CT‐guided iodine‐125 brachytherapy as salvage therapy for recurrent mediastinal lymph node metastasis

Abstract

Background The treatment of recurrent mediastinal lymph node metastasis (MLNMs) is challenging. We conducted this study to evaluate the effectiveness and safety of computed tomography (CT)‐guided percutaneous iodine‐125 brachytherapy for MLNMs. Methods We retrospectively analyzed 33 patients with recurrent MLNMs treated with CT‐guided interstitial implantation of iodine‐125 seeds. Regular contrast‐enhanced CT was conducted to evaluate the tumor response. Follow‐up survival, quality of life, and adverse events were analyzed. Results The number of implanted seeds was 16–85 (median, 40). The matched peripheral dose was 110–160 Gy. The patients were followed up for 5–24 months (median, 14 months). At the last follow‐up or death, complete response to therapy was achieved in 11 patients (33.3%) and partial response in 18 patients (54.5%). The median survival time of this cohort was 15.2 months (95% confidence interval [CI], 9.9–20.5 months); the estimated one‐ and two‐year survival rates were 68.6% and 31.1%, respectively. The Karnofsky performance score increased significantly after the procedure (p = 0.007). Pneumothorax with pulmonary compression of 30% to 40% occurred in five (15.2%) patients and was cured after drainage. No severe complications occurred. Conclusions CT‐guided iodine‐125 brachytherapy provided a safe and effective choice for recurrent mediastinal lymph node metastasis with significant local therapeutic effects and minor complications, especially for patients who were not eligible for surgical resection and had failed to benefit from systemic therapy.

A retrospective study on unresectable or inoperable head and neck cancers treated with stereotactic ablative brachytherapy

“…Stereotactic ablative brachytherapy (SABT) is clinically important brachytherapy that is effective, minimally invasive, and safe [ 6 ]. It is a stand-alone treatment for primary or recurring head and neck cancers, and can be also applied as a combination therapy with surgery, external radiotherapy, or systemic chemotherapy [ 7 , 8 ]. Classic brachytherapy for head and neck tumors consist of lip, oral mucosa, mobile tongue, floor of mouth, oropharynx, nasopharynx, and paranasal sinuses.…”

“…Criteria for inclusion were as follows: (1) Lesions confirmed by pathology and imaging; (2) Refusal or intolerance of surgery and/or radiotherapy; (3) Appropriate puncture route: the puncture needle should avoid important nerves, bones, large blood vessels, and adjacent important organs as far as possible to reach the target area; (4) No tendency to bleed and hyper-coagulable status; (5) Tumor diameter ≤ 7 cm (considering radiation safety, clinical costs, and previous studies, we have limited the size of tumor [14]); (6) Patients in a good general condition, with a KPS ≥ 60; (7) Expected survival time of more than 3 months. Criteria for exclusion were as fol-lows: (1) Severe bleeding tendency; (2) Severe cardio-pulmonary insufficiency; (3) Severe hepatic and renal insufficiency; (4) Acute or chronically active infection status;…”