Objective To evaluate the short-term effect of CT-guided interstitial implantation of 125I seeds for metastatic lung carcinoma. Methods A total of 82 patients with 126 metastatic lung tumors were treated with CT-guided percutaneous interstitial implantation of 125I seeds at a dose of 80 Gy. Six months after the treatment, the change of tumor volume was observed by using CT scan. The patients were followed up for 2 years. Results The mean radioactive dose was (159.3?34.5) Gy, and the median dose was (118.6?33.2) Gy. Six months after the treatment, CT scan showed a CR of 25.4% (32/126), PR 64.3% (81/126), NC 6.3% (8/126), PD 4.0% (5/126), and CR+PR 89.7% (113/126). Twelve patients showed pneumothorax and 41 had hemoptysis. During the follow-up, 11 patients (6 cases of malignant fibrous histiotoma, 3 cases of lung cancer, 1 rectal carcinoma, and 1 liver carcinoma) died within 8-12 months after the surgery. Fifteen patients (4 cases of malignant fibrous histiotoma, 4 lung cancer, 4 ovarian cancer, 2 multiple myeloma, and 1 uterine leiomyosarcoma) died within 13-24 months after the implantation. The 1-and 2-year survival rates were 86.6% (71/82) and 68.3% (56/82) respectively. Conclusion CT-guided percutaneous interstitial implantation of 125I seeds is effective for lung metastatic carcinoma.

Objective To evaluate the short-term efficacy of interstitial implantation of 125I seeds by using flexible fiberoptic bronchoscope (FFB) guided by CT for advanced non-small cell lung cancer (NSCLC). Methods A total of 185 patients with NSCLC, who were diagnosed clinically and pathologically, were enrolled into this study and divided into two groups. In 125I seeds group (n=121), the patients received interstitial implantation of 125I combined with NP regimen (NVB+DDP) chemotherapy with a prescribed dose (PD) of 80 Gy. Among the patients, the implantation was guided by CT in 89, and was performed directly under a FFB in 32. In control group (n=64), NP regimen (NVB+DDP) chemotherapy was used. Six months after the treatments, the tumor volume in the two groups was measured by using CT and FFB. The outcomes of the 2 groups were compared, and the efficacy of the treatments was evaluated according to the international standards. Results In the 125I seeds group, the mean radiation dose was 153.7 Gy, matched peripheral dose (MPD) was 89.6 Gy, and D90 was 93.5 Gy. Six months after the treatment, the effectiveness rate (CR+PR) was 95.0% (115/121), and 1-year survival rate was 0.90. In the control group, the effectiveness rate was 42.2% (27/64), and 1-year survival rate was 0.65. There existed significant difference between the two groups (log-rank test, ?2=5.12, Prob=0.04

Objective To investigate the short-term clinical efficacy of CT-guided percutaneous implantation of 125I radioactive seeds in treating the postoperative lung metastases of malignant fibrous histiocytoma(MFH).Methods Eight patients with lung metastases after MFH surgery received CT-guided percutaneous implantation of 125I radioactive seeds.There are 28 metastasis lesions in total.Prescribed dose (PD) was 80 Gy and radioactivity was 0.7 mCi(2.59 × 107 Bq).Six months after implantation,chest CT-scan was performed and the changes were reviewed according to the international standards.ResultsAverage dose received by tumor was ( 172.9 ± 39.9 ) Gy,D100 ( 77.7 ± 10.2 ) Gy and D90 ( 97.2 ± 6.8 ) Gy.The overall response rate was 82.1％.Patients' survival period was 10.0 - 26.0 ( 14.6 ± 3.5 ) months with the median survival time of 13 months.ConclusionIn the treatment of postoperative lung metastases of MFH,implantation of 125I radioactive seeds produces a good short-term clinical efficacy.

Objective To explore influential factors of local therapeutic effect in CT guided brachytherapy of 125I seeds for non-small-cell lung carcinoma (NSCLC).Methods Totally 141 primary NSCLC patients diagnosed by bronchoscope or puncture biopsy were treated with CT guided 125I seeds implantation treatment from 2003 January to 2005 January.Among them,26 patients were treated with seeds implantation only and remaining 115 combined with chemical therapy.Preplans were performed by using treatment planning system before the implantation.We took the implantation with the prescription dose of 80-110 Gy,1 seed per 1 cm3,under the guide of computed tomography.Six months after implantation treatment,CT graphs were taken to evaluate the therapeutic effect.Results All the patients were survival until 6 months after implantation,and 37 were complete remission,93 were partial remissions.The effective rate was 92.2％.Among all the observed factors,pathologic type (F =5.162,P =0.023),dose of cover 100％ tumor(D100) (F =100.713,P =0.000) and treatment methods (F =16.205,P =0.000) were the independent influent factors (P ＜ 0.05).Among these,D100 was the most important factor (P =0.000).Single factor analysis indicated that pathologic type (x2 =7.313,P =0.007),D100 (x2 =71.6,P =0.000)and treatment methods (x2 =20.5,P =0.000) were significant influent factors.Of all 141 cases,24 had complications during or after implantation treatment,while no severe complications were reported.There was no significant correlation between complication and local therapeutic effect (P ＞ 0.05).Conclusion CT guided implantation of 125I seeds for lung cancer has good clinical effects and few complications.D100 is the most important factor to influence the local therapeutic effect.Implantation treatment combined with chemotherapy is an ideal measure for NSCLC treatment.

As an interstitial brachytherapy,radioactive seed implantation could provide high doses in the local site and minimal doses at surrounding normal tissues.It has become one of the best choice for early stage prostate carcinoma.Radioactive seeds were implanted under the guidance by ultrasound,CT and MRI,featured with surgical and interventional treatment.Based on dosimetry for target and organs at risk,radioactive seed implantation is multiple disciplinary.In order to acquire the accurate and high quality seed implantation,it is necessary to set up a team including surgeons,radiation oncologists,interventional doctors and nuclear medicine doctors.The content of the consensus is as follows:radiation physics and dosimetry,indications,side-effects and 3 D-printing template work-follow.Despite the benefit of radioactive seed implantation for solid carcinoma,there still a compelling need for prospective randomized and stage Ⅲ clinical trials from multiple centers,so as to upgrade the evidencebased level,above all confirm the role of radioactive seed implantation in the comprehensive treatment of tumors.

Objective To evaluate the dosimetry accuracy and clinical efficacy of 125I radioactive seed implantation using coplanar template (CPT) in the treatment of metastatic or recurrent chest wall tumor.Methods Thirty-one patients with metastasis or recurrence of chest wall tumor,who had been diagnosed with pathology between July 2005 and July 2015,were retrospectively studied.All patients underwent CPT-assisted 125I radioactive seed implantation.Brachytherapy radiation treatment planning system (BTPS) was used to make preoperative plans,and the prescribed dose (PD) was 110 Gy.CPT was used to assist CT guided 125I radioactive seeds implantation.Dose evaluation was performed immediately after implantation.The difference of dose parameters was compared between preoperation and postoperation,including Dg0,D100,V90,V100 and the numbers of seeds.Postoperative chest CT was conducted regularly to assess the treatment efficacy based on the response evaluation criteria in solid tumors (RECIST Version 1.1).The patients were followed up till July 2016.Results All patients went through implantation procedure successfully and there was no significant statistical difference between preoperative and postoperative dose parameters (P ＞ 0.05).The conformal index (CI) was 0.951 ± 0.13,external index(EI) was 6.5％ ±0.9％.Six months after implantation,CR,PR,SD and PD were 25.8％ (8/31),51.6％ (16/31),6.5％ (2/31) and 16.1％ (5/31),respectively.The effective rate was 77.4％,and local control rate was 83.9％ (26/31).Skin pigmentation occurred in 13 patients during the follow-up period,without any special treatment.Conclusions The auxiliary of CPT in the treatment of metastatic or recurrent chest wall tumor under the guiding of CT could achieve quality control,safety and effectiveness.

Objective To evaluate the clinical effects of CT-guided 125I radioactive seed implantation in treatment of stage Ⅲ non-small cell lung cancer ( NSCLC ) and the influential factors of prognosis.Methods 247 patients of stage Ⅲa/Ⅲb NSCLC underwent CT-guided 125I radioactive seed implantation.The clinical effects and the factors affecting prognosis were analyzed by univariate and multivariate analyses.Results The 1-,3-,and 5- year overall survival rates were 82.8％,23.8％,and 11.5 ％,respectively.The median survival time was 24.8 months,and the local control rate was 92.2 ％,63.8％,and 25.7％,respectively.The 5- year overall survival rate was 14.7％,and the median survival time was 29.7 months of the stage Ⅲ,patients.And the 5- year overall survival rate was 11.2％,and the median survival time was 24.0 months at the stage Ⅲb.Univariate analysis showed that age,course of disease,hemoglobin before treatment,clinical stage,maximum diameter of tumor,prescribed dose (PD),post-operational mean dose,post-operational dose covering 100％ volume (D100),remedial model were the main prognostic factors; however,multivariate analysis revealed that hemoglobin ≥ 120 g/L before treatment,post-operational dose covering 100％ volume (D100) and maximum diameter of tumor were the independent risk factors for predicting the survival.Aerothorax was observed in 37 patients with an incidence rate of 14.9％,and hemothorax was observed in 22 patients with an incidence rate of 9％.Conclusions 125I radioactive seed implantation therapy is effective in the treatment of stage Ⅲ NSCLC.Hemoglobin level before treatment,post-operational dose covering 100％ volume (D100 ),and maximum diameter of tumor are the main prognostic factors for the NSCLC patients treated with radiotherapy for NSCLC.

Objective To systematically evaluate the efficacy and safety of 125I seed implantation for treatment of advanced pancreatic cancer.Methods An electronic literatuire search was performed about randomized controlled trials(RCTs) of 125I implantation for treamtent of advanced pancreatic cancer in CNKI,Wanfang Data,CBM,Cochrane Library,PubMed and Embase (from the date of building the database to November 2016).Two investigators independently screened literature,extracted data and assessed the risk bias of included studies,and the Meta-analysis was performed by using Revman 5.3software.Results There were 12 RCTs (n =689) included.Meta-analysis showed that the objective respond rate(ORR) (OR =3.24,95％CI2.33-4.52,P＜0.001),the 6-month survival rate(OR =3.61,95％ CI 1.53-8.52,P =0.003),the 12-month survival rate(OR =4.80,95％ CI 2.40-9.57,P ＜ 0.001) and the relief rate of pain were higher than those in the control group.However,there were no significant differences between both groups in the 2-year survival rate and the adverse reaction rate,which were (OR=2.36,95％ CI 0.47-11.74,P =0.29) and (OR =4.94,95％ CI 1.05-23.23,P =0.04),respectively.Conclusions The limited current evidence showed that 125I implantation for treatment of advanced pancreatic cancer is effective and safety.125I implantation can improve the ORR,short-time survival rate and pain relief rate.In addition,there was no significant increase in the incidence of related adverse events except for seed malposition.Although the quality and quantity of evidences is limited,it merits further study to provide high quality evidences.

Objective To investigate the efficacy and side effects of radioactive seed implantation in the treatment of non-surgical early stage non-small cell lung cancer (NSCLC) based on CT guidance combined with template.Methods Twenty-one patients with inoperable T1 2N0M0 NSCLC who underwent CT-guided radioactive seed implantation therapy were retrospectively analyzed from December 2010 to October 2016 in the Second Hospital of Tianjin Medical University.All patients were diagnosed by histopathology.All seeds,with the activity of 18.5-29.6 MBq and prescription dose of 120-160 Gy,were completed in an operation of the radioactive seed implantation.The preoperative and postoperative TPS treatment plans and quality verification were corducted.In addition,the local control rate of tumors,overall survival (OS),progression free survival time (PFS),satisfaction rate of dose validation and adverse reactions were evaluated.Results The median follow-up was 25.1 months (range 4.4-72.7months).The local control rate of primary tumor in 1-,2-and 3-year was 100％,95.2％ and 95.2％,respectively.Of all patients,the median OS was 48 months with the median PFS 43.4 months.In particular,the 1-,2-and 3-year survival rate was 100％,91.7％ and 72.9％,respectively.Moreover,the rate of 3-year PFS was 70.2％ and the satisfactory rate of postoperative quahty verification was 100％.The treatment-related adverse events included pneumothorax,bronchial hemorrhage,pleural effusion,cough,pulmonary fibrosis and seed shifts.In all,7 (33.3％) patients had grade 1 adverse events and 4 (19％) patients with grade 2,but no grade 3 adverse event.Conclusions CT and template-guided radioactive seed implantation in NSCLC with T1 2 N0 M0 has a high tumor local control rate and low treatment-related adverse reactions,suggesting that it might provide an alternative way for the treatment of inoperable early stage NSCLC.

Objective To evaluate the clinical effectiveness and safety of stents loaded with 125I seeds compared to conventional stents.Methods Literatures were searched in PubMed,EMbase,Cochrane Library,CBM,CNKI,Wanfang Data and other electronic databases from inception to November 2016.Two reviewers independently screened the literature according to the inclusion and exclusion criteria,extracted data and assessed quality of the included studies independently.Meta-analyses were performed using RevMan 5.3.Results A total of five RCTs and 14 CCTs involving 1 211 patients were included.The mean survival time of the 125I stent group was significantly higher than that of the control group [mean difference =4.11,95％ CI (2.16-6.07)P ＜0.001].The incidence of restenosis after 3:The available data showed that the incidence of re-staging of 125I stent in the treatment group was lower than that of the normal stent group [RR =0.23,95％ CI(0.12-0.62),P =0.002].Postoperative bleeding [RR =0.80,95％CI (0.52-1.23),P=0.30];Postoperative pain[RR=1.06,95％CI(90.88-1.27),P=0.55];postoperative stent shift [RR =0.53,95％ CI(0.27-1.05),P =0.07].The difference of incidence of complications was not statistically significant.There was no difference in the incidence of complications between the two groups.Conclusions The available data suggest that 125I stent is superior to common stent in the treatment of advanced esophageal cancer.There are no differences found in the incidence of complications between 125I stent and conventional stent.However,due to the limited quality of the included studies,more high-quality and multicenter-based studies are needed to verify the above conclusion.