Computed tomography fluoroscopy-guided percutaneous 125I seed implantation for safe, effective and real-time monitoring radiotherapy of inoperable stage T1-3N0M0 non-small-cell lung cancer

Abstract

Abstract. The management of inoperable lung cancer remains a challenge. It has been proven that computed tomography (CT)-guided iodine-125 ( 125 I) seed implantation is a safe and efficient method for treating lung cancer. Computed tomographic fluoroscopy (CTF) is superior to traditional CT for percutaneous management of lung lesions, due to the real-time guidance and accurate localization of the lesions. The aim of the present prospective study was to evaluate the feasibility, safety and efficacy of CTF-guided percutaneous permanent implantation of 125 I seeds for the treatment of selected patients with inoperable stage T1-3N0M0 non-small-cell lung cancer (NSCLC). A total of 24 patients with resectable but inoperable stage T1-3N0 NSCLC, with a total of 28 lesions, underwent CTF-guided percutaneous implantation of radioactive 125 I seeds. A prescription dose of 100-120 Gy was delivered to each lesion. The complications and local tumor control rates were documented. Survival was estimated using the Kaplan-Meier method. All the patients successfully completed the procedure, with a mean procedure duration of 45.7 min (range, 30-75 min). No severe complications occurred. Small asymptomatic pneumothorax with lung volume compression of <10% and minor hemorrhage along the needle track without hemoptysis occurred immediately after the procedure in 3 (12.5%) and 4 (16.7%) of the 24 patients, respectively. At a median follow-up of 31.5 months (range, 8-46 months), the local control rate (LCR) of the lesions was 78.6% (22/28). The 1-, 2-and 3-year overall survival rate was 95.8, 78 and 55%, respectively. In conclusion, CTF is the favourable imaging guidance method for the percutaneous implantation of 125 I seeds. CTF-guided brachytherapy with implantation of 125 I seeds is a safe, feasible and effective modality for the treatment of inoperable early-stage NSCLC and may be considered an alternative option in selected patients with medically inoperable NSCLC.

Efficacy and safety of CT‑guided 125I brachytherapy in elderly patients with non‑small cell lung cancer

“…The present study demonstrated an improved RR, LCR and 1-year OS compared with that of Zhang et al (30) due to the patients in the present study having early-stage NSCLC. These studies have demonstrated the good results of 125 I seed implantation for NSCLC (30)(31)(32). However, these studies all involved combination therapies of 125 I brachytherapy with chemotherapy or EBRT.…”

“…The results of the present study indicated that 125 I brachytherapy may be used alone to improve the LCR, relieve the symptoms and prolong the OS time. Li et al (31) performed CT fluoroscopy-guided 125 I seed implantation for patients with stage T1-3N0M0 NSCLC and reported that at the median follow-up of 31.5 months, the LCR was 78.6% and the 1-, 2-and 3-year OS rates were 95.8, 78.0 and 55.0%, respectively. Another study reported that 125 I brachytherapy combined with chemotherapy was an effective treatment for inoperable stage III/IV NCSLC.…”

Patient-Derived Xenograft Models for Endometrial Cancer Research

“…It has been used to study bone metastases [37] in mice and also has been applied to monitor the progression of lung and liver tumours [38,39,40]. …”

The value of spectral imaging to reduce artefacts in the body after 125I seed implantation

“…The alternative is to implant radioactive seeds under the guidance of ultrasound, CT or laparoscope . The biological damage effects of CT‐guided radioactive seed implantation treatment are lower compared to the external irradiation …”

“…[2][3][4][5] The biological damage effects of CT-guided radioactive seed implantation treatment are lower compared to the external irradiation. 6,7 The CT has good spatial resolution and density resolution, which can accurately reveal the size, shape, position, necrotic cavity inside the lesion and the anatomic relationship with surrounding vessels of tumours. The CT is widely used in the diagnosis of malignant tumours and the assessment of the therapeutic effectiveness of 125 I seeds implantation.…”