Similar therapeutic effects of ^(125I) seed radiotherapy andγ-ray radiotherapy on lacrimal gland adenoid cystic carcinoma

AIM:To evaluate the survival outcomes of patients with lacrimal gland adenoid cystic carcinoma who underwent eye-sparing surgery combined with ^(125I)seed implantation radiotherapy or local externalγ-ray radiotherapy.METHODS:In this retrospective comparative case series,the clinical records of 27 primary and 8 recurrent patients were reviewed.Univariate and multivariate analyses were used to identify risk factors associated with distant metastasis(DM),and the overall survival(OS)after the initial surgery was analyzed.RESULTS:The median follow-up after radiotherapy was 36 mo(range 6-120 mo).At the last follow-up after radiotherapy,26(74.3%)patients had no evidence of disease,7(20%)patients had DM,2(5.9%)patients died of DM,and 1 patient with DM was lost to follow-up.Univariate analyses showed that duration of symptoms,bone destruction,T stage classification,and wide excision surgery were risk factors influencing DM(P<0.05).The 5-year and 10-year OS rates after the initial surgery were 95.8%and 79.9%,respectively.The 5-year DM-free survival and disease-free survival rates after radiotherapy were 66.4%and 52.7%,respectively.CONCLUSION:^(125I)seed radiotherapy and local externalγ-ray radiotherapy may have similar therapeutic effects in preventing DM.Patients with T1/T2 stage disease have a better prognosis than those with T3/T4 stage disease.

DTI and pathological changes in a rabbit model of radiation injury to the spinal cord after ^(125)I radioactive seed implantation

Excessive radiation exposure may lead to edema of the spinal cord and deterioration of the nervous system. Magnetic resonance imaging can be used to judge and assess the extent of edema and to evaluate pathological changes and thus may be used for the evaluation of spinal cord injuries caused by radiation therapy. Radioactive ^125I seeds to irradiate 90% of the spinal cord tissue at doses of 40–100 Gy （D90） were implanted in rabbits at T10 to induce radiation injury, and we evaluated their safety for use in the spinal cord. Diffusion tensor imaging showed that with increased D90, the apparent diffusion coefficient and fractional anisotropy values were increased. Moreover, pathological damage of neurons and microvessels in the gray matter and white matter was aggravated. At 2 months after implantation, obvious pathological injury was visible in the spinal cords of each group. Magnetic resonance diffusion tensor imaging revealed the radiation injury to the spinal cord, and we quantified the degree of spinal cord injury through apparent diffusion coefficient and fractional anisotropy.

Dosimetry for ^(125) I radioactive seed implantation therapy for hepatocellular carcinoma

Hepatocellular carcinoma （HCC） is an aggressive malignancy. Early lesions respond well to hepatic resection or liver transplantation. However, only a few of HCC patients are suitable for surgical intervention. External beam radiation and chemotherapy is poorly efficacious. In the last 20 years, HCCs belonging to the radiosensitive tumor group has been confirmed. Along with the development of new radiotherapy technology and facilities, the research about brachytherapy（especially ^125I seed implantation therapy） has provoked more interests in the world. Radioactive seed implantation therapy is a form of interstitial brachytherapy, with the property of local ＂conformal radiotherapy＂ and the advantages of minimal invasion, convenience, high performance, and minimal adverse effects. It is a promising therapy for HCC, however the dosimetry hasn＇ t yet been identified and lacks verification in prospective research. This report aims to further explore the best prescription dose and radioactivity for ^125I interstitial implantation brachytherapy for HCC.

A pilot study on combination of cryosurgery and ^(125)iodine seed implantation for treatment of locally advanced pancreatic cancer

AIM: To study the therapeutic value of combination o cryosurgery and 125iodine seed implantation for locally advanced pancreatic cancer. METHODS: Forty-nine patients with locally advanced pancreatic cancer (males 36, females 13), with a median age of 59 years, were enrolled in the study. Twelve patients had liver metastases. In all cases the tumors were considered unresectable after a comprehensive evaluation. Patients were treated with cryosurgery, which was performed intraoperatively or percutaneously unde guidance of ultrasound and/or computed tomography (CT), and 125iodine seed implantation, which was performed during cryosurgery or post-cryosurgery under guidance of ultrasound and/or CT. A few patients received regional celiac artery chemotherapy. RESULTS: Thirteen patients received intraoperative cryosurgery and 36 received percutaneous cryosurgery Some patients underwent repeat cryosurgery. 125Iodine seed implantation was performed during freezing procedure in 35 patients and 3-9 d after cryosurgery in 14 cases. Twenty patients, 10 of whom had hepaticmetastases received regional chemotherapy. At 3 mo after therapy, CT was repeated to estimate tumor response to therapy. Most patients showed varying degrees of tumor necrosis. Complete response (CR) of tumor was seen in 20.4% patients, partial response (PR), in 38.8%, stable disease (SD), in 30.6%, and progressive disease (PD), in 10.2%. Adverse effects associated with cryosurgery included upper abdomen pain and increased serum amylase. Acute pancreatitis was seen in 6 patients one of whom developed severe pancreatitis. All adverse effects were controlled by medical management with no poor outcome. There was no therapy-related mortality. During a median follow-up of 18 mo (range of 5-40), the median survival was 16.2 mo, with 26 patients (53.1%) surviving for 12 mo or more. Overall, the 6-, 12-, 24- and 36-mo survival rates were 94.9%, 63.1%, 22.8% and 9.5%, respectively. Eight patients had survival of 24 mo or more. The patient with the longest survival (40 mo) is still living without evidence of tumor recurrence. CONCLUSION: Cryosurgery, which is far less invasive than conventional pancreatic resection, and is associated with a low rate of adverse effects, should be the treatment of choice for patients with locally advanced pancreatic cancer. 125Iodine seed implantation can destroy the residual surviving cancer cells after cryosurgery. Hence, a combination of both modalities has a complementary effect.

Relationship between miR-7-5p expression and ^(125)I seed implantation efficacy in pancreatic cancer and functional analysis of target genes

Objective The aim of this study was to investigate the relationship between miR-7-5p expression and intertissue-^(125)I irradiation sensitivity in pancreatic cancer tissues and to analyze the function of target genes.Methods Thirty-seven patients with unresectable pancreatic ductal adenocarcinoma(PDAC)treated with radioactive ^(125)I seed implantation were enrolled.RT-PCR was used to detect the expression level of miR-7-5p in cancer tissues and analyze the relationship between miR-7-5p expression and ^(125)I radiation sensitivity.Bioinformatic software and online tools were used to predict the miR-7-5p target genes and analyze their functional annotation and pathway enrichment.Results Radioactive ^(125)I seed implantation was followed up for 2 months.The objective response rate of the miR-7-5p high expression group was 65.0%(13/20),whereas the objective response rate of the miR-7-5p low expression group was 5.88%(1/17),and the difference between the two groups was statistically significant(χ^(2)=13.654,P<0.001).A total of 187 target genes were predicted using three databases.GO functional annotation showed that target genes were mainly involved in cellular response to insulin stimulus,regulation of gene expression by genetic imprinting,cytosol,peptidyl-serine phosphorylation,bHLH transcription factor binding,cargo loading into vesicles,cellular response to epinephrine stimulus,and nucleoplasm.KEGG pathway enrichment analysis showed that target genes were mainly involved in the ErbB signaling pathway,HIF-1 signaling pathway,axon guidance,longevity regulatory pathway,endocrine resistance,glioma,choline metabolism in cancer,and EGFR tyrosine kinase inhibitor drug resistance.Molecular complex detection analysis by Cytoscape revealed that PIGH,RAF1,EGFR,NXT2,PIK3CD,PIK3R3,ERBB4,TRMT13,and C5orf22 were the key modules of miR-7-5p target gene clustering.Conclusion The expression of miR-7-5p in pancreatic cancer tissues positively correlated with the radiosensitivity of ^(125)I seeds.Via targeted gene regulation,miR-7-5p acts on the network of multiple signaling pathways in PDAC and participates in its occurrence and development.Thus,miR-7-5p may become a predictive index of ^(125)I seed implantation therapy sensitivity in PDAC patients.

A case report of iodine-125 seed placement during operation for the treatment of advanced gallbladder carcinoma with septic shock

This case report describes a patient with advanced gallbladder cancer who developed septic shock associated with iodine-125(^(125)I)seed implantation.The treatment process is described to provide a clinical reference for similar cases.A 52-year-old woman with recurrence of advanced gallbladder cancer underwent ^(125)I seed implantation and developed postoperative sepsis with septic shock.The blood culture suggested infection with Aeromonas caviae and Enterococcus faecalis.Vancomycin and imipenem were immediately administered according to the drug sensitivity results,along with immunoglobulin therapy and vasoactive drugs.The patient’s condition gradually stabilized after comprehensive treatment.Sepsis with septic shock is a rare but potentially fatal complication of ^(125)I seed implantation.Timely administration of broad-spectrum antibiotics,immunoglobulin therapy,and vasoactive drugs is very important to stabilize the patient’s condition.Our treatment of this patient can serve as a reference for clinicians to manage this complication in similar cases.

Treatment of Unresectable Advanced Gastric Cancer Using lodine-125 Brachytherapy

OBJECTIVE The purpose of the study was to examine the efficacy of treating patients with advanced gastric cancer using iodine-125 （^125Ⅰ） brachytherapy. METHODS Ten patients with unresectable advanced gastric cancer were selected based on their pattern of CT scans. We utilized a brachytherapy planning system to determine the distribution of the ^125Ⅰ seeds, their activity and quantity. The matched peripheral dose （MPD） was 110-135 Gy.^125Ⅰ seeds were implanted in a single plane or biplane by an intraoperative small incision or percutaneous puncture. The postoperative hemogram, CT, KPS, pain-relieving period and survival period were recorded. RESULTS One patient developed a complete response （CR）, 4 patients a partial response （PR）, 3 patients showed no change （NC） and 2 patients developed progressive disease （PD）. The overall response rate （CR＋PR） was 50% （5/10）. The pain-relieving rate was 89% （8/9）. The patients＇ appetite and KPS were improved. The longest survival period was 10 months and median life span was 4 months. There were 8 patients whose seeds fell off resulting in an expulsion rate of 3.8% （26/692）. The patients showed 0-1 degree acute radio-therapeutic side-effects without other symptoms such as abdominal pain, vomitus cruentes or intestinal obstruction etc.CONCLUSION Applying ^125Ⅰ implantation to treat advanced gastric cancer with a reasonable seed distribution can significantly improve clinical symptoms and their quality of life. The radioactive damage is mild. This method can be used as an important supplementary treatment for unresectable advanced gastric cancer.

Personalized radioprotection in tumor patients after^(125)I seed brachytherapy

Objective:To investigate patient-specific radioprotection mathods for people in close contact with cancer patientstreated by 12I-seed implantation.Methods:The initial dose rates(D_(0))at distances of 30 and 100 cm from 80 patients who had undergone ^(125)I-seed implantation were measured within 24 h of the procedure.The dose rate at t(D_(t))and effective dose(E)were calculated according to the measurad vales of D.The appropriate precaution times for general adult family members,spouses,coworkers,and children or pregnant women were determined,and the relationships between and precaution time for different close-contact groups were derived by curve-fitting the corresponding data.Results:The mean D vahes of 80 patients at distanes of 30 and 100cm were(15.24±11.25)μSv/h and(1.96±2.63)μSv/h,respectively(P<0.05).The mean values and range of precaution time for general adult familymembers,spouses,coworkers,and children or pregnant women were(4.17±16.55),(102.93±49.22),(51.00±61.29),and(34.27±56.90)d(0-90.61),(0-234.01),(0-247.81),and(0-224.69)d,respectively.Furthemore,a logarithmic relationship betwen D and precaution time(Y)was observed for the different groujps.The equations of these relationships were detemined to be Y=-131.569+83.256 lnD_(0) for general adult family mambers,Y=—108.532+83.318 lnD_(0) for spouses,Y=25.470+83.318 lnD,for coworkers,and Y=2.585+83.229 lnD_(0) for children or pregnant women.Conchusions:Some cancer patients treated by ^(125)I-seed brachytherapy emitover-dose levels of γ-rays,necessitatingradiation protection for their close contacts.However,appropriate patient-specific radiation protection fordifferent close contacts can be determined based on the precaution time calculated using the D_(0) value.

CT guided ^125iodine seed implantation for portal vein tumor thrombus in primary hepatocellular carcinoma

Background This study evaluated the clinical application of CT guided ^125iodine implantation in patients with portal vein tumor thrombus in primary hepatocellular carcinoma. Methods The ten patients （9 males and 1 female, aged from 36 to 72 years） with portal vein tumor thrombus accompanying hepatocellular carcinoma had been treated with comprehensive therapy including surgery, transcatheter arterial chemoembolization, radiotherapy ablation, microwave ablation or percutaneous ethanol injection. The average diameter of each tumor thrombus was 21.5 mm × 30.5 mm. Seeds of 30 MBq ^125I were implanted 5 mm apart within the portal vein tumor thrombus. The follow-up after 4 months included enhanced spiral CT. Results CT screening of the tumours indicated that 4 out of 10 patients showed complete response to the therapy, 5 partial response and 1 stable disease. Adverse effects included aggravated abdominal dropsy and temporarily increased transaminase, which were controlled by medical management. Severe complications such as haemorrhage, biliary fistula hepatic abscess, pancreatic fistula and hepatic function failure were not observed. Implanted seeds migrated to lung and left hepatic lobe in 1 case. Conclusion CT guided implantation of ^125iodine seeds, can effectively treat portal vein tumor thrombus accompanying hepatocellular carcinoma with minimal damage and few complications.

Particle implantation combined with chemotherapy for rhabdomyosarcoma of the head and neck:A 8-year long-term follow-up case report

Rhabdomyosarcomas(RMSs)are highly malignant soft-tissue sarcomas.Head and neck RMSs often pose unique challenges to treatment because of their closeness to important structures.We here report a rare case of a 1-year-old boy with a 1-month history of right eye swelling and an eye mass.Biopsy of deep tumors in the maxillofacial region supports embryonal RMS.Postoperative positron emission computed tomography showed a 5.0 cm×4.8 cm×4.2 cm malignant tumor in the right maxillary region.In accordance with the international RMS study group guideline,the child was diagnosed with IIIa and TNM stage T2bN1M1 embryonal RMS.The child was treated with a combination of chemotherapy and ^(125)I seed implantation radiotherapy and eventually achieved partial remission.This case report shows that ^(125)I seed implantation is a safe and effective means of delivering radiotherapy to young children with head and neck RMSs.It may be an option for children with RMSs for whom surgery or external radiotherapy is unsuitable.