Feasibility and Clinical Value of CT-Guided 125I Brachytherapy for Pain Palliation in Patients With Breast Cancer and Bone Metastases After External Beam Radiotherapy Failure

Abstract

Objectives: To evaluate the feasibility and clinical value of CT-guided iodine-125 (125I) brachytherapy for pain palliation in patients with breast cancer and bone metastases after external beam radiotherapy failure.Methods: From January 2014 to July 2016, a total of 90 patients, who had received the standard therapies for bone metastases but still suffered moderate-to-severe pain, were retrospectively studied. About 42 patients were treated with both 125I brachytherapy and bisphosphonates (Group A), and 48 patients were treated with bisphosphonates alone (Group B).Results: In Group A, 45 125I brachytherapy procedures were performed in 42 patients with 69 bone metastases; the primary success rate of 125I seed implantation was 92.9%, without severe complications. Regarding pain progression of the two groups, Group A exhibited significant relief in “worst pain,” “least pain,” “average pain,” and “present pain” 3-day after treatment and could achieve a 12-week-remission for “worst pain,” “least pain,” “average pain,” and “present pain.” The morphine-equivalent 24-h analgesic dose at 3 days, 4 weeks, 8 weeks, and 12 weeks was 91 ± 27, 53 ± 13, 31 ± 17, and 34 ± 12 mg for Group A, and 129 ± 21, 61 ± 16, 53 ± 15, and 105 ± 23 mg for Group B. Group A experienced a lower incidence of analgesic-related adverse events and better quality of life than Group B.Conclusion: The CT-guided 125I brachytherapy is a feasible and an effective treatment for the palliation of pain caused by bone metastases from breast cancer after external beam radiotherapy failure.

Micronutrient Status and Breast Cancer: A Narrative Review

“…Very similar results had been observed in some previous studies [288]. Moreover, the literature supports that iodine can also be used in photoimmunotherapy [289] and brachytherapy [290,291] and has potential in targeted radionuclide therapy [292]. A very interesting application of iodine is in 125I seeds, which can be implanted into a patient's lesion to provide treatment, improve the treatment's effects, reduce adverse reactions, and better the quality of life.…”

125I brachytherapy: a useful treatment to control painful osteoblastic bone metastases

“…Although previous studies [26,28] reported that due to osteosclerosis, OBMs were more difficult to puncture than osteolytic metastases, our center's clinical experience was that an ISI needle was used in conjunction with medical drills for puncturing lesion sites; this greatly reduced the difficulty of puncture, and the technical success rate was 100%. During the operation, CT or CBCT guidance clearly showed the volume of the tumor and the location of vital organs, making the entire operation safer and more accurate.…”