Percutaneous computed tomography/ultrasonography-guided permanent iodine-125 implantation as salvage therapy for recurrent squamous cell cancers of head and neck

Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, PR China.
Cancer biology & therapy (Impact Factor: 3.07). 06/2010; 9(12):959-66. DOI: 10.4161/cbt.9.12.11700
Source: PubMed


To assess the feasibility, efficacy, and morbidity of permanent percutaneous 125I seed implantation under computed tomography (CT)/ultrasonography guidance for recurrent squamous cell carcinomas of head and neck.
Twenty-five patients underwent 125I seed implantation under CT or ultrasonography guidance. Postoperative dosimetry was routinely performed for all the patients. The actuarial D90 of the implanted 125I seeds ranged from 90 Gy to 160 Gy (median: 130 Gy). The activity of 125I seed ranged from 0.35 mCi to 0.8 mCi (median: 0.6 mCi). The total number of seeds implanted ranged from 3 to 61 (median: 22). The follow-up period ranged from 3 to 40 months (median: 8 months).
The median local disease-free progression was 12 months (95% CI, 4.8-19.2), and the 1- and 2-year local tumor control rates were 48.7% and 39.9%, respectively. The 1- and 2-year survival rates were 42.5% and 28.3%, respectively (median: 11 months) (95% CI, 8.2-13.8). Of the 25 patients, 6 (24%) died of local recurrence and 5 (20%) died of metastases; 2 patients showed recurrences at 3 and 8 months after seed implantation and subsequently died of pneumonia. One patient died of heart disease. One developed ulceration with tumor progression. Blood vessel damage and neuropathy were not observed.
The high local tumor control rates, minimal invasion, and low morbidity suggest that percutaneous 125I seed implantation is a feasible and safe salvage for patients with recurrent squamous cell carcinomas of the head and neck.

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    • "With increasing distance from the radioactive source, gamma ray energy decreased rapidly. When the low-energy 125I seeds are implanted, the gamma rays are concentrated in the immediate surrounding tissues, sparing adjacent normal structures and medical personnel [4,5]. Because of its high precision and low complication rate, radioactive 125I seed implantation has been widely applied in treatment of cancers, such as recurrent colorectal cancer [6,7], head and neck carcinoma and NPC [4,5]. "
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    ABSTRACT: Although radiotherapy technology has progressed rapidly in the past decade, the inefficiency of radiation and cancer cell resistance mean that the 5-year survival rate of patients with nasopharyngeal carcinoma (NPC) is low. Radioactive (125)I seed implantation has received increasing attention as a clinical treatment for cancers. Vascular endothelial growth factor-A (VEGF-A) is one of the most important members of the VEGF family and plays an important role in cell migration through the extracellular-signal-regulated kinase (ERK) pathway. Here we show that radioactive (125)I seeds more effectively inhibit NPC cell growth through DNA damage and subsequent induction of apoptosis, compared with X-ray irradiation. Moreover, cell migration was effectively inhibited by (125)I seed irradiation through VEGF-A/ERK inactivation. VEGF-A pretreatment significantly blocked (125)I seed irradiation-induced inhibition of cell migration by recovering the levels of phosphorylated ERK (p-ERK) protein. Interestingly, in vivo study results confirmed that (125)I seed irradiation was more effective in inhibiting tumor growth than X-ray irradiation. Taken together, these results suggest that radioactive (125)I seeds exert novel anticancer activity by triggering DNA damage and inactivating VEGF-A/ERK signaling. Our finding provides evidence for the efficacy of (125)I seeds for treating NPC patients, especially those with local recurrence.
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    ABSTRACT: Objective: To evaluate the efficacy and safety of brachytherapy plus operation for salivary gland malignant tumors. Methods: From June 2006 to June 2011, a total of 105 patients with salivary gland malignant tumors undergone brachytherapy by implantation of iodine 125 seeds. The effectiveness was evaluated by periodical radiological film and computed tomography. The complications were analyzed. Results: Among them, 92 patients were observed for 12 - 60 months. The rates of clinical response rate (CRPR) and no change (NC) were 91.3% (84/92) and 8.7% (8/92) respectively of the patients. Pain, mucosa ulcer, skin darkness and radiation osteomyelitis were common complications. Conclusion: The combined regimen of operation and brachytherapy of iodine 125 seed implantation for salivary gland malignant tumors is quite effective and convenient. And it has fewer complications.
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    ABSTRACT: Purpose: This study explored the clinical efficacy of CT-guided radioactive (125)I seed implantation in treating patients with symptomatic retroperitoneal lymph node metastases. Methods: Twenty-five patients with pathologically confirmed malignant tumors received CT-guided radioactive (125)I seed implantation to treat metastatic lymph nodes. The diameter of the metastatic lymph nodes ranged from 1.5 to 4.5 cm. Treatment planning system (TPS) was used to reconstruct the three-dimensional image of the tumor and then calculate the corresponding quantity and distribution of (125)I seeds. Results: Follow-up period for this group of patients was 2-30 months, and median time was 16 months. Symptoms of refractory pain were significantly resolved postimplantation (P < 0.05), and Karnofsky score rose dramatically (P < 0.05). Most patients reported pain relief 2-5 days after treatment. Follow-up imaging studies were performed 2 months later, which revealed CR in 7 patients, PR in 13 patients, SD in 3 patients, and PD in 2 patients. The overall effective rate (CR + PR) was 80 %. Median survival time was 25.5 months. Seven patients died of recurrent tumor; 16 patients died of multiorgan failure or other metastases. Two patients survived after 30 months follow-up. Two patients reported localized skin erythema 1 week postimplantation, which disappeared after topical treatment. Conclusions: CT-guided radioactive (125)I seed implantation, which showed good palliative pain relief with acceptable short-term effects, has proved in our study to be a new, safe, effective, and relatively uncomplicated treatment option for symptomatic retroperitoneal metastatic lymph nodes.
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