Efficacy and safety of 3D printing coplanar template-assisted iodine-125 seed implantation as palliative treatment for inoperable pancreatic cancer

Abstract

Purpose To investigate clinical efficacy and safety of 3D printing coplanar template-assisted iodine-125 ( 125 I) seed implantation as a palliative treatment for inoperable pancreatic cancer. Material and methods Consecutive 28 patients (16 males and 12 females, median age of 64 years) with histologically diagnosed pancreatic cancer who underwent 3D printing coplanar template-assisted 125 I seed implantation between June 2016 and May 2019 were analyzed. Among these 28 patients, 9 (32.1%) and 19 (67.9%) patients were presenting with tumor node metastasis (TNM) stage IIB and stage III cancer, respectively. Seed implantation was conducted for pain palliation intent in 25 patients and recurrent cancer after radiotherapy in 3 patients. Results No significant differences were found between pre-planned and post-operative dosimetric parameters, involving D 90 , D 100 , V 90 , V 100 , V 150 , conformity index, external index, and homogeneity index (all p > 0.05). Two months after implantation, pain relief rate was 76% (19/25) for pain patients. Overall tumor response rate (complete response + partial response) was 60.7% (complete response 0 patients, partial response 17 patients, stable disease 8 patients, and progressive disease 3 patients). Median survival was 10.5 months and estimated 1-year survival rate was 26.7%. Only one patient presented with a slightly upper gastro-intestinal hemorrhage, and another patient suffered from incomplete intestinal obstruction soon after implantation, both recovered after conservative medical treatment without a prolonged hospital stay. No major complication was observed. Conclusions 3D printing coplanar template-assisted 125 I seed implantation appears to be safe and effective palliative treatment for inoperable pancreatic cancer with favorable clinical outcomes.

Intratumoral injection therapies for locally advanced pancreatic cancer: systematic review

“…For the application method, 14 studies (542 patients) implanted the seeds intraoperatively in an open approach using X-ray, CT, or ultrasonography guidance 27 , 28 , 30 , 34–36 , 38 , 40 , 44 , 46 , 48 , 50 , 51 , 54 . Twelve studies (401 patients) used percutaneous implantation guided by ultrasonography or CT 25 , 26 , 31 , 32 , 39 , 43 , 45 , 49 , 52 , 53 , 55 , 56 . Since 2006, four studies (179 patients) implemented endoscopic ultrasonography (EUS) to deliver the radioactive seeds to the tumour with a transgastric or transduodenal injection 37 , 41 , 42 , 47 .…”

The efficacy and safety of CT-guided 125I seed implantation by coplanar template as a salvage therapy for vertebral metastases after failure of external beam radiation therapy: a retrospective study

“…Most doctors still use unarmed experience to implant radioactive seeds, which leads to inconsistent preoperative and postoperative dose, unable to repeat, uncontrollable dose, and di cult to promote technical means. In recent years, studies [37,[40][41][42] have shown that 3D-printed coplanar template assisted 125 I seed implantation is a safe and effective method for the treatment of malignant tumors.However, there are few studies on coplanar template-assisted 125I seed implantation in the treatment of vertebral metastases.In our study, there were no signi cant differences in D90, D100, V90, V100, V150, V200, CI, EIand HI before and after implantation of 76 lesions, indicating the accuracy and consistency of the coplanar template assisted particle implantation. CI and EI are important dosimetric evaluation indexes of radioactive seeds.Because the dose attenuation of seeds follows the law of inverse square of distance and exponential attenuation, a little change of particle spacing can lead to obvious change of dose distribution [39] .…”

Feasibility of 125I brachytherapy combined with arterial infusion chemotherapy in patients with advanced pancreatic cancer

“…The 125 I radiation range is small and precise with high local treatment dose, high-dosed radiation increased local tumor control and OS. [8][9][10] A computer 3-dimensional TPS and CT-guided imaging can accurately position particle placement position and help peripheral tumor doses reach the MPD of 100 to 150 Gy and reduce the risk of local recurrence. Dose distribution around the source decreased according to the distance of radioactive sources by the inverse square law.…”

“…So a highly effective dose of radiation as a single source can effectively kill tumor cells over long periods of time, lasting for weeks or months. [9][10][11][16][17][18][19][20] Compared with traditional surgery, the seed implantation is simpler and can reduce the operative time, with smaller surgical trauma, less physical and mental pain, fewer complications and lower costs. [21] In addition, the particles are easy to be preserved.…”

“…While, the radiation dose outside the radioactive sources can decay quickly, with less damage on the surrounding normal tissues and better protection of the normal tissues. [8][9][10] Intraoperative radiotherapy is another type of brachytherapy. However, it is only suitable for patients willing to undergo surgery.…”