肿瘤保守切除联合放射性粒子植入治疗腮腺癌

目的 观察肿瘤保守性切除联合¹²⁵I放射性粒子组织间永久植入治疗早期腮腺癌的临床疗效。方法 选取2004年11月至2012年6月在北京大学口腔医院就诊的腮腺癌患者共30例,所有患者行腮腺肿瘤保守性切除,术后联合¹²⁵I放射性粒子组织间永久植入治疗。中位随访时间41个月,观察临床疗效及并发症。结果 患者的5年生存率及无瘤生存率为100%,无局部复发及远处转移。手术后暂时性面神经损伤发生率为3.33%（1/30）,无永久性面瘫发生,未见放射性骨髓炎、耳聋、重度张口受限等。结论 肿瘤保守性切除联合¹²⁵I放射性粒子组织间永久植入治疗早期腮腺癌临床效果良好,可保存面形,保留面神经,降低并发症发生率,提高患者生存质量。     

125I放射性粒子治疗复发性腮腺癌24例临床分析

目的 探讨应用¹²⁵I放射性粒子组织间植入近距离放疗在腮腺区复发恶性肿瘤的临床应用及疗效。方法 回顾性分析2006年至2013年,就诊于北京大学口腔医院,经放射性¹²⁵I粒子组织间植入治疗的24例复发腮腺腺源性恶性肿瘤患者的临床资料,所有患者均为临床Ⅳ期。定期随访,观察并分析局部控制率,生存率及不良反应。结果 24例复发肿瘤患者,随访时间4至59个月。6例局部控制失败,10例患者死亡。患者1年、3年生存率分别为74.8%和39.3%,1年、3年无进展生存率分别为74.8%和31.5%,1年、3年局部控制率分别为82.0%和69.4%。无3级以上放射性损伤。结论 单纯放射性¹²⁵I粒子组织间植入治疗,对于无法手术切除的复发腮腺恶性肿瘤患者,为可选治疗方式,局部控制率较好。     

125I放射性粒子治疗腮腺复发性腺样囊性癌的靶区设计及剂量学分析

目的 分析¹²⁵I放射性粒子单纯植入治疗腮腺区复发性腺样囊性癌的靶区设计方法及剂量学参数。方法 回顾性分析2005年1月至2019年10月北京大学口腔医院收治的行单纯¹²⁵I放射性粒子近距离植入治疗的25例复发性腮腺腺样囊性癌患者的靶区设计及剂量学参数。术前结合腺样囊性癌病理学特点对不同复发部位设计靶区范围,处方剂量为100~120 Gy,术后验证靶区范围与剂量学参数。随访统计局部控制情况及放疗相关不良反应。结果 25例患者复发部位分别为腮腺浅叶区10例,腮腺深叶区7例,颅底区及乳突颌后区复发各4例。中位植入粒子数量为59颗,粒子活度18.5~25.9 MBq,植入后验证所有患者均实现植入前靶区设计范围,D₉₀、V₁₀₀、V₁₅₀等剂量学参数与植入前相近,差异无统计学意义（P>0.05）。3年、5年局部控制率分别为81.5%和61.5%,不同部位的局部控制率差异无统计学意义（P>0.05）。结论 单纯应用¹²⁵I放射性粒子植入治疗腮腺区复发性腺样囊性癌,通过结合病理学特点及复发部位优化靶区设计,合理准确应用达到剂量学参数,可获得较好的局部控制。     

125I放射性粒子组织间植入治疗腮腺癌专家共识(2023年版)

¹²⁵I放射性粒子组织间植入治疗是腮腺癌主要治疗方法之一,具有局部剂量高和周围组织损伤小的特点。放射性粒子治疗效果与剂量、精度密切相关。然而,¹²⁵I放射性粒子在腮腺癌中的应用尚无明确规范,各治疗中心对于放射性粒子治疗的标准不尽相同。为进一步规范腮腺癌近距离放射治疗流程,经国内多位专家反复讨论后达成一致意见,制定本共识。本共识对¹²⁵I放射性粒子组织间植入治疗腮腺癌的适应证与禁忌证、治疗参数、操作流程、技术规范、放射防护、不良反应、随访等给出了规范化建议,可供临床实践参考。     

Surgery combined with iodine-125 interstitial brachytherapy for treatment of parotid adenoid cystic carcinoma: A single-institution experience

PurposeThe purpose of this study was to analyze the effectiveness and safety of the combination of surgery plus postoperative iodine-125 interstitial brachytherapy for treatment of adenoid cystic carcinoma (ACC) of the parotid.Methods and MaterialsThis study included a retrospective analysis of the data of patients who underwent postoperative iodine-125 interstitial brachytherapy for histology-confirmed ACC of the parotid between January 2002 and November 2018 in Peking University Hospital of Stomatology. Acute and long-term radiation-related toxicities were assessed by the criteria of the Radiation Therapy Oncology Group and European Organization for Research and Treatment of Cancer. Multivariate analysis was used to identify the factors affecting overall survival, disease-free survival (DFS), and distant metastasis–free survival (DMFS).ResultsA total of 86 patients (53 women; median age 50 years, SD = 13.1) were included. Median followup was for 45.5 months. About half the patients (44/86, 51.3%) had clinical stage IV disease. Local recurrence occurred in 11 of 86 (12.8%) patients. No patient had nodal metastases in the followup period. The five- and 10-year DFS rates were 74.8% and 66.6%, respectively. The mean DMFS was 60.6 months. On multivariate analysis, preoperative facial palsy, type of surgery, perineural spread (PNS), and distant metastases were independent prognostic factors for DFS; preoperative facial palsy, nodal metastases, and PNS were independent prognostic factors for overall survival; and preoperative facial palsy, type of surgery, PNS, and pathological type were independent prognostic factor for DMFS.ConclusionsThe combination of surgery and iodine-125 interstitial brachytherapy appears to be an effective and safe treatment for primary ACC of the parotid.     

125I粒子近距离治疗在局部晚期腮腺腺样囊性癌的应用

目的单纯应用¹²⁵I放射性粒子组织间植入治疗局部晚期腮腺腺样囊性癌,评估疗效并分析相关预后因素,为局部晚期腮腺腺样囊性癌的治疗提供临床参考。方法回顾性纳入2007年8月至2018年1月于北京大学口腔医院接受单纯应用¹²⁵I放射性粒子植入治疗的局部晚期腮腺腺样囊性癌患者,分析其总生存率(OS)、无进展生存率(PFS)和局部控制率(LCR)及相关影响因素,并观察近、远期放射不良反应情况。结果本组病例共16例(cT4bN0M0),女性患者占多数(11/16,68.7%),中位年龄55.4岁。随访8~104个月(中位时间41.5个月),1、3、5年LCR分别为93.7%、80%、68.7%,1、3、5年OS分别为86.7%、72%、54%;1、3、5年PFS分别为74%、53%、18.9%。9例(56.2%)患者出现不同部位器官转移,以颅内转移、肺转移常见;其中6例术前伴有颅底骨质侵犯者出现多器官转移,肿瘤侵犯颈动脉是影响远处转移的危险因素(HR=12,P=0.045)。共有8例(8/16,50%)患者出现不同程度远期放射性不良反应。结论单纯应用¹²⁵I放射性粒子植入治疗局部晚期腮腺腺样囊性癌的5年局部控制率为68.7%,肿瘤侵犯颅底骨质、包绕颈动脉是其预后不佳与发生多器官远处转移的主要因素。     

放射性粒子治疗早期腮腺癌靶区优化初步研究

目的 分析采用部分腮腺靶区行放射性粒子治疗早期腮腺癌的可行性。方法 回顾2004年11月至2013年2月在本院就诊的早期腮腺癌患者14例，所有患者手术均行肿物局部切除，术后联合¹²⁵I放射性粒子植入，根据靶区设计不同分为两组，部分腮腺靶区组和全腮腺靶区组，每组7例。比较两组患者的总生存率及局部控制率，并比较两组病例靶区体积、植入粒子数量、患侧下颌骨升支、咽缩肌、颈髓、外耳道、中耳、乳突等危及器官的受照剂量。结果 经随访51~116个月，两组病例均未见局部区域复发及远处转移，总生存率及局部控制率均为100%。部分腮腺靶区组CTV D₉₀平均为（90.3±20.4）Gy，全腮腺靶区组CTV D₉₀平均为（104.3±10.1）Gy，两组之间差异无统计学意义（P>0.05）。部分腮腺靶区组和全腮腺靶区组的靶区体积平均分别为（9.2±2.4）和（35.1±13.5）cm³（t=5.003，P<0.05）。两组患侧下颌骨升支、咽缩肌、外耳道、中耳、乳突平均剂量及颈髓最大剂量相比较，差异均有统计学意义（t=3.534、4.279、3.034、3.471、7.221、6.103，P<0.05），部分腮腺靶区组较全腮腺靶区组靶区体积缩小、危及器官受照剂量明显降低。结论 早期低度恶性腮腺癌保守切除后，近距离治疗采用肿瘤周围区域的部分腮腺靶区具有一定的可行性，在保证临床疗效的同时可降低对正常组织的损伤。     

腮腺癌术后 125I 粒子组织间近距离治疗靶区确定方法的探讨

目的 探讨腮腺癌术后¹²⁵I粒子组织间近距离治疗靶区的确定方法。方法 2002年10月至2006年11月北京大学口腔医院的31例腮腺癌患者,男女比例14 ∶17,平均年龄38.2岁,肿瘤有包膜外浸润并与面神经关系密切(黏连或神经侵犯),采用保留面神经的肿瘤及腺体切除术,术后行¹²⁵I粒子组织间近距离治疗,匹配周缘剂量60 Gy。治疗前后行薄层螺旋CT扫描以制定治疗计划和质量验证,以腮腺周围骨性结构和肌组织为参照确定计划靶区和临床靶区,并比较治疗前后靶体积、靶区D₉₀值的差异,同时计算粒子植入后颌骨、中耳D₉₀值以及脊髓最大接受剂量。结果 ¹²⁵I粒子治疗前后靶体积、靶区D₉₀值差异无统计学意义,粒子植入后靶区D₉₀值均大于匹配周缘剂量。本组病例随访时间3~7年,未见肿瘤复发。结论 根据目前随访结果,采用本方法确定¹²⁵I粒子腮腺区组织间近距离治疗靶区,临床治疗效果满意。     

125I粒子腮腺区组织间近距离治疗对面神经功能恢复的影响

目的 研究¹²⁵I粒子腮腺区组织间近距离治疗对面神经功能恢复的影响。方法 对无面瘫的21例腮腺原发癌患者,采用外科手术切除(保存面神经),术后1周行¹²⁵I放射性粒子腮腺区组织间治疗,粒子活度24.05×10⁶~25.9×10⁶ Bq,处方剂量60 Gy。应用House-Brackmann(HB)评价系统和面神经肌电图对患者分别进行主观评价和客观评价,随访时间4年。按照面神经功能分区评价的方法,以神经传导潜伏时为指标,将患侧面神经分为异常组和正常组,分别与健侧相应面神经分支进行比较。结果 所有患者术后均出现不同程度面瘫,随访术后6个月内均恢复至术前正常水平;面神经患侧异常组与健侧对应神经分支传导潜伏时的差异在术后1周至术后6个月具有统计学意义( t= 2.362, P= 0.028),患侧较健侧明显延长,而术后1~4年差异无统计学意义;面神经患侧正常组与健侧对应分支神经传导潜伏时的差异在术后1周具有统计学意义( t=2.522, P=0.027 ),患侧较健侧延长,而术后2月~4年差异无统计学意义。结论 ¹²⁵I 粒子组织间近距离治疗不影响腮腺癌术后面神经功能的临床恢复,对面神经无迟发损害。     

Re-irradiation with interstitial pulsed-dose-rate brachytherapy for unresectable recurrent head and neck carcinoma

PurposeTo assess the long-term results of protocol-based interstitial pulsed-dose-rate (PDR) brachytherapy combined with simultaneous chemotherapy in selected patients with recurrent head and neck tumors not amenable to salvage surgery.Methods and MaterialsA total of 51 patients with recurrent head and neck cancer were treated with interstitial PDR brachytherapy. Forty patients (78%) had salvage brachytherapy alone using a median total dose of 60 Gy. Salvage brachytherapy in combination with external beam therapy was performed in 11 patients (22%) using a median total dose of D_REF = 27 Gy. Simultaneously with the PDR brachytherapy, a concomitant chemotherapy was administered in 35/51 (69%) of patients. The analysis was performed after a median followup of 58 months.ResultsLocal control rates calculated according to Kaplan–Meier after 2 and 5 years were 71% and 57%, respectively. Comparing results of salvage PDR brachytherapy with or without simultaneous chemotherapy, the 5-year local recurrence-free survival rates were 78.9% vs. 38.5% (p = 0.01), respectively. No other patient or treatment-related parameters had a significant influence on treatment results. A total of 9/51 (17.7%) and 6/51 (11.8%) patients developed soft-tissue necrosis or bone necrosis, respectively, but only 2% of patients required surgical treatment.ConclusionsPDR interstitial brachytherapy with pulse doses between 0.4 and 0.7 Gy/h/24 h with simultaneous chemotherapy is an effective and safe option for curative therapy in selected patients with head and neck cancer in previously irradiated areas, which are not suitable for salvage surgery.     

125I Seed implant brachytherapy for the treatment of parotid gland cancers in children and adolescents

Background and purpose

There is a lack of optimal treatment strategies for managing salivary gland cancers in children and adolescents. This study is aimed at assessing the effect of ¹²⁵I seed implantation for the treatment of parotid cancers in children and adolescents.

Patients and methods

A total of 12 patients younger than 16 years with parotid gland malignant tumors underwent ¹²⁵I seed implant brachytherapy between October 2003 and November 2008. All patients were assessed after treatment and at the local tumor control appointments. Facial nerve function, maxillofacial development, and radioactive side-effects were assessed.

Results

The follow-up period ranged from 41–104 months. One patient with T4b died of pulmonary metastasis. The other patients were alive during the follow-up period. There were no serious radiation-related complications. The treatment did not affect facial nerve function and dentofacial growth in any of the children.

Conclusion

For parotid gland cancers in children, ¹²⁵I seed implant brachytherapy may be an acceptable treatment without serious complications and with satisfactory short-term effects.     

放射性125I粒子组织间植入治疗不能手术唾液腺癌患者的生存质量分析

目的 初步评价放射性¹²⁵I粒子组织间植入近距离治疗不能手术唾液腺癌患者的生存质量（quality of life,QOL）及影响因素。方法 选择2013年至2017年间就诊于北京大学口腔医院颌面外科的不能手术唾液腺癌患者23例,行单纯¹²⁵I放射性粒子组织间植入近距离治疗,应用QLQ-C30（V3.0）及QLQ-H&N35中文版生存质量量表,评价患者的生存质量情况,并分析疾病及治疗相关因素对生存质量的影响。结果 23例患者治疗后1年及3年总生存率分别为100%与67%,其治疗前及治疗后生存质量评分平均分为201.48分和199.48分,差异无统计学意义（P>0.05）,患者总体生存质量评分及各项功能评分均处于较高水平。疾病及治疗相关因素中,肿瘤发生部位对患者生存质量的影响具有统计学意义（F=9.127,P<0.05）,其余因素的影响规律尚需更大样本量的研究。结论 ¹²⁵I放射性粒子组织间植入近距离治疗能较好的保存不能手术唾液腺癌患者的头颈部功能和生存质量。     

放射性125I粒子植入腮腺区后位置的稳定性

目的 研究放射性¹²⁵I粒子植入腮腺区后的位置稳定性。 方法 随机选择10例行¹²⁵I粒子腮腺区组织间植入治疗的患者,植入后1周内使用放射治疗模拟机拍摄两张不同角度的平片,计数粒子数量,并通过治疗计划系统(TPS)做平面剂量分析,计算处方剂量的50%、100%、150%等剂量曲线所包围的面积、剂量均匀指数。粒子植入后2个月,重复上述过程,比较两次结果并进行统计学分析。结果 两次检查粒子数量一致。处方剂量50%、100%、150%等剂量曲线所包围面积以及剂量均匀指数包括粒两次之间差异无统计学意义。结论 放射性¹²⁵I粒子植入腮腺嚼肌区后,位置稳定,使治疗效果得到保证。     

Prostate brachytherapy seed migration to a left varicocele

PurposeTo report a rare case of seed migration to a left varicocele after transperineal interstitial prostate brachytherapy with loose iodine-125 (¹²⁵I) seeds.Methods and MaterialsA 73-year-old man presented with a serum prostate-specific antigen level of 5.21 ng/mL, Gleason score of 7 (3 + 4), and clinical T1c adenocarcinoma of the prostate. The patient underwent transperineal interstitial prostate brachytherapy with loose ¹²⁵I seeds followed by external beam radiation therapy. Two weeks after seed implantation, a followup pelvic radiograph was obtained. One month after seed implantation, a pelvic computed tomography scan for postimplant dosimetric analysis was carried out. Subsequent ultrasound examination of the scrotum was undertaken.ResultsTwo weeks after seed implantation, an anteroposterior pelvic radiograph showed that a migrated seed was overlapped by the scrotum. Postimplant pelvic computed tomography revealed that a seed had migrated to the left side of the scrotum. Subsequent ultrasound examination of the scrotum revealed that the patient had a left varicocele to which the seed had migrated. The patient had no symptoms related to the migrated seed.ConclusionsThis is the first report of seed migration to a left varicocele after transperineal interstitial prostate brachytherapy with loose ¹²⁵I seeds. For the present case, we suggest that the seed moved from the prostate to the left varicocele through the pelvic veins, bypassing the systemic circulation.     

106Ru plaque brachytherapy for uveal melanoma: Factors associated with local tumor recurrence

PurposePlaque brachytherapy is a common form of treatment for uveal melanoma, and the Collaborative Ocular Melanoma Study (COMS) used ¹²⁵I. Recently, ¹⁰⁶Ru has been reintroduced for plaque brachytherapy in the United States. We reviewed our experience treating uveal melanoma with ¹⁰⁶Ru plaque brachytherapy using COMS planning techniques, hypothesizing that we would observe similar outcomes to those in the COMS.Methods and MaterialsMedical records of patients undergoing ¹⁰⁶Ru plaque brachytherapy were reviewed retrospectively. Patient, tumor, and treatment characteristics were recorded. Outcomes including visual acuity, local tumor recurrence, salvage treatment, metastasis, and survival were recorded. Cox regression analyses were used to determine factors associated with local tumor recurrence and enucleation.ResultsTwenty-eight patients were studied. Median age was 60 years, and 50% were men. Median tumor base diameter and height were 9.4 and 2.6 mm, respectively. Ophthalmic complications were rare. Local tumor recurrence and enucleation occurred in 13 and 4 patients, respectively. Local tumor recurrence was associated with low visual acuity in the tumor-bearing eye, posterior tumors, small plaque size, and difference in plaque–tumor diameter of <6 mm. Enucleation was associated with low visual acuity and posteriorly located tumor. Estimated 5-year rate of death and metastasis was 18.5% and 11.4%, respectively.ConclusionsAmong patients treated with ¹⁰⁶Ru plaque brachytherapy using COMS planning techniques, we found a greater than expected rate of local tumor recurrence. Planning ¹⁰⁶Ru plaque brachytherapy should be done carefully at centers that have previously used COMS protocols and ¹²⁵I.     

Iodine-125 brachytherapy in the management of squamous cell carcinoma of the oral cavity and oropharynx

PurposeBrachytherapy is an acknowledged modality for treating head and neck cancers and has moved from low-dose-rate (LDR) to high-dose-rate remote afterloading to reduce staff exposure. Iodine-125 (¹²⁵I) is a low-energy source and can be used for LDR brachytherapy with minimal staff exposure. The results of treating with this isotope at Groote Schuur Hospital, Cape Town, are reported here.Methods and Materials¹²⁵I brachytherapy was used to treat 114 tumors from 1994 to 2010. Brachytherapy alone was used for 72 tumors, 39 postsurgery and 33 de novo. A brachytherapy boost together with external beam radiotherapy was used for 42 tumors, eight postsurgery and 34 de novo. Tumors were in the tongue, floor of mouth, soft palate, and tonsil, and mainly T1 or T2 classification. Brachytherapy was administered via an applicator or in plastic tubes implanted into the soft tissues or through the submandibular region.ResultsLocal control rates of 80.7% at 5 years and 80% at 10 years were comparable to LDR, pulsed-dose-rate, and high-dose-rate results with iridium-192, likewise the 5- and 10-year disease-specific survival rate of 74.3%. Complications of soft tissue ulceration occurred in 21 patients (18.4%) and healed spontaneously in 20 patients. There was no mandibular necrosis.Conclusions¹²⁵I can be used as the sole treatment or as a boost to external beam radiotherapy, with or without surgery for early mouth cancer. It combines the radiobiological advantages of LDR brachytherapy with minimum staff exposure. It is a flexible system. Local control is excellent with acceptable morbidity, and the treatment time is short.     

125I Interstitial brachytherapy with or without androgen deprivation therapy among unfavorable-intermediate and high-risk prostate cancer

PURPOSE/OBJECTIVE(S)To determine if patients with unfavorable intermediate-risk (UIR), high-risk (HR), or very high-risk (VHR) prostate cancer (PCa) treated with ¹²⁵I interstitial brachytherapy benefit from androgen deprivation therapy (ADT).MATERIALS/METHODSWe reviewed our institutional database of patients with UIR, HR, or VHR PCa, per 2018 NCCN risk classification, treated with definitive ¹²⁵I interstitial brachytherapy with or without ADT from 1998?2017. Outcomes including biochemical failure (bF), distant metastases (DM), and overall survival (OS) were analyzed with the Kaplan-Meier method and Cox proportional hazards regression. PCa-specific mortality (PCSM) was analyzed with Fine-Gray competing-risk regression.RESULTSOf 1033 patients, 262 (25%) received ADT and 771 (75%) did not. Median ADT duration was 6 months. By risk group, 764 (74%) patients were UIR, 219 (21%) HR, and 50 (5%) VHR. ADT was more frequently given to HR (50%) and VHR (56%) patients compared to UIR (16%; p<0.001), to older patients (p<0.001), corresponding with increasing PSA (p<0.001) and Grade Group (p<0.001). Median follow-up was 4.9 years (0.3?17.6 years). On multivariable analysis accounting for risk group, age, and year of treatment, ADT was not associated with bF, DM, PCSM, or OS (p≥0.05 each).CONCLUSIONAmong patients with UIR, HR, and VHR PCa, the addition of ADT to ¹²⁵I interstitial brachytherapy was not associated with improved outcomes, and no subgroup demonstrated benefit. Our findings do not support the use of ADT in combination with ¹²⁵I interstitial brachytherapy. Prospective studies are required to elucidate the role of ADT for patients with UIR, HR, and VHR PCa treated with prostate brachytherapy.     

Gleason score 7 prostate cancer treated with interstitial brachytherapy with or without supplemental external beam radiation and androgen deprivation therapy: Is the primary pattern on needle biopsy prognostic?

PurposeTo evaluate the effect of primary Gleason pattern on biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) in Gleason 7 prostate cancer patients treated with low-dose-rate (LDR) interstitial brachytherapy with or without supplemental external beam radiation therapy and androgen deprivation therapy.Methods and MaterialsWe retrospectively reviewed the medical records of 932 consecutive patients with biopsy-confirmed Gleason 7 prostate cancer who received LDR interstitial brachytherapy as a component of their definitive treatment regimen. Treatment outcomes were compared between patients with primary Gleason pattern 3 and 4.ResultsWith a median followup of 7.4 years, the 10- and 14-year bPFS, CSS, and OS for the entire Gleason 7 study group were 95.7/95.7%, 98.6/98.6% and 77.2/64.3%, respectively. When biochemical control was evaluated as a function of primary Gleason pattern, the primary pattern 3 had a statistically higher 10- and 14-year bPFS (97.8/97.8% vs. 93.1/93.1%, p = 0.006). The Gleason pattern 3 patients also trended toward a higher 10- and 14-year CSS (99.3/99.3% vs. 96.9/96.9%, p = 0.058). OS was not statistically different between the two Gleason 7 cohorts.ConclusionsGleason 7 prostate cancer patients treated with LDR interstitial brachytherapy have an excellent long-term outcome. There was a small but statistically significant advantage in bPFS and a trend toward improved CSS in patients with a primary Gleason pattern of 3.     

Dosimetric and clinical outcome in image-based high-dose-rate interstitial brachytherapy for anal cancer

PurposeTo evaluate dosimetric and clinical outcome in patients of anal cancer treated with image-based interstitial high-dose-rate brachytherapy following chemoradiation.Methods and MaterialsSixteen patients with anal cancer were treated with chemoradiation followed by brachytherapy boost with image-based high-dose-rate interstitial brachytherapy from January 2007 to June 2011. Two brachytherapy dose schedules were used: 21 Gy in seven fractions and 18 Gy in six fractions depending on response to chemoradiation. CT scan was done after placement of needles for confirmation of placement and treatment planning. Target volume was contoured on CT scans. Volumetric quality indices and dose parameters were calculated.ResultsThe mean clinical target volume was 17.7 ± 4.98 cm³, and the median overall tumor size was 4.2 cm (3.4–5 cm). The mean values of coverage index, dose homogeneity index, overdose volume index, dose non-uniformity ratio, and conformal index were 0.94, 0.83, 0.21, 0.37, and 0.88, respectively. With a median followup of 41 months (range, 20–67.2 months), preservation of the anal sphincter was achieved in 14 patients. The 1- and 2-year local control rates were 93.8% and 87.5%, respectively. Treatment was well tolerated and none of the patients developed Grade 3 or higher late toxicity.ConclusionsThe combination of external beam radiotherapy with interstitial brachytherapy increases the dose to the tumor volume and limits the volume of irradiated normal tissue, thereby decreasing late toxicity. The use of image-based treatment planning provides better dose conformality with reduced toxicity and helps to prevent a geographic miss.     

Efficacy and safety of iodine-125 radioactive seeds brachytherapy for advanced non–small cell lung cancer—A meta-analysis

PURPOSEThis meta-analysis was conducted to investigate the efficacy and safety of ¹²⁵I brachytherapy for locally advanced non–small cell lung cancer (NSCLC).Methods AND MATERIALSTrials comparing ¹²⁵I brachytherapy with chemotherapy in NSCLC were identified. Meta-analysis was performed to obtain pooled risk ratios for an overall response rate (ORR), disease control rate (DCR) and complications, and pooled hazard ratio for overall survival (OS).ResultsFifteen studies including 1188 cases were included. The pooled result indicated that there were significant differences in ORR, DCR, and OS between ¹²⁵I brachytherapy combined with chemotherapy and chemotherapy alone, but no statistic differences in gastrointestinal symptoms, leukopenia, myelosuppression, and hemoglobin reduction. Patients treated with ¹²⁵I brachytherapy combined with chemotherapy have a higher relative risk of pneumothorax, bloody sputum, and pneumorrhagia compared with chemotherapy alone. Seeds migration only occurred in the group treated with ¹²⁵I brachytherapy. There were significant differences in ORR, DCR, and myelosuppression between ¹²⁵I brachytherapy alone and chemotherapy.Conclusions¹²⁵I brachytherapy combined with chemotherapy can significantly enhance the clinical efficacy and improve the OS of patients with advanced NSCLC without increasing the incidence of complications of chemotherapy. ¹²⁵I brachytherapy alone can significantly enhance the clinical efficacy and reduce the incidence of myelosuppression compared with chemotherapy. However, ¹²⁵I brachytherapy may cause lung injury. Large sample and higher-quality randomized controlled trials are needed to confirm the pooled results of complications.