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Minimally invasive CT-guided radioactive 125I seeds permanent implantation for local treatment of extrahepatic extrapulmonary secondary malignancies
2008-11-5 10:53:54
 
[Abstract][Purpose] The purpose was to evaluate the safety and efficacy of CT-guided radioactive 125I seeds permanent implantation in the treatment of extrahepatic extrapulmonary secondary malignancies. [Method]Twenty-four patients were included in this prospective study.Underlying primaries comprised 7 colorectal carcinomas,3 nasopharyngeal carcinomas,3 cervical carcinomas, 2 thyroid carcinoma, and 1 vaginal melanoma , gastric carcinoma ,lung carcinima, ovary carcinoma, oropharynx carcinoma ,  primary hepatic carcinoma, duodenum carcinoma, pheochromocytoma,or breast carcinoma. The single secondary solid carinoma locations included local lymph node, pelvic metastatic tumor, obturator internus,  chest wall and local recurrence. There were 12 males, and 12 females, the median age was 56.5 years (range: 31–76). The diameter of tumors was 1.5~6.5 cm,the average was 3.7 cm. All patients had undergone extensive pretreatments.CT-guided radioactive seeds permanent implantation employed a 125-Iodine source. According to Treatment Planning System (TPS), the matched peripheral dose( MPD) was 90~140Gy each local lession, and  total number of the seeds implanted was 10~165 each patient.CT or MRI follow-up was performed 2 months and every 2 or 3 months post intervention. Primary endpoints were complications, local tumor control and progressive-free survival. [Results]Minor complications comprised Grade Ⅱradioactive rectum proctitis rectum morbidity(n=2),pain (n=5) ,fever(n=2) and 2 seeds migration to lung in one patient. The median follow-up time for all 24 patients surviving was 6 months (range: 1~22 months). One patient with oropharynx sqamous carcinima was in poor overall condition because of long time malnutrition,and died 29 days posttreatment due to progessive overall failure. One patient with vaginal melanoma died 3 months posttreatment due to acute cerebral hemorrhage which was assured by CT. One patient with right colon carcinoma died of bowel obstruction 4 months posttreatment due to long time malnutrition.Two patients with nasopharyngeal carcinoma,one patient with thyroid carcinoma and one patient with rectal adenocarcinoma died 5,12,6,14 months posttreatment, repectively,all due to systemic progression.  No other major complications such as pancreatic leakage, acute pancreatitis, enterorrhagia and intra-abdominal abscess were  recorded. Cumulative local control rate of the treated lessions  was quite satisfactory during follow-up,with median time of 17.13 months.Local tumor control rate was 70.8% during the follow-up period, with observed CR in 41.7% (n=10) and PR in 29.1% (n=7), while the tumor-free survival had a median progression-free time of  10.76 months. However, the excellent overall survival with 75% survival after 12 months and median time was 15.21 months. [Conclusion] Minimally invasive CT-guided radioactive 125I seeds permanent implantation  is safe and  effective in the palliative treatment of extrahepatic extrapulmonary secondary malignancies.
Keywords  :  Brachytherapy ; Iodine-125; CT ;  Intervention  
 
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