例,PD 3例。总有效率80%。除1例出现胰瘘,无急性胰腺炎、出血等严重并发症,结论CT引导下~(125)I放射性粒子植入治疗胰腺癌具有近期疗效好、创伤小、并发症少等优点。     

CT引导下125I粒子植入治疗复发性直肠癌的临床应用

目的探讨CT引导下^125I放射性粒子植入治疗胰腺癌技术的可行性和疗效。方法对40例不能手术切除的晚期胰腺癌患者作CT引导下植入^125I粒子治疗。术前采用治疗计划系统（TPS）重建胰腺肿瘤的三维立体图像,计算出植入的^125I粒子数目、空间分布和剂量分布率,在CT引导下将^125I粒子植入胰腺肿瘤内,采用^125I粒子活度为0．5～0．8mCi／颗,相隔1．0cm植入,避开血管和胰管等周围要脏器。放射性粒子的肿瘤匹配周边剂量（matched peripheral dose,MPD）为60～140Gy。中位植入粒子36颗（18～68颗）,术后即刻行CT扫描进行粒子质量验证。术后1周10例患者给予吉西他滨和5-Fu动脉灌注化疗,3～4个疗程。结果全组肿瘤平均直径为4．9cm。治疗后随访2～28个月,术后患者顽固性疼痛症状明显缓解（P〈0．05）,Karnofsky评分显著提高（P〈0．05）。平均术后2～5d疼痛开始缓解。术后2个月CT随访,肿瘤完全缓解（CR）3例,部分缓解（PR）20例,无变化（NC）14例,进展（PD）3例。总有效率（CR＋PR）为57．5％。全组中位生存时间为10．2个月。Ⅱ、Ⅲ、Ⅳ期粒了植入术后中位生存期分别为14．7、10．9及7．1个月;6个月和12个月累计生存率分别为100％、88％、62％和70％、41％、0。其中5例合并肝转移患者,则同时行动脉栓塞治疗。3例患者术后随访发现4颗粒了迁移到肝脏内。住随访过程中未见上消化道出血、胰腺炎、胰瘘及放射十牛肠炎等并发症。结论CT引导下植入^125I放射性粒子治疗胰腺癌,近期疗效确切,具有良好的止痛效果,是一种安全、有效、并发症发生率低的微创治疗方法,粒了治疗后联合化疗药物动脉灌注治疗,有望提高疗效,远期疗效尚待进一步随访和观察。     

CT导引下125I粒子植入治疗恶性实体肿瘤

目的 探讨CT导引下放射性125I粒子瘤内植入治疗恶性实体肿瘤的疗效.方法 在CT引导下对经病理证实的70例恶性肿瘤病人,根据治疗计划系统(TPS)按拟定计划实施肿瘤组织内125I粒子植入,术后随访2～45个月,观察疗效.结果 70例(76个病灶)病人在CT导引下顺利完成125I粒子植入,粒子分布满意,11例(11个病灶)完全缓解(14.47%,11/76),53例(55个病灶)部分缓解(72.37%,55/76),6例稳定(10个病灶)(13.16%,10/76),总有效率84.2%(66/76).随访观察结果显示大部分病人疼痛等不适症状有不同程度的缓解.结论 CT导引下125I粒子瘤内植入治疗恶性实体肿瘤,近期疗效满意,可有效改善病人的疼痛等临床症状.     

125I粒子植入治疗盆腔及后腹膜肿瘤23例分析

目的 评价CT引导下放射性125I粒子植入治疗盆腔及后腹膜恶性肿瘤的临床疗效.方法 23例盆腔及后腹膜恶性肿瘤患者,在CT引导下行放射性125I粒子植入.粒子植入前1周行腹部或盆腔螺旋CT扫描,将图像传送到计算机三维肿瘤治疗计划系统;勾画靶区轮廓(同时勾画肿瘤周围危险器宫,如膀胱、肠管、大血管等);靶区及相关轮廓三维重建;确定肿瘤靶区放射剂量、粒子数量和粒子空间排列.术后随访均设定4个月,以观察局部治疗效果、有无消化道或泌尿系等不良反应、疼痛变化情况、局部肿瘤缓解情况.结果 本组23例中有16例患者术前有骶尾部或腰背部疼痛,术后5～14d疼痛缓解,缓解率为69.6％,局部疼痛缓解近期疗效较显著.肿瘤局部控制2个月时有效率(CR+PR)为47.8％(11/23);4个月时有效率为43.5％(10/23).患者术后随访未见腹痛、肠瘘、出血、尿痛等不良反应,也未见放射性肠炎、骨髓抑制等并发症.结论 初步研究表明CT引导下经皮穿刺植入125I粒子近距离内照射治疗盆腔及后腹膜肿瘤安全、局部疗效明显等优势.对于无法手术、术后复发及单纯化、放疗效果差的盆腔及后腹膜恶性肿瘤是一种有效的补救治疗措施,并有效改善患者生存质量、提高肿瘤局部控制率.     

~(125)I粒子CT导向植入治疗恶性肿瘤多发腹膜后淋巴结转移

目的：探讨125I粒子CT导向植入治疗恶性肿瘤多发腹膜后淋巴结转移的临床疗效及安全性。方法：根据放射性粒子植入计划系统（TPS系统）,通过CT引导对33例患者共50组腹膜后淋巴结转移灶穿刺植入125I粒子,植入数量根据每个淋巴结转移灶的大小计算。术后1个月复查CT或MRI,测量转移灶大小变化情况,并通过判断疼痛程度评定患者生活质量变化情况。结果：50组腹膜后淋巴结转移灶均成功植入125I粒子;每组淋巴结转移灶植入10～100粒,平均46粒。术后1个月疗效评价：肿瘤完全缓解（CR）22组,部分缓解（PR）23组,无变化（NC）5组,无进展病例。125I粒子植入治疗有效率90.0%。疼痛缓解情况：术后1周疼痛明显缓解,24例中重度疼痛患者中20例明显或部分缓解,缓解率83.3%。术后随访3～20个月,3个月内无死亡病例,无严重不良反应。结论：CT引导下125I粒子植入治疗恶性肿瘤腹膜后淋巴结转移是短期疗效肯定而且安全的方法。     

125I放射性粒子植入联合栓塞化疗治疗肾上腺转移瘤临床应用

目的 探讨CT导引下经皮穿刺植入125I放射性粒子联合介入栓塞化疗治疗肾上腺转移瘤的方法及疗效.方法 对12例肾上腺转移瘤患者,应用介入栓塞化疗,2周后复查CT,采用治疗计划系统(TPS)计算剂量和布粒计划,CT定位下行病灶内125I放射性粒子植入术.植入结束后,再次进行CT扫描观察粒子分布情况及有无并发症,评价粒子分布情况.术后2～6个月定期CT随访.结果 术后2、4、6个月随访,12例有效率分别为58.33 %、81.82 %、80.00 %.结论 CT引导下经皮穿刺125I粒子植入联合介入栓塞化疗治疗肾上腺转移瘤安全,损伤小,并发症轻,近期疗效确切,值得推广和应用.     

超声引导 125I粒子腹腔神经节植入术治疗进展期胰腺癌疼痛的疗效分析

目的评价经腹超声引导下¹²⁵I粒子腹腔神经节植入治疗不可切除及复发胰腺癌顽固性癌痛的疗效以及其安全性。 方法对15例不能切除的胰腺癌患者及10例术后局部复发胰腺癌患者行经腹超声引导下¹²⁵I粒子腹腔神经节植入术,术后每周随访1次,观察腹痛评分、镇痛药物的使用情况、患者生活质量评分并记录手术相关的并发症。 结果所有患者均一次性手术成功,平均每例患者植入4枚粒子（2～8枚）。术后2周,患者的疼痛评分由平均7.56分降至3.36分（P<0.05）,所需要麻醉药物的剂量由术前87.60 mg迅速减少到50.00 mg（P<0.05）,随访过程中在其生存期内一直维持在较低水平,无1例出现进展;患者术后1个月、3个月的生活质量较术前明显好转;术后并发症分析胃潴留1例,腹泻2例,站立性晕厥1例,辅助治疗后消失。 结论经腹超声引导下¹²⁵I粒子腹腔神经节植入术,对缓解不可切除及复发胰腺癌顽固性癌痛安全有效。     

Clinical efficacy of CT-guided iodine-125 seed implantation therapy in patients with advanced pancreatic cancer

Objective  

To examine the clinical efficacy of CT-guided radioactive iodine-125 (125I) seeds implantation treatment in patients with unresectable pancreatic cancer.     

Intraoperative I-125 seed implantation for extensive recurrent head and neck carcinomas

From 1978 to 1988, 41 patients with extensive recurrent carcinomas of the head and neck were treated with surgical resection plus intraoperative iodine-125 seed implantation. Surgery was performed to resect the tumors and to expose the tumor beds for implantation. I-125 seeds were implanted intraoperatively, with a spacing of 0.75-1 cm between adjacent seeds, either into the soft tissue in the tumor bed or onto small patches of gelatin sponges to cover the bone, nerve, or blood vessel involved with disease. Reconstructive flaps were used in 18 patients. The average I-125 dose delivered by the implanted seeds was 8,263 cGy. The determinate 5-year actuarial survival rate for the entire group was 40%. The 5-year local disease control rate was 44%. Major complications were transient wound infection (32%), flap necrosis (24%), fistula formation (10%), and carotid blowout (5%). These results indicate that surgical resection plus I-125 seed implantation provides a potentially curative treatment for patients with extensive recurrent head and neck carcinomas that would be considered traditionally unresectable and that would be treated only with palliative therapy.     

Experience of brachytherapy using I-125 seed permanent implants for localized prostate cancer

PURPOSE: We report here our experience of brachytherapy using I-125 seeds for localized prostate cancer in 100 patients. MATERIALS AND METHODS: We carried out brachytherapy with I-125 seed permanent implants in 100 patients with localized prostate cancer between September 2003 and October 2004. Preplanning dosimetry was done using transrectal ultrasonic images obtained three or four weeks prior to treatment. Using transrectal ultrasound, we inserted I-125 seeds in the prostate through needles according to the preplanning diagram. We then examined the results on prostate CT performed one month later. RESULTS: It was necessary to describe transrectal ultrasonic image such as preplanning. There were several cases in which the source arrangement of the schedule was corrected immediately before the operation. In the examination after one month, the numerical value at the start of treatment initially was not satisfactory, but we eventually obtained a result that could to be evaluated. CONCLUSION: We carried out permanent implant brachytherapy for localized prostate cancer using I-125 seeds and reported our experience.     

A novel combination of percutaneous stenting with iodine-125 seed implantation and chemotherapy for the treatment of pancreatic head cancer with obstructive jaundice

PurposeInsertion of radioactive strips through the biliary stent has been reported to offer longer survival and patency than an uncovered conventional self-expanding metal stent in patients with unresectable malignant biliary obstruction. The aim of this study was to investigate the safety and effectiveness of intraluminal brachytherapy combined with ¹²⁵I seed implantation and transarterial infusion chemotherapy for the treatment of pancreatic head cancer with obstructive jaundice.MethodFrom October 2012 to January 2018, 21 consecutive patients diagnosed with biliary obstruction caused by locally advanced, nonmetastatic pancreatic cancer with cytologically or histologically confirmed by biopsy were enrolled and receive treatment with intraluminal brachytherapy using ¹²⁵I seed strand and CT-guided percutaneous radioactive seed implantation therapy. The procedure-related and radiation complications were assessed. The outcomes were measured in terms of stent patency, patient survival, complications related to the procedure.ResultOne of the 22 patients (4.5%, 1/22) with pancreatic head cancer failed to perform the above procedure because the guidewire was unable to pass through the obstruction segment. The remaining 21 patients (95.5%, 21/22) with pancreatic head cancer with obstructive jaundice were successfully placed with biliary stents and radioactive strips through drainage tubes. The median number of ¹²⁵I seeds loaded was 15, ranging from 12 to 17. After the chemotherapy with gemcitabine and cisplatin, no adverse reaction of Grade Ⅲ ～ Ⅳ occurred in all cases. Median stent patency was 12.50 months (95% CI: 10.26, 14.74). By May 2019, all 21 patients had died, with overall survival of 5.2–23.3 months, with a median survival of 13.20 months (95% CI: 10.96, 15.44).ConclusionPercutaneous ¹²⁵I seed implantation combined with insertion of radioactive strips through the biliary stent has the characteristics of less trauma, fewer complications, simple operation, and so on. These procedures bring remission of obstructive jaundice combined with the increased survival for the treatment of obstructive jaundice caused by unresectable pancreatic head cancer if follow-up chemotherapy is carried out. The long-term efficacy of this treatment combination needs to be confirmed by further multicenter, large sample size prospective randomized controlled studies.     

Quality assurance of I-125 seed permanent implant therapy using a self-color developing reflection-type dosimetry sheet film

PURPOSE: We evaluated a self-color developing sheet-type film for the detection of dead seeds in I-125 permanent implant therapy for prostate cancer. MATERIALS AND METHODS: As a preliminary study, we irradiated X-rays to a self-developing reflection-type sheet film and created a relational curve between absorbed dose and film density. I-125 seeds were placed on a film and the approximate absorbed dose of I-125 was calculated from the relational curve of X-rays. A cartridge in which a dead seed was loaded among 10 I-125 seeds was placed on the film and the detectability of the dead seed was evaluated. RESULTS: Using the relational curve of X-rays, it was possible to measure the approximate absorbed dose of I-125 seeds and to easily detect a dead seed at a glance. Using sterilized film, it was possible to detect a dead seed. CONCLUSION: The self-developing film method is feasible for the detection of a dead seed in a cartridge without re-sterilization of seeds.     

放射性~(125)I粒子组织间植入治疗胰腺癌的疗效分析

目的探讨125^I粒子组织间植入治疗胰腺癌的疗效。方法回顾性分析2005年7月至2008年6月我院采用125^I粒子植入治疗的33例胰腺癌患者资料。肿瘤最大径1．5～6．6cm,平均3．7cm。结果粒子植入术后,止痛有效率为60．6％,术后3个月内4例死亡。术后3个月CT复查,部分缓解（PR）8例,疾病稳定（SD）13例,疾病进展（PD）8例,总有效率27.6％。全组生存时间2～19个月,中位生存时间5．1个月,6例仍在随访中。随访中无胰瘘和胃肠道出血等严重并发症,有51粒粒子（18例患者）丢失,11粒粒子（5例患者）出现迁移,移至肠道9粒,肝、脾各1粒,未见放射性肠炎和肝功能改变。结论125^I粒子组织间植入治疗胰腺癌在疼痛缓解方面疗效明确,但本组病例Ⅳ期患者较多,未取得较好的疗效,具体疗效还有待于大样本前瞻性队列研究证实。     

Effectiveness and security of CT-guided percutaneous implantation of 125I seeds in pancreatic carcinoma

Objective:

To assess the effectiveness and security of CT-guided percutaneous implantation of iodine-125 (¹²⁵I)-labelled seeds in pancreatic carcinoma.

Methods:

A total of 36 patients (25 males and 11 females) with an average age of 57 years (range, 39–84 years) were enrolled and categorized into Stage III (27 cases) and Stage IV (9 cases) of pancreatic cancer. There were 3 tumours in the pancreatic head and 33 tumours in the pancreatic body or tail. The average diameter of the tumours was 37.1 mm (range, 15–65 mm). The implantation of ¹²⁵I seeds was performed by using 18-G needles (length, 150–200 mm) through the anterior, lateral and posterior approaches. Then, ¹²⁵I seeds were loaded and released into the lesions.

Results:

Implantations were performed via the anterior (23 patients), lateral (9 patients) and posterior (4 patients) approaches. During implantation, 3–14 punctures were performed for each patient, and a total of 164 punctures were recorded. Meanwhile, a total of 657 seeds were implanted with an average of 25.27 (range, 12–50) seeds per patient, and the success rate was 100%. The activity of each seed ranged from 0.55 to 0.65 mCi. A main adverse event occurred in one puncture and minor events in seven punctures. No significant relationship between the punctures or adverse events was identified. No serious complication was detected after the implantations during follow-up visits.

Conclusion:

This study suggested that CT-guided percutaneous implantation of ¹²⁵I seeds in a pancreatic carcinoma was relatively safe and effective for treating unresectable pancreatic cancer.

Advances in knowledge:

The CT-guided percutaneous implantation of ¹²⁵I seeds in unresectable pancreatic cancer showed highly successful rates without serious complications.Pancreatic cancer is the sixth most common cause of cancer-related deaths in China and the fourth worldwide.¹ The life quality of a patient with pancreatic cancer is severely influenced, since pancreatic cancer develops rapidly and can lead to abdominal pain, weight loss and jaundice.² Clinically, early pancreatic cancer does not cause obvious symptoms, while the later symptoms are usually non-specific and varied.³ As a result, most patients are diagnosed with mid- and terminal-staged pancreatic cancer that cannot be removed surgically. Although 15–20% of patients are diagnosed at an early stage, only 20–25% of them may survive more than 5 years after a tumour resection.⁴ For all stages of pancreatic cancer, the 5-year relative survival rate is 6%, whereas the 5-year survival rate is approximately 15% for a local tumour.⁵ Local control and distant metastases are the major factors that affect prognoses.⁶ During the past decades, the treatment outcome of locally advanced pancreatic carcinoma has not been improved significantly.⁷Currently, comprehensive therapy (radiotherapy plus chemotherapy) is the most common treatment for locally advanced pancreatic carcinoma.^8,9 Radioactive seeds, interstitial brachytherapy¹⁰ and conformal radiotherapy,⁷ show great curative effects on local control. The implantation methods include intra-operative and ultrasound- and CT-guided implantations.^10–12With the development of modern medical imaging technology, the CT-guided percutaneous implantation technique has been widely applied in clinics.^12,13 Additionally, CT-guided implantation of iodine-125 (¹²⁵I)-labelled seeds shows precision position, minimal invasion and great effectiveness. Also, the slow and continuous release of ¹²⁵I seeds has been radiobiologically advantageous, allowing the repair of non-lethal damage and re-oxygenation of hypoxic areas in normal tissues.⁷ However, the security of percutaneous implantation guided by CT scanning is still contradictory, because the pancreas is surrounded by the liver, stomach, intestines, spleen, kidney and blood vessels.In this present study, we retrospectively analysed 36 cases with unresectable pancreatic carcinoma who underwent CT-guided percutaneous implantation of ¹²⁵I seeds. The security of CT-guided percutaneous implantation of ¹²⁵I seeds in pancreatic carcinoma was assessed, which might provide the basis for individual treatment of CT-guided percutaneous implantation.     

Physikalische Grundlagen und klinische Durchführung der interstitiellen Brachytherapie der Prostata mit Jod-125

BACKGROUND: Interstitial brachytherapy with I-125 seeds can be used for successful treatment of early stage prostate cancer. There is presented the technique of permanent transperineal implantation of I-125 seeds with intraoperative treatment planning which is suited for the treatment of prostate cancer up to the clinical stage of T2a. MATERIAL AND METHODS: Some weeks before the implantation of the seeds the prostate volume is determined using transrectal ultrasound (TRUS) so as to estimate the required number of I-125 seeds. At the outset of the treatment the prostate is stabilized by two perineally inserted needles. Subsequently there is carried out an ultrasound guided treatment planning that allows to optimize the distribution of the seeds within the prostate. In interstitial brachytherapy we use RAPID STRANDS((R)), i. e. the I-125 seeds are embedded in vicryl suture at distances of 1 cm. During implantation of the I-125 seeds the transversal placement of the applicator needles is controlled by TRUS and the cranio-caudal placement of the applicator needles is controlled using the fluoroscopic unit as well as TRUS. About 4 weeks after the implantation of the seeds there is carried out a postoperative computation of the dose distribution of the implant using CT imaging. RESULTS: The procedure possesses the advantage that ultrasound imaging, treatment planning and seed implantation are carried out with the prostate remaining in an unaltered position. During implantation the combined imaging of TRUS and fluoroscopy allows a safe placement of the seeds with in the prostate. CONCLUSION: The methods for the calculation of the actually attained dose distribution must still be optimized, because the postoperative examination of the individual results has so far been possible only with difficulties resulting from methodological inconveniences.