CT导向下组织间植入125I粒子治疗胰腺癌

70年代后期，欧美一些发达国家相继开展了肿瘤内植入放射性粒子治疗恶性肿瘤的研究。随着CT设备的出现，CT引导下肿瘤内植入粒子的新兴微创方法悄然兴起。我们在CT导向下对10例胰腺癌患者肿瘤内植入了^125I粒子，现将结果报告如下。     

放射性粒子植入治疗中晚期胰腺癌疗效分析

目的:探讨125I放射粒子植入术治疗手术无法切除的胰腺癌的疗效。方法:选择胰腺癌患者50例。内放射治疗组30例,肿瘤内部125I放射粒子植入,有梗阻症状者,加行胆-肠吻合术和胃-空肠吻合术;对照组20例,均行单纯剖腹探查或胆-肠吻合术和/或胃-空肠吻合术。观察肝肾功能、总胆红素变化;肿瘤大小变化;并发症发生情况;腹痛、背痛变化等。结果:两组患者总胆红素术后4周时均接近正常,肝功能明显改善,手术前后比较均具有统计学意义;粒子植入组患者手术前后腹痛、腰痛改善明显。有效率100%(30/30),完全缓解率97%;粒子植入组肿瘤直径有缩小趋势,对照组无明显变化;两组患者均无吻合口瘘、胆瘘、胰瘘、腹腔出血和腹腔感染。结论:125I粒子植入对不可切除的胰腺癌具有确定疗效,不仅可以明显延长患者生存期,提高生活质量,且对胰腺癌引起的疼痛有明显的缓解效果。     

CT引导下125I粒子及5-Fu缓释剂植入治疗中晚期胰腺癌

目的 探讨CT引导下经皮穿刺125I粒子及5-氟尿嘧啶(5-Fu)缓释剂植入治疗中晚期胰腺癌的临床应用价值.方法 13例经证实的中晚期胰腺癌,采用放射性粒子治疗计划系统(treatment plan system,TPS)计算布源,在CT引导下将125I粒子缓释剂植入瘤灶内,并在125I粒子间间隔植入5-Fu缓释剂.术后2个月,分别对患者进行CT检查,根据肿瘤大小变化和临床症状缓解程度对疗效进行分级.结果 7例患者疼痛完全缓解,2例部分缓解,4例无效,平均术后3d-7d疼痛缓解.6个月后CT复查,完全缓解(CR)1例;部分缓解(PR)6例;无变化(NC)4例;进展(PD)2例.总有效率(CR+PR) 53.8%.术后未见胰瘘、胰腺炎、肠出血、腹腔内脓肿等严重并发症.结论 CT引导下经皮穿刺植入125I粒子及5-Fu缓释剂治疗中晚期胰腺癌创伤小,并发症少,姑息止痛效果好,是治疗中晚期胰腺癌安全,可靠,有效的方法 之一.     

CT引导下~（125）I粒子植入治疗48例肺癌分析

[目的]探讨CT引导下125I粒子植入治疗肺癌的临床价值及并发症发生情况。[方法]2008年10月至2010年12月48例肺癌行CT引导下125I粒子组织间植入治疗。观察患者治疗完成情况及并发症发生情况。[结果]所有病例均将放射性125I粒子成功植入,45例患者1次成功植入,3例患者2次成功植入。无手术死亡。出现轻度并发症30例（62.50%）,包括：术中出现咯血4例（8.33%）,少量肺出血9例（18.75%）,气胸14例（29.17%）,粒子游走或迁移3例（6.25%）。[结论]CT引导下125I粒子植入治疗肺癌较安全,并发症轻,值得推广应用。     

125I放射性粒子组织间植入在局部进展期胰腺癌治疗中的研究进展

胰腺癌是难治恶性肿瘤之一,其发病率及死亡率均较高,缺乏有效治疗手段,近年来我国相继开展125I放射性粒子植入治疗局部进展期胰腺癌.放射性粒子植入治疗肿瘤具有微创、并发症少、安全性高等特点,并可提高肿瘤局部控制率和患者生存质量.全文就125I放射性粒子植入治疗胰腺癌的治疗方法、安全性及临床疗效作一综述.     

CT引导下经皮穿刺植入放射性125I粒子治疗肺癌的临床应用

目的 探讨CT引导下经皮穿刺植入放射性125I粒子的肺癌治疗方法,观察临床疗效和不良反应.方法 于2004年6月-2005年10月,经CT引导125I粒子植入治疗肺癌32例.所有病例均行术前TPS制定治疗计划,术后质量验证.全部患者均植入0.5 mCi-1.0 mCi的放射性粒子,12-60颗.结果 植入病例全部成功,无死亡,部分出现气胸、出血,术后1周复查外周血象、1月复查CT及临床观察无毒副反应,术后定期复查CT,未出现放射损伤症状,未发现粒子脱落或游走等并发症.CR 22.58%、PR 61.29%、SD 12.9%、PD 3.2%.中位生存期大于12个月.结论 CT引导下经皮穿刺放射性125I粒子近距离照射治疗肺癌安全、有效,并且创伤小、并发症少.     

复发性直肠癌CT引导~(125)I粒子植入的剂量学验证

[目的]探讨复发性直肠癌CT引导125I粒子植入的剂量分布。[方法]选择10例接受CT引导125I粒子植入的复发性直肠癌患者。计划靶区D90(90%体积接受的剂量)为100Gy。CT引导进针和植入粒子,粒子针间距1cm,平行排列,粒子间隔1cm均匀植入。术后即刻行CT扫描和剂量学验证。[结果]计划靶区平均体积为101cc,平均植入粒子80颗,单颗粒子活度为0.5～0.8mCi。计划靶区平均植入粒子活度0.69mCi/cc。平均D90为91.5Gy,平均V100(计划靶区接受100%处方剂量的体积百分比)为85.5%。平均V150和V200分别是68.9%和52.1%,平均最小周边剂量是38.5Gy。[结论]复发性直肠癌CT引导125I粒子植入可以实现预期的剂量分布。均匀植入粒子靶区剂量不均匀,部分患者因骨骼和危及器官限制,靶区周边剂量偏低。     

125I放射性粒子术中植入治疗晚期胰腺癌的疗效评价

目的初步分析^125Ⅰ放射性粒子术中植入内照射治疗晚期胰腺癌的临床疗效。方法对10例手术不能切除的晚期胰腺癌在术中植入^125Ⅰ放射性粒子进行组织间内照射。结果全组10例获得2-13个月的随访，中位6个月。生存期达12个月1例，6个月3例，3个月4例，1个月2例。中位生存期4．6个月。肿瘤完全缓解(CR)2例，部分缓解(PR)3例，无变化(NC)4例，进展(PD)1例。总有效率(CR PR)为50％。止痛有效率为60%。经术后X线片验证，粒子数目符合率为100％，粒子空间分布符合率仅为30％。结论^125Ⅰ放射性粒子术中植入内照射治疗晚期胰腺癌有一定疗效，但在按照粒子计算机治疗计划完成术中粒子空间分布技术方面尚须进一步完善。     

脊柱软骨肉瘤术后复发CT引导下放射性^125I粒子植入的初步观察

目的评价脊柱软骨肉瘤术后复发cT引导下放射性^125I粒子植入的初步结果。方法采用cT引导放射性125I粒子植入的方法对5例脊柱软骨肉瘤术后复发患者进行治疗,术前应用三维治疗计划系统制定粒子分布计划,术中间距0．5～1．0cm植入粒子,距离危险器官的安全距离大于1．0cm,术后进行质量验证。结果本组平均随访时间15．2个月（2—41个月）,局部有效率60．0％。平均局部控制时间11．4个月,1年局部控制率60．0％。平均生存期15．2个月,1年生存率为66．7％。术前和术后NRS评分分别为6．00±2．65分和1．00±1．00分,二者差异有显著性（P值〈O．05）,镇痛有效率100．0％。结论CT引导下放射性^125I粒子植入治疗脊柱软骨肉瘤术后复发病例效果确切．疼痛缓解满意,临床应用价值较高。     

CT引导下125Ⅰ粒子植入治疗48例肺癌分析

[目的]探讨CT引导下125Ⅰ粒子植入治疗肺癌的临床价值及并发症发生情况.[方法] 2008年10月至2010年12月48例肺癌行CT引导下125Ⅰ粒子组织间植入治疗.观察患者治疗完成情况及并发症发生情况.[结果]所有病例均将放射性125Ⅰ粒子成功植入,45例患者1次成功植入,3例患者2次成功植入.无手术死亡.出现轻度并发症30例(62.50％),包括:术中出现咯血4例(8.33％),少量肺出血9例(18.75％),气胸14例(29.17％),粒子游走或迁移3例(6.25％).[结论]CT引导下125Ⅰ粒子植入治疗肺癌较安全,并发症轻,值得推广应用.     

Iodine-125 Seed Implantation and Deferred Transurethral Resection of the Prostate for Patients With Lower Urinary Tract Symptoms and Localized Prostate Cancer

Introduction/BackgroundMany localized PCa patients with preexisting LUTS are considered poor candidates for seed implants because of the greater risk of postoperative urinary morbidity. We report our department's experience with performing deferred LTURP 6 months after iodine-125 seed implantation to treat localized PCa patients with LUTS.Patients and MethodsOf 225 men undergoing prostate brachytherapy at our institution between 2005 and 2011, 38 patients were treated with deferred LTURP 6 months after ¹²⁵I seed implantation. LTURP was considered after brachytherapy for patients whose International Prostate Symptom Score (IPSS) was greater than 12, or who still need a catheter for an elevated postvoid residual (PVR) (>100 mL) after α-blocker therapy for LUTS for 6 months. IPSS, quality of life (QOL) score, peak flow rate (PFR), and PVR were evaluated before and after LTURP.ResultsAll 38 patients in our series underwent LTURP 6 months after prostate brachytherapy for low- or intermediate-risk PCa. Mean IPSS, QOL score, PFR, and PVR were significantly improved after LTURP, and improvement persisted at the latest follow-up. After a mean of 32 months of follow-up, no patient developed retention, urethral necrosis, or urinary incontinence after brachytherapy and LTURP.ConclusionIodine-125 seed implantation and deferred LTURP 6 months after brachytherapy is a safe and effective treatment strategy for patients with both LUTS and localized prostate cancer.     

CT-guided Radioactive 125I Seed Implantation for Abdominal Incision Metastases of Colorectal Cancer: Safety and Efficacy in 17 Patients

IntroductionTo retrospectively evaluate the safety and efficacy of computed tomography (CT)-guided iodine-125 (¹²⁵I) seed implantation for patients with abdominal incision metastases from colorectal cancer.Materials and MethodsData of patients with abdominal incision metastases of colorectal cancer from November 2010 to October 2020 were retrospectively reviewed. Each incisional metastasis was percutaneously treated with ¹²⁵I seed implantation under CT guidance. Follow-up contrast-enhanced CT was reviewed, and the outcomes were evaluated in terms of objective response rate, complications, and overall survival.ResultsA total of 17 patients were enrolled in this study. The median follow-up was 18 months (range, 2.7-22.1 months). At 3, 6, 12, and 18 months after the treatment, objective response rate was 52.9%, 63.6%, 33.3%, and 0%, respectively. A small amount of local hematoma occurred in two patients and resolved spontaneously without any treatment. Two patients experienced a minor displacement of radioactive seeds with no related symptoms. Severe complications, such as massive bleeding and radiation injury, were not observed. No ≥ grade 3 adverse events were identified. By the end of follow-up, 14 patients died of multiple hematogenous metastases. The one-year overall survival rate was 41.6%, and the median overall survival was 8.6 months.ConclusionCT-guided ¹²⁵I seed implantation brachytherapy is safe and feasible for patients with abdominal incision metastases from colorectal cancer.     

Nationwide Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 Seed Implantation (J-POPS): first analysis on survival

Background

Investigating oncological outcomes in patients registered in the Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 Seed Implantation (J-POPS) in terms of biochemical relapse-free survival (bRFS) by the Phoenix and the newly developed J-POPS definitions, exploration of predictive factors for bRFS, and preliminary verification of pitfalls of prostate-specific antigen (PSA) failure definitions.

Methods

Between July 2005 and June 2007, 2316 clinically localized patients underwent permanent seed implantation. The primary endpoint was bRFS. One of the secondary endpoints was overall survival (OS).

Results

The median age was 69 and performance status was 0 in 99.1% of participants. The median biologically effective dose (BED) was about 180 Gy². During a median follow-up of 60.0 months, 8.4 and 5.9% had PSA failure by the Phoenix and the J-POPS definitions, respectively. The 5-year bRFSs based on the Phoenix and the J-POPS definitions were 89.1 and 91.6%, respectively. The 5-year OS was 97.3%. According to multivariate analyses, only age affected bRFS based on the Phoenix definition, whereas the risk group and BED independently affected bRFS based on the J-POPS definition. A spontaneous PSA decrease was seen in 91.1% of participants after PSA failure based on the Phoenix definition alone, but in only 22.2% after PSA failure based on the J-POPS definition alone.

Conclusion

The world’s largest registration study, J-POPS, consisted of patients with longevity, and a highly quality-controlled BED resulted in excellent bRFS and OS. The high likelihood of PSA bounce by the Phoenix definition should be taken into account, especially in younger patients.

Clinical trial information

NCT00534196.

     

Treatment of Unresectable Advanced Gastric Cancer Using Iodine-125 Brachytherapy

OBJECTIVE The purpose of the study was to examine the efficacy of treating patients with advanced gastric cancer using iodine-125 （^125Ⅰ） brachytherapy. METHODS Ten patients with unresectable advanced gastric cancer were selected based on their pattern of CT scans. We utilized a brachytherapy planning system to determine the distribution of the ^125Ⅰ seeds, their activity and quantity. The matched peripheral dose （MPD） was 110-135 Gy.^125Ⅰ seeds were implanted in a single plane or biplane by an intraoperative small incision or percutaneous puncture. The postoperative hemogram, CT, KPS, pain-relieving period and survival period were recorded. RESULTS One patient developed a complete response （CR）, 4 patients a partial response （PR）, 3 patients showed no change （NC） and 2 patients developed progressive disease （PD）. The overall response rate （CR＋PR） was 50% （5/10）. The pain-relieving rate was 89% （8/9）. The patients＇ appetite and KPS were improved. The longest survival period was 10 months and median life span was 4 months. There were 8 patients whose seeds fell off resulting in an expulsion rate of 3.8% （26/692）. The patients showed 0-1 degree acute radio-therapeutic side-effects without other symptoms such as abdominal pain, vomitus cruentes or intestinal obstruction etc. CONCLUSION Applying ^125Ⅰ implantation to treat advanced gastric cancer with a reasonable seed distribution can significantly improve clinical symptoms and their quality of life. The radioactive damage is mild. This method can be used as an important supplementary treatment for unresectable advanced gastric cancer.     

CT引导下经皮~(125)I放射粒子植入治疗肺恶性肿瘤临床观察

目的探讨CT引导下经皮~(125)I放射粒子植入治疗肺恶性肿瘤的临床效果。方法选取2012年6月至2013年8月间上海交通大学医学院附属仁济医院肿瘤介入科收治的52例肺癌患者,采用随机数字表法分为观察组和对照组,每组26例。观察组患者采用CT透视引导下经皮~(125)I放射粒子植入治疗,对照组患者采用序贯放化疗法治疗,比较两组患者近期疗效,中位生存时间、1年及2年生存率、并发症和不良反应发生率。结果观察组患者近期有效率为88.5%,对照组患者为61.5%,两组比较,差异有统计学意义(P<0.05)。观察组患者的中位生存时间为19个月,1年生存率为88.5%,对照组患者的中位生存时间为14个月,1年生存率为57.7%,两组中位生存时间和1年生存率比较,差异有统计学意义(P<0.05),观察组2年生存率与对照组比较,差异无统计学意义(P>0.05)。对照组患者胃肠道反应发生率(26.9%)高于观察组(3.8%),两组相比,差异有统计学意义(P<0.05),而两组在血象异常、气胸和出血发生率方面差异无统计学意义(P>0.05)。结论CT引导下经皮~(125)I放射粒子植入治疗肺恶性肿瘤近期临床疗效显著,可增加1年生存率,降低因放化疗引起的胃肠道反应发生率。     

PD-1 Inhibitor Maintenance Therapy Combined Iodine-125 Seed Implantation Successfully Salvage Recurrent Cervical Cancer after CCRT: A Case Report

Cervical cancer is the fourth most common cancer in females worldwide. Patients with stage III and IV cervical cancer based on the Federation of Gynecology and Obstetrics (FIGO) classification have higher recurrence rates. Because of organs at risk (OAR) protection and the low indication rate of salvage surgery, the choice of treatment is always challenging. Systemic chemotherapy is palliative and can be performed in conjunction with surgery or radiotherapy; however, it has no significant benefit to survival. Brachytherapy and stereotactic body radiotherapy (SBRT) are characterized by extremely high radiation doses applied to tumor cells while sparing the normal tissues. Several studies have investigated the efficacy of these technologies in recurrent cervical cancer and showed promising results. The immune checkpoint inhibitors approach was also investigated and showed promising results too. Herein, we report a case of a patient with cervical cancer that recurred five months after adjuvant chemotherapy and concurrent chemoradiotherapy. The disease prognosis after interstitial implantation brachytherapy (IIB) was determined. Then, the patient underwent radioactive 125I-seed implantation combined with PD-1 inhibitor treatment. The patient exhibited a partial response after seed implantation, and up to now, the duration of this partial response was 24 months.