Biological effects of low-dose-rate irradiation of pancreatic carcinoma cells in vitro using ^(125)I seeds

AIM:To determine the mechanism of the radiationinduced biological effects of 125I seeds on pancreatic carcinoma cells in vitro.METHODS:SW1990 and PANC-1 pancreatic cancer cell lines were cultured in DMEM in a suitable environment.Gray’s model of iodine-125(125I)seed irradiation was used.In vitro,exponential phase SW1990,and PANC-1cells were exposed to 0,2,4,6,and 8 Gy using 125I radioactive seeds,with an initial dose rate of 12.13c Gy/h.A clonogenic survival experiment was performed to observe the ability of the cells to maintain their clonogenic capacity and to form colonies.Cell-cycle and apoptosis analyses were conducted to detect the apoptosis percentage in the SW1990 and PANC-1 cells.DNA synthesis was measured via a tritiated thymidine(3H-Td R)incorporation experiment.After continuous low-dose-rate irradiation with 125I radioactive seeds,the survival fractions at 2 Gy(SF2),percentage apoptosis,and cell cycle phases of the SW1990 and PANC-1 pancreatic cancer cell lines were calculated and compared.RESULTS:The survival fractions of the PANC-1 andSW1990 cells irradiated with 125I seeds decreased exponentially as the dose increased.No significant difference in SF2 was observed between SW1990 and PANC-1 cells(0.766±0.063 vs 0.729±0.045,P<0.05).The 125I seeds induced a higher percentage of apoptosis than that observed in the control in both the SW1990and PANC-1 cells.The rate of apoptosis increased with increasing radiation dosage.The percentage of apoptosis was slightly higher in the SW1990 cells than in the PANC-1 cells.Dose-dependent G2/M cellcycle arrest was observed after 125I seed irradiation,with a peak value at 6 Gy.As the dose increased,the percentage of G2/M cell cycle arrest increased in both cell lines,whereas the rate of DNA incorporation decreased.In the 3H-Td R incorporation experiment,the dosimetry results of both the SW1990 and PANC-1cells decreased as the radiation dose increased,with a minimum at 6 Gy.There were no significant differences in the dosimetry results of the two cell lines when they were exposed to the same dose of radiation.CONCLUSION:The pancreatic cancer cell-killing effects induced by 125I radioactive seeds mainly occurred via apoptosis and G2/M cell cycle arrest.

Implantation of Radioactive ^(125)I Seeds Improves the Prognosis of Locally Advanced Pancreatic Cancer Patients:A Retrospective Study

Locally advanced pancreatic cancer is associated with a very poor prognosis. This study was performed to evaluate whether patients with locally advanced pancreatic cancer benefit from 125 ^I seed implantation. This retrospective study included 224 patients with locally advanced pancreatic cancer, with 137 patients（61.2%） in the implantation（IP） group and 87（38.9%） in the non-implantation（NIP） group. The survival status, complications and objective curative effects were compared between the groups. The average operative time in the IP group was significantly longer than that in the NIP group（243±51 vs. 214±77 min）. The tumor response rates were 9.5% and 0 at the 2nd month after surgery in the IP and NIP groups, respectively（P〈0.05）. The IP group exhibited a trend toward pain relief at the 6th month after surgery. The global health status scores of the IP group were higher than those of the NIP group at the 3rd and 6th month after surgery. The median survival time in the IP group was significantly longer than that in the NIP group. In conclusion, patients with locally advanced pancreatic cancer can benefit from 125 I seed implantation in terms of local tumor control, survival time, pain relief and quality of life.

Percutaneous biliary stent combined with brachytherapy using 125I seeds for treatment of unresectable malignant obstructive jaundice:A meta-analysis

BACKGROUND Malignant obstructive jaundice(MOJ)is a common pathologic manifestation of malignant biliary obstruction.Recently,several clinical trials have explored the clinical effectiveness of intraluminal^(125)I seed-based brachytherapy for MOJ patients,and various outcomes have been reported.AIM To assess the efficacy and safety of percutaneous biliary stents with^(125)I seeds compared to conventional metal stents in patients with unresectable MOJ.METHODS A systematic search of English-language databases(PubMed,Embase,Cochrane Library,and Web of Science)was performed to identify studies published prior to June 2020 that compared stents with or without^(125)I seeds in the treatment of unresectable MOJ.The outcomes analyzed included primary outcomes(stent patency and overall survival)and secondary outcomes(complications and liver function parameters).RESULTS Six randomized controlled trials and four retrospective studies involving 875 patients were eligible for the analysis.Of the 875 included patients,404 were treated with^(125)I seed stents,while 471 were treated with conventional stents.Unadjusted pooled analysis demonstrated that compared to conventional stents,^(125)I seed stents extended the stent patency time[hazard ratio(HR)=0.36,95%confidence interval(CI)=0.28-0.45,P<0.0001]and overall survival period(HR=0.52,95%CI=0.42–0.64,P<0.00001).Subgroup analyses based on the type of^(125)I seed stent and type of study design showed consistent results.However,there were no significant differences in the occurrence of total complications[odds ratio(OR)=1.12,95%CI=0.75-1.67,P=0.57],hemobilia(OR=1.02,95%CI=0.45-2.3,P=0.96),pancreatitis(OR=1.79,95%CI=0.42-7.53,P=0.43),cholangitis(OR=1.13,95%CI=0.60-2.13,P=0.71),or pain(OR=0.67,95%CI=0.22-2,P=0.47).In addition,there were no reductions in the levels of serum indices,including total bilirubin[mean difference(MD)=10.96,95%CI=-3.56-25.49,P=0.14],direct bilirubin(MD=7.37,95%CI=-9.76-24.5,P=0.4),alanine aminotransferase(MD=7.52,95%CI=-0.71-15.74,P=0.07),and aspartate aminotransferase(MD=-4.77,95%CI=-19.98-10.44,P=0.54),after treatment.Publication bias was detected regarding the outcome overall survival;however,the conclusions were not changed after the adjustment.CONCLUSION Placement of stents combined with brachytherapy using^(125)I seeds contributes to a longer stent patency and higher overall survival than placement of conventional stents without extra complications or severe liver damage.Thus,it can be considered an effective and safe treatment for unresectable MOJ.

Implanting iodine-125 seeds into rat dorsal root ganglion for neuropathic pain: neuronal microdamage without impacting hind limb motion

The use of iodine-125 （L251） in cancer treatment has been shown to relieve patients＇ pain. Consid- ering dorsal root ganglia are critical for neural transmission between the peripheral and central nervous systems, we assumed that 125I could be implanted into rat dorsal root ganglia to provide relief for neuropathic pain. 125I seeds with different radioactivity （0, 14.8, 29.6 MBq） were im- planted separately through L4-5 and L5-6 intervertebral foramen into the vicinity of the L5 dorsal root ganglion, von Frey hair results demonstrated the mechanical pain threshold was elevated after implanting 125I seeds from the high radioactivity group. Transmission electron microscopy revealed that nuclear membrane shrinkage, nucleolar margination, widespread mitochondrial swelling, partial vacuolization, lysosome increase, and partial endoplasmic reticulum dilation were visible at 1,440 hours in the low radioactivity group and at 336 hours in the high radio- activity group. Abundant nuclear membrane shrinkage, partial fuzzy nuclear membrane and endoplasmic reticulum necrosis were observed at 1,440 hours in the high radioactivity group. No significant difference in combined behavioral scores was detected between preoperation and postoperation in the low and high radioactivity groups. These results suggested that the mechan- ical pain threshold was elevated after implanting 125I seeds without influencing motor functions of the hind limb, although cell injury was present.

The influence of interstitial brachytherapy with ～(125)I seeds on Caspase-3 and Egr-1 expressions of Lewis lung carcinoma in C57BL mice

Objective:The aim of our study was to explore the influence of interstitial brachytherapy with 125I seeds on Caspase-3 and Egr-1 expressions of Lewis lung carcinoma in C57BL mice.Methods:Model mice of C57BL were planted with Lewis lung cells (LLC) and divided into the treatment group (n=18) and the control group (n=17).In each mouse of the treatment group,two BT-125-1 Model 125I seeds with apparent activity of 9.25 MBq were implanted into the tumor;whereas in each mouse of the control group two dummy seeds were implanted.The mice survival rates of both groups were recorded after 21 days.The tumor weights and dimensions of survived mice were measured,and the tumor volume inhibition rate was calculated.T-test was performed to compare differences of tumor weights and volumes between these two groups.Routine pathological slides of tumor tissue were observed under light microscope.The expression of Caspase-3 was detected by immunohistochemical method and the expression of Egr-1 was detected by RT-PCR method.Results:The survival rates were 88.88% in the treatment group and 70.59% in the control group,the difference had no statistical significance (P > 0.05).The tumor volume inhibition rate was 71.12%.Pathological examination showed degeneration and necrosis of cancer cells at the site nearby the seed in the treated group,but the tumor cells alive were still presented nearby the seed in the control group.The expressions of Caspase-3 and Egr-1 in the treated group were higher than those in the control group (t=12.825,P < 0.01;t=7.039,P < 0.01;respectively).Conclusion:The interstitial brachytherapy with 125I seeds could significantly inhibit the growth of Lewis lung carcinoma of mice.The possible mechanism may be that 125I interstitial brachytherapy can enhance the expressions of Egr-1 and Caspase-3,which could induce tumor cellular apoptosis.

Study of the Positioning Influence in the Water Activity Measurement during Leak Test of Iodine-125 Seeds

In the prostate cancer treatment, brachytherapy with iodine-125 seeds has been used. lodine-125 seeds are sealed radioactive sources, made by a titanium capsule containing the radioisotope inside. In the final phase of the seeds production, it is necessary to ensure that there is no leakage of the radioactive material. A leakage test is performed, immersing the seeds in water during 24 h and measuring the resulting activity in the water. This measurement is made in a sodium iodide detector. The immersion water is transferred to a plastic tube with a cap. The tube is placed by an automated positioning system, in the detector chamber. This study aims to determine the best positioning of the tube for the detection. It is also important to determine the influence of the positioning variation intrinsic of the automated positioning system during the iodine-125 seeds production. The results obtained will be used as a reference to adjust the equipment and process control system, in the production of the iodine-125 seeds.

放射性125^I粒子组织间植入治疗胰腺癌的疗效分析

目的探讨125I粒子组织间植入治疗胰腺癌的疗效。方法回顾性分析2005年7月至2008年6月我院采用125I粒子植入治疗的33例胰腺癌患者资料。肿瘤最大径1.5～6.6cm,平均3.7cm。结果粒子植入术后,止痛有效率为60.6%,术后3个月内4例死亡。术后3个月CT复查,部分缓解(PR)8例,疾病稳定(SD)13例,疾病进展(PD)8例,总有效率27.6%。全组生存时间2～19个月,中位生存时间5.1个月,6例仍在随访中。随访中无胰瘘和胃肠道出血等严重并发症,有51粒粒子(18例患者)丢失,11粒粒子(5例患者)出现迁移,移至肠道9粒,肝、脾各1粒,未见放射性肠炎和肝功能改变。结论125I粒子组织间植入治疗胰腺癌在疼痛缓解方面疗效明确,但本组病例Ⅳ期患者较多,未取得较好的疗效,具体疗效还有待于大样本前瞻性队列研究证实。

125^I标记抗人CD40 mAb 5H6在荷人卵巢癌(HO8910)BALB/c裸鼠体内分布及放射免疫显像

目的:研究125I标记抗人CD40单克隆抗体(mAb)5H6同卵巢癌细胞HO8910体外结合的生物学特性以及在荷瘤鼠体内的分布和放射免疫显像。方法:氯胺-T法进行mAb 5H6 125I标记(125I-5H6),Lindmo法计算125I-5H6的免疫活性分数;细胞结合饱和实验进行Scatchard分析计算解离常数Kd及最大结合位点数Bmax;建立荷人卵巢癌(HO8910)裸鼠模型,分析125I-5H6在体内的分布,并用SPECT进行放射免疫显像。结果:mAb 5H6标记率为(85.4±5.2)%,放射化学纯度为(99.2±0.5)%,125I-5H6免疫活性分数为(38.6±5.4)%,与HO8910细胞的亲和力Kd=(0.711±0.06)nmol/L。在荷瘤鼠体内特异性结合HO8910肿瘤,48小时达到高峰,放射免疫显像肿瘤清晰可见。结论:125I-5H6同卵巢癌HO8910细胞在体外结合具有很高亲和力,在体内能特异性结合HO8910肿瘤,能获得优质的放射免疫图像。

(125)^I放射性粒子植入在肿瘤综合治疗中的应用现状

(125)^I放射性粒子植入是肿瘤内放疗的一种,自21世纪初引入中国后取得了长足的发展,尤其是近年来3D打印模板引导植入的出现,使得(125)^I放射性粒子植入进入一个高速发展的时期。(125)^I放射性粒子植入因其具有较为广泛的适应证在肿瘤的治疗中发挥着重要作用,然而其在肿瘤综合治疗中的应用现状报道较少。本文分别就放射性粒子植入技术的适应证及其在各类肿瘤综合治疗中的应用现状进行总结和分析。

(125)^I粒子植入前装载人员受照剂量的研究

目的研究(125)^I粒子植入前装载过程中操作人员的受照剂量,探讨放射防护管理措施。方法采用射线检测仪对操作人员装载85粒(125)^I粒子过程中的辐射情况进行监测,评估不同装载方法操作人员的受照剂量。结果操作室本底辐射剂量率为0.15 Sv/h。活度为14.8 MBq的(125)^I粒子在裸露状态下正面同一方向,10、30、50、70、100 cm时,单个粒子剂量率分别为221.3、43.5、20.4、16.3、10.4μSv/h。工作人员以不同的倒出装载方式,装载85粒活度为14.8 MBq的(125)^I粒子时,在不同距离位置受到的辐射剂量,随着距离的增加以及装载倒出次数的增加辐射剂量均可见减少。结论在(125)^I粒子装载过程中建议采取必要的防护措施,以降低粒子源对操作人员的辐射。优化操作流程,采用分次倒出装载的方法,可以更有效减低辐射剂量。

125^I籽源持续照射诱发胃癌细胞株MKN45凋亡的实验研究

目的观察胃癌细胞株MKN45在125I籽源的持续作用下发生凋亡的变化,包括细胞形态、早期凋亡率以及Bcl-2、Bax表达的变化,为临床使用125I籽源治疗胃癌提供实验依据。方法实验组用7粒125I籽源所制成的园盘形状照射源持续照射人胃癌细胞株MKN45,对照组则不予照射,72h后收集各组细胞,分别在光镜、电镜下观察细胞形态,DAPI染色测细胞凋亡率,用流式细胞仪检测细胞的早期凋亡率,RT-PCR检测细胞内的Bcl-2、Bax的表达情况。结果①实验组各组细胞在光镜、电镜下能观察到凋亡细胞的典型形态学改变。②DAPI染色细胞凋亡率比对照组高(P<0.01)。③实验组细胞的早期凋亡率比对照组高(P<0.01)。④RT-PCR检测细胞内的Bax表达明显增强(P<0.01)。⑤半定量PCR检测Bax表达明显增强,Bcl-2的表达减弱,实验组的Bcl-2/Bax的比值低于对照组(P<0.01)。结论125I籽源持续照射能诱发人胃癌细胞株MKN45的凋亡,Bcl-2/Bax的比值降低可能是人胃癌细胞株MKN45凋亡的机制之一。

(125)^I粒子植入术联合同步放化疗治疗局部晚期非小细胞肺癌的疗效

目的探讨(125)^I粒子植入术联合同步放化疗治疗局部晚期非小细胞肺癌的疗效。方法共纳入106例局部晚期NSCLC患者,根据治疗方案的不同分为观察组(n=56)和对照组(n=50),对照组患者给予同步放化疗治疗,观察组患者给予(125)^I粒子植入术联合同步放化疗治疗。治疗4个疗程后比较两组近期疗效、血清肿瘤标志物[癌胚抗原(CEA)、糖类抗原125(CA125)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)]水平和不良反应发生情况。结果观察组患者的近期疗效优于对照组(P﹤0.05)。观察组患者客观缓解率(ORR)为91.07%,明显高于对照组患者的70.00%(P﹤0.01),疾病控制率(DCR)为96.43%,高于对照组患者的84.00%(P﹤0.05)。治疗后,两组CEA、CA125、CYFRA21-1水平均低于本组治疗前(P﹤0.05),且观察组患者CEA、CA125、CYFRA21-1水平均低于对照组(P﹤0.05)。观察组患者的不良反应总发生率为51.79%,与对照组患者的50.00%无明显差异(P﹥0.05),且均为1~2级不良反应。结论(125)^I粒子植入联合同步放化疗治疗局部晚期NSCLC患者的近期疗效显著,可有效降低CEA、CA125、CYFRA21-1肿瘤标志物水平,且不良反应少,安全可控。

Intraoperative radiofrequency ablation combined with ^(125)iodine seed implantation for unresectable pancreatic cancer

AIM: To evaluate the feasibility, efficacy and safety of intraoperative radiofrequency ablation (RFA) combined with 125 iodine seed implantation for unresectable pancreatic cancer. METHODS: Thirty-two patients (21 males and 11 females) at the age of 68 years (range 48-90 years) with unresectable locally advanced pancreatic cancer admitted to our hospital from January 2006 to May 2008 were enrolled in this study. The tumor, 4-12 cm in diameter, located in pancreatic head of 23 patients and in pancreatic body and tail of 9 patients, was found to be unresectable during operation. Diagnosis of pancreatic cancer was made through intraoperative biopsy. Patients were treated with FRA combined with 125 iodine seed implantation. In brief, a RFA needle was placed, which was confirmed by intraoperative ultrasound to decrease the potential injury of surrounding vital structures, a 125 iodine seed was implanted near the blood vessels and around the tumor border followed by bypass palliative procedure (cholangio-jejunostomy and/or gastrojejunostomy) in 29 patients.RESULTS: The serum CA 19-9 level was decreased from 512 ± 86 U/mL before operation to 176 ± 64 U/mL, 108 ± 42 U/mL and 114 ± 48 U/mL, respectively, 1, 3 and 6 mo after operation (P < 0.05). The pain score on day 7 after operation, 1 and 3 mo after combined therapy was decreased from 5.86 ± 1.92 before operation to 2.65 ± 1.04, 1.65 ± 0.88 and 2.03 ± 1.16, respectively, after operation (P < 0.05). The rate of complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD) in 32 patients was 21.8% (7/32), 56.3% (18/32), 15.6% (5/32) and 6.3% (2/32), respectively, 6 mo after operation, with a median overall survival time of 17. 5 mo. The median survival time of patients at stage Ⅲ was longer than that of those at stage Ⅳ (19 mo vs 10 mo, P = 0.0026). The median survival time of patients who received and did not receive chemotherapy after operation was 20 mo and 16 mo, respectively (P = 0.0176). Of the 32 patients, 3 (10.6%) experienced postoperative complications including transient biliary leaks in 2 patients and acute pancreatitis in 1 patient. All the patients recovered well after conservative support treatment. CONCLUSION: Intraoperative RFA combined with 125 iodine seed implantation is a feasible and safe procedure for unresectable pancreatic cancer with acceptable minor complications, and can prolong the survival time of patients, especially those at stage Ⅲ.

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.

Radical treatment of stage Ⅳ pancreatic cancer by the combination of cryosurgery and iodine-125 seed implantation

AIM:To investigate the therapeutic effect of radical treatment and palliative treatment in stage Ⅳ pancreatic cancer patients.METHODS:81 patients were enrolled in the study.Radical treatment was performed on 51 patients,while 30 patients were put under palliative treatment.The procedural safety and interval survival for stage Ⅳ pancreatic cancer(IS-Ⅳ) was assessed by almost 2.5 years of follow-ups.The IS-Ⅳ of patients under the two kinds of treatment,and the effects of treatment timing and frequency on IS-Ⅳ,were compared.RESULTS:The IS-Ⅳ of patients who received radical treatment was significantly longer than those who received palliative treatment(P < 0.001).The IS-Ⅳ of patients who received delayed radical or palliative treatment was longer than those who received accordingly timely treatment(P = 0.0034 and 0.0415,respectively).Multiple treatments can play an important role in improving the IS-Ⅳ of patients who received radical treatment(P = 0.0389),but not for those who received palliative treatment(P = 0.99).CONCLUSION:The effect of radical treatment was significantly more obvious than that of palliative treatment,and multiple radical treatments may contribute more to patients than a single radical treatment.

Placement of ^(125)I seed strands and stents for a type Ⅳ Klatskin tumor

Herein,we report a new technique that consists of placing two 125 I seed strands and two stents in the right and left intrahepatic bile ducts for the treatment of hilar cholangiocarcinoma.A 75-year-old man presented with jaundice and was diagnosed with Bismuth type Ⅳ Klatskin tumor.Abdominal computed tomography(CT) showed intrahepatic and extrahepatic bile ductdilatation and a soft tissue mass in the hepatic hilum.Because curative surgical resection was not possible,we placed 125 I seed strands and stents in the right and left intrahepatic bile ducts.Three months later,abdominal CT showed less intrahepatic and extrahepatic bile duct dilatation than before the procedure.This technique was feasible and could be considered for the treatment of patients with Bismuth type Ⅳ tumors.

Radioactive ^125I seed implantation for locally advanced pancreatic cancer:A retrospective analysis of 50 cases

BACKGROUND Pancreatic cancer is one of the common malignant tumors of the digestive system,and radical resection is the first choice of treatment for pancreatic cancer.If patients with locally advanced pancreatic cancer cannot be treated in time and effectively,their disease often develops rapidly and their survival period is very short.AIM To evaluate the therapeutic effect of ^125I seed implantation in patients with locally advanced pancreatic cancer.METHODS The demographics and perioperative outcomes of a consecutive series of patients who underwent ^125I seed implantation to treat locally advanced pancreatic cancer between January 1,2017 and June 30,2019 were retrospectively analyzed.According to the results of preoperative computed tomography or magnetic resonance imaging,the treatment planning system was used to determine the area and number of ^125I seeds implanted.During the operation,^125I seeds were implanted into the tumor under the guidance of intraoperative ultrasound,with a spacing of 1.5 cm and a row spacing of 1.5 cm.For patients with obstructive jaundice and digestive tract obstruction,choledochojejunostomy and gastroenterostomy were performed simultaneously.After operation,the patients were divided into a non-chemotherapy group and a chemotherapy group that received gemcitabine combined with albumin-bound paclitaxel treatment.RESULTS Among the 50 patients,there were 29 males and 21 females,with a mean age of 56.9±9.8 years.The main reason for the failure of radical resection was superior mesenteric artery invasion(37,74%),followed by superior mesenteric vein invasion(33,66%).Twenty-one(62%)patients underwent palliative surgery and postoperative pain relief occurred in 40(80%)patients.The estimated blood loss in operation was 107.4±115.3 mL and none of the patient received blood transfusion.The postoperative hospital stay was 7.5±4.2 d;one patient had biliary fistula and three had pancreatic fistula,all of whom recovered after conservative treatment.After operation,26 patients received chemotherapy and 24 did not.The 1-year survival rate was significantly higher in patients who received chemotherapy than in those who did not(60.7%vs 35.9%,P=0.034).The mean overall survival of patients of the chemotherapy group and nonchemotherapy group was 14 and 11 mo,respectively(χ^2=3.970,P=0.046).CONCLUSION Radioactive ^125I seed implantation combined with postoperative chemotherapy can prolong the survival time,relieve pain,and improve the quality of life of patients with locally advanced pancreatic cancer.

Radioactive 125I seed implantation for pancreatic cancer with unexpected liver metastasis:A preliminary experience with 26 patients

BACKGROUND Preoperative diagnosis rate of pancreatic cancer has increased year by year.The prognosis of pancreatic cancer patients with unexpected liver metastasis found by intraoperative exploration is very poor,and there is no effective and unified treatment strategy.AIM To evaluate the therapeutic effect of radioactive 125I seed implantation for pancreatic cancer patients with unexpected liver metastasis.METHODS The demographics and perioperative outcomes of patients who underwent 125I seed implantation to treat pancreatic cancer with unexpected liver metastasis between January 1,2017 and June 1,2019 were retrospectively analyzed.During the operation,125I seeds were implanted into the pancreatic tumor under the guidance of intraoperative ultrasound,with a spacing of 1.5 cm and a row spacing of 1.5 cm.For patients with obstructive jaundice and digestive tract obstruction,choledochojejunostomy and gastroenterostomy were performed simultaneously.After operation,the patients were divided into a non-chemotherapy group and a chemotherapy group that received gemcitabine combined with albumin-bound paclitaxel treatment.RESULTS Preoperative imaging evaluation of all patients in this study showed that the tumor was resectable without liver metastasis.There were 26 patients in this study,including 18 males and 8 females,aged 60.5±9.7 years.The most common tumor site was the pancreatic head(17,65.4%),followed by the pancreatic neck and body(6,23.2%)and pancreatic tail(3,11.4%).Fourteen patients(53.8%)underwent palliative surgery and postoperative pain relief occurred in 22 patients(84.6%).The estimated blood loss in operation was 148.3±282.1 mL and one patient received blood transfusion.The postoperative hospital stay was 7.6±2.8 d.One patient had biliary fistula,one had pancreatic fistula,and all recovered after conservative treatment.After operation,7 patients received chemotherapy and 19 did not.The 1-year survival rate was significantly higher in patients who received chemotherapy than in those who did not(68.6%vs 15.8%,P=0.012).The mean overall survival of patients in the chemotherapy group and non-chemotherapy group was 16.3 mo and 10 mo,respectively(χ2=7.083,P=0.008).CONCLUSION Radioactive 125I seed implantation combined with postoperative chemotherapy can prolong the survival time and relieve pain of pancreatic cancer patients with unexpected liver metastasis.

To explore the curative effect of CT-guided Iodine-125 radioactive seed implantation in the treatment of stage Ⅳprimary hepatocellular carcinoma

Objectives: To explore the clinical efficacy and survival of CT-guided Iodine-125 radioactive seed implantation in the treatment of stage Ⅳ primary hepatocellular carcinoma.Methods: A retrospective study of 62 patients with primary hepatocellular carcinoma in our hospital from January2017 to December 2018 [60 males, 2 females, age(52.76 ± 10.82) years old], All patients were implanted with Iodine-125 radioactive seeds under CT guidance, followed up regularly after operation to observe the clinical efficacy, including comparison of changes in cancer size before and after treatment, tumor marker AFP, and improvement in complications such as abdominal pain and ascites. Follow-up 3–36 months to assess patient survival.Results: Among the 62 patients, 3 months after Iodine-125 radioactive seed implantation, 5 cases(8.1%) had complete remission of cancer, 33 cases(53.2%) had partial remission, 12 cases(19.4%) had stable lesions, and 12 cases(19.4%) had disease progression. The effective rate was 61.3%. The tumor volume(31.44 ± 14.51 cm3) was significantly smaller than before(50.96 ± 30.13 cm3)(t=5.303, p < 0.05). The tumor marker AFP(69.28 ±50.99) ug/L of 3 months after implantation was significantly lower than that before treatment(90.63 ± 68.58)ug/L(t=3.702, P < 0.05). The average survival time of Iodine-125 seed implantation for stageⅣhepatocellular carcinoma is 11.47 ± 0.85 months, and the median survival time is 9 months. The survival time of the group with better pathological differentiation(grade Ⅰ+ⅡⅠ) was significantly better than that of the group with poor differentiation(grade Ⅲ+Ⅳ)(x2=6.869 p < 0.05). Among the 38 patients with different degrees of abdominal pain,22 patients improved better than before;15 of 28 patients with different degrees of ascites were better than before. All patients had no serious complications related to treatment.Conclusions: Iodine-125 radioactive seed implantation therapy can safely and effectively treat hepatocellular carcinoma, and relieve the clinical symptoms of abdominal pain and ascites.

Iodine-125 seed implantation in the treatment of malignant tumors

Malignant tumors are major causes of morbidity and mortality in China.Despite advances in surgical,radiological,chemotherapeutic,molecular targeting,and immunotherapeutic treatments,patients with malignant tumors still have poor prognoses.Low-dose-rate brachytherapy,specifically 125I seed implantation,is beneficial because of its high local delivery dose and minimal damage to surrounding tissues.Consequently,it has gained increasing acceptance as a treatment modality for various malignant tumors.In this study,we explored the fundamental principles,clinical applications,and new technologies associated with 125I radioactive seed implantation.