~(125)I粒子组织间植入治疗局部进展期胰腺癌42例

目的:探讨125I粒子组织间植入治疗局部进展期胰腺癌的疗效。方法:选择局部进展期胰腺癌无法行根治手术患者42例,术中植入125I粒子及姑息性手术。结果: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),无明显骨髓抑制及免疫抑制。3个月、6个月、12个月生存率分别为100%、76.7%、33.3%。其中Ⅱ期6个月、12个月生存率为90.0%、55.5%,Ⅲ期6、12个月生存率为68.2%、13.6%(P<0.05)。结论:125I组织间放射治疗局部进展期胰腺癌,方法简单、安全,能较好改善疾病相关症状,近期疗效确切,是治疗局部进展期胰腺癌较理想的方法之一。     

Salvage high-dose-rate (HDR) brachytherapy for recurrent head-and-neck cancer

BACKGROUND: A significant portion of head-and-neck cancer patients will develop persistent or recurrent disease after definitive treatment. Radiation therapy is often used as definitive therapy or as an adjunct to surgery. Recurrent cancer of the head and neck in the previously irradiated field is, thus, a common occurrence and poses a therapeutic challenge. Some studies have evaluated low-dose-rate (LDR) brachytherapy as a therapeutic option, including a large case series with long-term follow-up by our own institution. High-dose-rate (HDR) brachytherapy offers therapeutic advantages over LDR brachytherapy. This study evaluates the local control and outcomes of patients with previously irradiated recurrent head-and-neck cancer treated with HDR interstitial brachytherapy. METHODS AND MATERIALS: Between 1997 and 2002, 30 patients who received prior radiation therapy for primary tumors of the head and neck were treated for biopsy-proven recurrent disease. All patients received previous radiation as definitive therapy alone or as adjunct to surgery. All patients were inoperable, refused surgery, or had gross residual disease after salvage surgery for their recurrent disease. Thirty-six sites on the 30 patients were implanted by application of high-dose-rate interstitial brachytherapy techniques with mean tumor dose of 34 Gy (18-48 Gy) in twice daily fractions of 300 to 400 cGy per fraction. RESULTS: At a minimum follow-up of 12 months, local tumor control was achieved in 69% of implanted sites. Disease-specific survival at 1 and 2 years was 54% and 45%, respectively. Overall survival at 1 and 2 years was 56% and 37%, respectively. Grade 3/4 late complications occurred in 16% of the patients. No fatal complications occurred. CONCLUSION: HDR brachytherapy can play an important role in the salvage treatment of previously irradiated recurrent head-and-neck cancer. This study shows that comparable results are obtained by HDR brachytherapy with fewer late complications than were indicated by previously reported data for LDR brachytherapy.     

Comparison of dosimetric and biologic effective dose parameters for prostate and urethra using 131 Cs and 125 I for prostate permanent implant brachytherapy

PURPOSE: To compare the urethral and prostate absolute and biologic effective doses (BEDs) for 131 Cs and 125 I prostate permanent implant brachytherapy (PPI). METHODS AND MATERIALS: Eight previously implanted manually planned 125 I PPI patients were replanned manually with 131 Cs, and re-planned using Inverse Planning Simulated Annealing. 131 Cs activity and the prescribed dose (115 Gy) were determined from that recommended by IsoRay. The BED was calculated for the prostate and urethra using an alpha/beta ratio of 2 and was also calculated for the prostate using an alpha/beta ratio of 6 and a urethral alpha/beta ratio of 2. The primary endpoints of this study were the prostate D90 BED (pD90BED) and urethral D30 BED normalized to the maximal potential prostate D90 BED (nuD30BED). RESULTS: The manual plan comparison (alpha/beta = 2) yielded no significant difference in the prostate D90 BED (median, 192 Gy2 for both isotopes). No significant difference was observed for the nuD30BED (median, 199 Gy2 and 202 Gy2 for 125 I and 131 Cs, respectively). For the inverse planning simulated annealing plan comparisons (alpha/beta = 2), the prostate D90 BED was significantly lower with 131 Cs than with 125 I (median, 177 Gy2 vs. 187 Gy2, respectively; p = 0.01). However, the nuD30BED was significantly greater with 131 Cs than with 125 I (median, 192 Gy2 vs. 189 Gy2, respectively; p = 0.01). Both the manual and the inverse planning simulated annealing plans resulted in a significantly lower prostate D90 BED (p = 0.01) and significantly greater nuD30BED for 131 Cs (p = 0.01), compared with 125 I, when the prostate alpha/beta ratio was 6 and the urethral alpha/beta ratio was 2. CONCLUSION: This report highlights the controversy in comparing the dose to both the prostate and the organs at risk with different radionuclides.     

125Ⅰ粒子组织间植入治疗局部进展期胰腺癌42例

目的:探讨125Ⅰ粒子组织间植入治疗局部进展期胰腺癌的疗效.方法:选择局部进展期胰腺癌无法行根治手术患者42例,术中植入125Ⅰ粒子及姑息性手术.结果:术后患者顽固性疼痛症状明显缓解(P＜0.05),Karnofskv评分显著提高(P＜0.05),无明显骨髓抑制及免疫抑制.3个月、6个月、12个月生存率分别为100%、76.7%、33.3%.其中Ⅱ期6个月、12个月生存率为90.0%、55.5%,Ⅲ期6、12个月生存率为68.2%、13.6%(P＜0.05).结论:125Ⅰ组织间放射治疗局部进展期胰腺癌,方法简单、安全,能较好改善疾病相关症状,近期疗效确切,是治疗局部进展期胰腺癌较理想的方法之一.     

Interstitial brachytherapy for recurrent breast cancer using a high dose rate lr-192 remote afterloading system: a report of two cases

We employed interstitial brachytherapy using a high dose rate Ir-192 remote afterloading unit in two breast cancer patients with locoregional recurrence. In the first case, skin metastasis was treated, with favorable control of the infield tumor but subsequent persistent sequelae and multiple outfield metastases. This experience caused us to be cautious when choosing brachytherapy for the second case, in whom a solitary metastasis to an axillary lymph node was successfully treated. Although this method is still investigational, it may play a critical role in the treatment of locoregional recurrence resistant to other treatment modalities.     

CT-guided interstitial brachytherapy of inoperable non-small cell lung cancer

Purpose

The aim of this study was to assess the technical feasibility, efficacy, and complications of CT-guided interstitial brachytherapy for treating inoperable non-small cell lung cancer (NSCLC).

Materials and methods

Twenty one patients were included in this prospective study. The median age was 72.6 years (57-85). Tumors were treated with brachytherapy that was positioned under CT-fluoroscopy. The treatment planning system (TPS) was used preoperatively to reconstruct three dimensional images of the tumor and to calculate the estimated seed number and distribution. The median matched peripheral dose (MPD) was 130 Gy (range, 100-160 Gy). All procedures were performed under local anesthesia. A follow-up CT was performed 6 weeks later and every 3 months post implantation.

Results

Follow-up period was 2-30 months. The mean diameter of the 21 lung tumors was 4.6 cm (range, 2.8-6.5 cm). The response rate of pain relief was 83.3% (10/12). The pain-free duration was 0-12 months (median: 6 months; 95% CI: 3-9 months). Overall responding rate (CR + PR) for this group of patients was 71.4%. Local tumor control rate was 85.7%. Six (28.6%) patients died as a result of primary tumor progression; thirteen (61.9%) patients died of multi-organ failure or other metastases. Two (9.5%) patients survived to follow-up. At the time of analysis, the median survival time for all patients was 10 months (95% CI: 6.6-13.4 months), with 1 year and 2 year survival rates were 42.4% and 6.5%, respectively. Median survival time for stage II, stage III, and stage IV was 20 months, 9 months, and 8 months, respectively. No major complications were observed. Minor complications (19%) included mild pneumothorax (n = 1), hemosputum (n = 1), pleural effusion (n = 1), and localized skin erythema (n = 1). None of these complications required further treatment, although hospital discharge was delayed. No ¹²⁵I seeds migrated to other tissues or organs.

Conclusion

Minimally invasive CT-guided interstitial brachytherapy is safe, useful, less complicated and considered as a palliative treatment option for inoperable non-small cell lung cancer.     

碘-125粒子植入治疗复发性头颈癌的效果评价

目的研究碘-125粒子(125I)组织间近距离植入治疗复发性头颈癌的安全性、疗效及不良反应。方法根据制定的放射性粒子植入治疗计划,对18例既往接受过颈部外照射或术后联合外照射再次局部复发的患者进行粒子植入治疗。随访观察疗效及不良反应。结果所有病例随访4~20个月,中位随访时间10个月。其中1年局部控制率为56.7%,2年局部控制率为39.2%。1年生存率为58.6%,2年生存率为40.1%。不良反应发生率较低,Ⅰ级或Ⅱ级不良反应7例,Ⅲ级不良反应1例。结论125I粒子植入治疗复发性头颈癌安全有效,为治疗复发性头颈癌提供了新的治疗手段。     

Stereotactic iodine-125 brachytherapy for the treatment of WHO grades II and III gliomas located in the central sulcus region

Background

Resection of gliomas located in eloquent brain areas remains a neurosurgical challenge. The reported incidence of transient or permanent neurological deficits after microsurgery in eloquent brain ranges 20%–100%, or 0%–47% among contemporary neurosurgical series. The aim of this study was to assess the feasibility of stereotactic brachytherapy (SBT) as a local treatment alternative to microsurgical resection for patients with gliomas in highly eloquent areas, located in the central sulcus region (CSR).

Method

Between 1997 and 2010, 60 patients with World Health Organization (WHO) grades II and III gliomas located in the CSR were treated with SBT (iodine-125 seeds; cumulative therapeutic dose, 50–65 Gy). Following SBT, WHO grade III glioma patients additionally received percutaneous radiotherapy (median boost dose, 25.2 Gy). We evaluated procedure-related complications, clinical outcome, and progression-free survival.

Results

Procedure-related mortality was zero. Within 30 days of SBT, 3 patients (5%) had transient neurological deficits, and 8 patients (13%) had temporarily increased seizure activity. One patient (1.6%) deteriorated permanently. Space-occupying cysts (6 patients) and radiation necrosis (1 patient) developed after a median of 38 months and required surgical intervention. Seizure activity, rated 12 months following SBT, decreased in 82% of patients (Engel classes I–III). Median progression-free survivals were 62.2 ± 19.7 months (grade II gliomas) and 26.1 ± 17.9 months (grade III gliomas).

Conclusions

Compared with microsurgical resection, SBT harbors a low risk of procedural complications, is minimally invasive, and seems to be an effective local treatment option for patients with inoperable, eloquent WHO grade II and III gliomas in the CSR. However, the value of SBT for treating gliomas still needs to be determined in prospective, randomized studies.     

CT引导125I放射性粒子植入治疗复发性脑胶质瘤的研究

目的：探讨^125I放射粒子植入治疗复发性脑胶质瘤的技术方法、疗效和安全性。方法：33例手术或放疗后复发性脑胶质瘤患者行CT引导下^125I粒子植入术,根据术前计划确定粒子数目、空间分布和粒子针数目。粒子活度为0．4-0．8mCi,间距为0．5～1.0cm,共植入粒子10～35颗,术后即刻行CT扫描并进行质量验证。术后定期复查CT。结果：按照WHO疗效评价标准,1、3和6个月时有效率分别为48．5％、67．7％和80．0％。全组中位生存期16个月,其中1～2级胶质瘤中位生存期26个月,3～4级胶质瘤中位生存期11个月;全组1年生存率为66．7％（22／33）,其中1～2级胶质瘤1年生存率为85．0％（17／20）,3～4级胶质瘤1年生存率为38．5％（5／13）。并发症包括针道少量出血4例,局部脑坏死5例。未出现与治疗相关的死亡病例。结论：CT引导^125I粒子植入治疗复发性脑胶质瘤具有安全、微创、并发症少和疗效肯定等优点,值得进一步应用。     

放射性~(125)I粒子植入治疗椎体及椎旁肿瘤

目的:评价放射性125I粒子组织间永久性植入治疗椎体及椎旁肿瘤的疗效和安全性.方法:对16例椎体及椎旁肿瘤患者(3例原发肿瘤,13例转移瘤)共28个病灶,行CT引导下或者术中125I粒子永久性植入治疗.粒子活度0.5-0.8mCi,每个病灶植入粒子数目7-100颗.肿瘤最小周边剂量(mPD)110-160Gy.术后行质量验证.结果:中位随访时间26.5个月(5-61个月).疼痛缓解率93.7%.神经功能恢复或者保留率93.75%.1年局部控制率64%,2年局部控制率50%,3年局部控制率32%,5年局部控制率4%.中位局部控制时间32个月.1年生存率73%,2年生存率59%,5年生存率41%.中位生存期36个月.1例患者因肿瘤进展出现截瘫,其余患者未出现明显的不良反应.结论:放射性125I粒子植入术单独或联合手术治疗椎体及椎旁肿瘤安全、不良反应小,耐受性好.临床疗效尚需进一步临床研究证实.     

Stereotactic biopsy combined with stereotactic (125)iodine brachytherapy for diagnosis and treatment of locally recurrent single brain metastases

This paper reports on stereotactic biopsy combined with stereotactic ¹²⁵iodine brachytherapy (SBT) for locally recurrent, previously irradiated cerebral metastases, focusing on feasibility, complications, cerebral disease control, and survival. All patients with suspected locally recurrent metastases detected by MRI were selected for this combined procedure. After stereotactic biopsy, all patients with a verified vital tumor underwent SBT (50 Gy surface dose applied for 42 days) during the same surgical procedure. Histological results of biopsy, complications, treatment response, local and distant disease control, and survival were evaluated. Thirty patients underwent stereotactic biopsy, and 27 were treated with SBT for histologically proved tumor recurrence. There was no treatment-related mortality, and morbidity was transient and low (6.6%). Median survival was 14.8 months. After one year the actuarial incidence of local and distant relapse was 6.7 and 45.5%, respectively. There was no grade 3 or 4 CNS toxicity, even among the 18.5% of patients with tumors >30 mm. For these patients stereotactic biopsy seems to be a safe and valuable means of differentiating between radiation-induced tissue changes and tumor recurrence/progression. SBT is a safe, minimally invasive, and highly effective treatment option for cerebral disease control and survival. Furthermore, it can be performed during the same stereotactic operation.     

Image and laparoscopic guided interstitial brachytherapy for locally advanced primary or recurrent gynaecological cancer using the adaptive GEC ESTRO target concept

Purpose

To retrospectively assess treatment outcome of image and laparoscopic guided interstitial pulsed dose rate brachytherapy (PDR-BT) for locally advanced gynaecological cancer using the adaptive GEC ESTRO target concept.

Materials and methods

Between June 2005 and December 2010, 28 consecutive patients were treated for locally advanced primary vaginal (nine), recurrent endometrial (12) or recurrent cervical cancer (seven) with combined external beam radiotherapy (EBRT) and interstitial PDR-BT. Treatment was initiated with whole pelvic EBRT to a median dose of 45 Gy followed by PDR-BT using the Martinez Universal Perineal Interstitial Template (MUPIT). All implants were virtually preplanned using MRI of the pelvis with a dummy MUPIT in situ. The GEC ESTRO high risk clinical target volume (HR CTV), intermediate risk clinical target volume (IR CTV) and the organs at risk (OAR) were contoured and a preplan for implantation was generated (BrachyVision, Varian). The subsequent implantation was performed under laparoscopic visualisation. Final contouring and treatment planning were done using a post-implant CT. Planning aim of PDR-BT was to deliver 30 Gy in 50 hourly pulses to HR CTV. Manual dose optimisation was performed with the aim of reaching a D90 > 80 Gy in the HR CTV calculated as the total biologically equivalent to 2 Gy fractions of EBRT and BT (EQD2). Dose to the OAR were evaluated using dose volume constraints for D_2cc of 90 Gy for bladder and 70 Gy for rectum and sigmoid.

Results

For HR CTV the median volume was 26 cm³ (7-91 cm³). Coverage of the HR CTV was 97% (90-100%) and D90 was 82 Gy (77-88 Gy). The D_2cc for bladder, rectum, and sigmoid were 65 Gy (47-81 Gy), 61 Gy (50-77 Gy), and 52 Gy (44-68 Gy), respectively. Median follow up was 18 months (6-61 months). The actuarial 2 years local control rate was 92% (SE 5), while disease-free survival and overall survival were 59% (SE 11) and 74%, respectively (SE 10). No complications to the laparoscopic guided implantation were encountered. Late grade 2 (CTC v 3.0) complications were recorded in nine (32%) patients. One patient had a grade 3 vaginal complication. No grade 4-5 complications have been recorded so far.

Conclusion

Image and laparoscopic guided interstitial PDR-BT using the GEC ESTRO target concept is applicable for locally advanced primary vaginal or recurrent endometrial and cervical cancer resulting in an excellent local control rate and limited morbidity.     

Long-term follow-up of patients of intrahepatic malignancies treated with iodine-125 brachytherapy

PURPOSE: We investigated the role of intraoperative iodine-125 (125I) brachytherapy as a treatment option for unresectable primary and metastatic liver tumors. METHODS AND MATERIALS: Between 1989 and 2002, 64 patients with unresectable or residual disease after surgical resection for intrahepatic malignancies underwent 160-Gy permanent 125I brachytherapy. RESULTS: The median length of follow-up was 13.2 years. The overall 1-year, 3-year, and 5-year actuarial intrahepatic local control rates were 44%, 22%, and 22%, respectively, with a median time to liver recurrence of 9 months (95% CI, 6-12 months). The 5-year actuarial intrahepatic control was higher for patients with solitary metastasis (38%) than for those with multiple metastases (6%, p = 0.04). The 1-year, 3-year, and 5-year actuarial overall survival rates were 73%, 23%, and 5%, respectively (median, 20 months; 95% CI, 16-24; longest survival, 7.5 years). Overall survival was higher for patients with smaller-volume implants (p = 0.003) and for patients without prior liver resection (p = 0.002). No mortality occurred. Radiation-related complications were minimal. CONCLUSIONS: For select patients with unresectable primary and metastatic liver tumors for whom curative surgical resection is not an option, 125I brachytherapy is a safe and effective alternative to other locally ablative techniques and can provide long-term local control and increased survival.     

~(125)I放射性粒子近距离照射在支气管肺癌治疗中的应用

125I放射性粒子组织间植入已应用于支气管肺癌的综合治疗,主要用于非小细胞肺癌。目前有多种植入方法,取得了较好的局部控制率。125I放射性粒子植入治疗支气管肺癌的方法正逐步发展,具有广阔的应用前景。     

Design of a cap for radioshielding during treatment with interstitial125I brain implants

A practical radiation shielding cap has been constructed for use during¹²⁵I brain implants. The cap is comfortable enough to be worn continuously during a 6-day implant and provides complete shielding from the implanted radioactive sources.