Objective:To explore the value of digital information line mark coplanar template (also referred to as the line mark template) in 125I radioactive seed implantation for the treatment of lung cancers. Methods:A retrospective analysis was conducted for 58 cases of lung cancers who were treated with template-assisted seed implantation in Oncology Department of the Second Hospital of Tianjin Medical University from Aug 2017 to May 2019.Line mark templates were adopted for 30 cases (the line mark template group) and general standard coplanar templates (also referred to as the general template) were used for 28 cases (the general template group). Pre-plan and post-implant parameters were compared, including the minimum prescription dose delivered to 90% of target volume ( D90), minimum peripheral dose (MPD), mean percentages of volume receiving 100%, 150% and 200% of the prescription doses ( V100, V150 and V200), external index (EI), conformity index (CI), and homogeneity index (HI) of target volume.The operation duration was also compared between the two groups. Results:There was no statistical difference between pre-plan and post-implant D90, MPD, V100, V150 and V200 in the line mark template group ( P>0.05). There was also no statistical difference between pre-plan and post-implant D90, MPD, V100, V150 and V200 of the general template group ( P>0.05). The operation duration of the line mark template group and the general template group was (44.3±12.4) and (60.0±12.8) min, respectively ( t=-3.03, P<0.05). Conclusions:The use of template-assisted seed implantation can accurately achieve preoperative planning, while the line mark template shortens the operation duration and thus improves the tolerance of patients.

Objective:To evaluate the pre- and post-implantation dosimetric consistency and efficacy of CT-guided 125I radioactive seed implantation for the treatment of the local recurrence of lung cancers under the assistance of a universal coplanar template (also referred to as the universal template). Methods:This study involved 38 patients with a local recurrence of non-small cell lung cancers who received universal template-assisted 125I radioactive seed implantation in the Second Hospital of Tianjin Medical University from Jan 2009 to Dec 2015.Preoperative planning was carried out before implantation, and the prescription dose was 110 Gy.The paired T-test was adopted for cooperation between intraoperative verification result and pre-plan values of the dosimetric parameters including minimum peripheral dose (MPD), the minimum prescription doses delivered to 90% and 100% of the target volume ( D90 and D100), conformity index (CI), external index (EI), and homogeneity index (HI). The efficacy was evaluated at the 6th month after implantation according to the RECIST 1.1 (Response Evaluation Criteria in Solid Tumors). Results:All patients successively received the seed implantation.The pre-plan and post-implant dosimetric parameters were as follows: MPD (222.7±26.2), (227.74±29.8) Gy; D90(130.8±13.6), (134.8±12.8) Gy; D100 (106.4±10.6), (110.7±11.8) Gy, CI ( 0.75±0.06), (0.74±0.04), EI(22.7±5.8)%, (24.3±4.8)%; HI(36.8±4.7)%, (37.2±5.3)%, the mean irradiation dose of hearts (19.3±7.2), (21.3±6.8) Gy( P> 0.05). The median follow-up period was 22.5 months (8-98 months). The median survival was 21 months (95% CI, 7.4-34.6), and the 2-year overall survival (OS), progression-free survival (PFS), and local control (LC) rate were 47.4%, 39.5%, and 83.5%, respectively. Conclusions:The universal template-assisted and CT-guided 125I radioactive seed implantation in the treatment of postoperative local recurrence of non-small cell lung cancers can achieve the goal of the preoperative TPS planning during the operation and achieve good efficacy.It is a minimally invasive, accurate, safe and effective therapy.

Objective:To analyze the efficacy and safety of radioactive 125I seed implantation in the treatment of unresectable early-stage non-small cell lung cancer (NSCLC), in order to provide data for clinical practice and relevant research. Methods:A retrospective study was conducted on the data of 39 patients with early-stage NSCLC who received CT-guided radioactive 125I seed implantation from Dec 2010 to Dec 2018 in multiple hospitals.The seed implantation process consisted of preoperative planning and design, CT-guided puncture, seed implantation, and postoperative evaluation and dose verification.The efficacy and complications of the treatment were analyzed.The clinical efficacy was evaluated by adopting the Response Evaluation Criteria in Solid Tumors (RECIST) (v1.1) and the adverse reactions were evaluated using the Common Terminology Criteria for Adverse Events (CTCAE v4.0). Results:All the patients were 70 years old on average (51-85). The median lesion diameter was 2.7 cm (1.1-6.0 cm), the median seed activity was 0.7 mCi (0.6-0.8 mCi), while the median follow-up duration was 29 months (3-97 months). Meanwhile, the 1-, 3-, and 5-year overall local control rates were 89.5%, 79%, and 79%, respectively, and the 1-, 3-, and 5-year overall survival rates were 100%, 74.8%, and 49.9%, respectively.Local recurrence and distant metastasis were the main causes of failure, accounting for 17.9% (7 cases) each.The incidence of pneumothorax was 56.4% (22 cases), among which nine cases (23.1%) required invasive closed thoracic drainage.Only 1 case of grade-2 radiation pneumonia (2.6%) was observed, with no other adverse reactions such as dermatoses, esophagitis, or myelitis being discovered.As indicated by univariate analysis, the patients with KPS scores of 80-90, pathological type of adenocarcinoma, T stage of T 1-2, and D90>180 Gy exhibited better local control ( χ2=6.202, P<0.05). Meanwhile, high D90 was also associated with a higher survival rate ( χ2=6.907, P<0.05). Conclusions:Radioactive 125I seed implantation is a safe and effective treatment for unresectable early-stage NSCLC.In cases where external beam radiotherapy is not available, radioactive 125I seed implantation can be considered as one of the treatment options.Pneumothorax is the most common complication of radioactive 125I seed implantation, and adenocarcinoma (pathological type) and higher values of D90 are predictors of better local control.

Objective:To investigate the feasibility, efficacy, and safety of CT- and bronchoscopy-guided 125I seed implantation in the treatment of central lung cancer complicated with atelectasis. Methods:Retrospective analysis was conducted on twenty-nine patients who were treated from May 2016 to Oct 2019 in the Second Hospital of Tianjin Medical University for central non-small-cell lung carcinoma complicated with pulmonary atelectasis that was inoperable due to medical reasons. 125I seeds were implanted into the trachea under the guidance of bronchoscopy first.The 125I seeds were then implanted into the hilum of the lungs by percutaneous puncture under the guidance of the CT and template.The seed activity was 18.5-29.6 MBq, and the prescription dose was 120 Gy.TPS planning and quality verification were performed before and after the operations.The rate of atelectasis recanalization, the satisfactory rate of dose verification, the improvement of dyspnea index, the survival time, and the adverse events during and after operation were observed. Results:All 29 patients with lung cancer complicated with atelectasis successfully completed the seed implantation, and the satisfactory rate of quality verification was 93.1%.The rate of atelectasis recanalization at 2, 6, 12, 18, and 24 months was 93.1%, 89.7%, 78.6%, 76.2%, and 60%, respectively.Their dyspnea and anoxia symptoms were significantly relieved in 5-28 months after treatment.The results showed that the patients′ dyspnea index was 2.8-0.8 before treatment and 1.4-0.9 after treatment.The median follow-up period was 20 months and median survival was 21 months.Adverse events associated with the radiation therapy included pneumothorax, hemoptysis, cough, fever, and particle displacement.No level-3 or more serious adverse events occurred.Conclusions:The CT- and bronchoscopy-guided 125I seed implantation is a safe and effective therapy option for the treatment of central non-small-cell lung carcinoma associated with atelectasis.It contributes to a high rate of local recanalization, and can rapidly improve clinical conditions and quality of life of the patients with few adverse reactions.

Objective To evaluate the clinical efficacy and prognostic factors of limited-stage small cell lung cancer ( LS-SCLC) treated with 125 I radioactive seed implantation guided by CT combined with systemic chemotherapy. Methods A total of 128 limited-stage small cell lung cancer patients were treated with 125 I radioactive seed implantation combined with chemotherapy from Jun 2008 to Jun 2012 in Tianjin Medical University Second Hospital. Theχ2 test was used to analyze the influencing factors of short-term efficacy. Survival rate was calculated by Kaplan-Meier method, single factor analysis was performed by Log-rank, and multivariate analysis was performed by Cox proportional hazard model. Results Totally 128 patients finished the treatment. The overall response rate was 86.7％ ( 111/128 ) after 6 months of treatment. The 1-, 2-and 3-year overall survival rate was 77.9％, 39.8％and 28.0％, respectively, and the median survival time was 21.0 months. The univariate analysis showed that the following factors were main prognostic factors:age, performance status ( PS) , hemoglobin≥120 g/L before treatment, smoking index, the maximum diameter of tumor, neuron-specific enolase before treatment, subscribe for prophylactic cranial irradiation ( PCI) , number of chemotherapy cycle, chemotherapy response, prescribed dose ( PD ) , postoperation dose covering 100％ volume ( D100 ) , remedial model. multivariate analysis revealed that age, PS, hemoglobin≥120 g/L before treatment and PD, the maximum diameter of tumor, number of chemotherapy cycle, chemotherapy response, and remedial model were the independent prognostic factors for survival. 29 patients of 128 suffered from aerothorax and the incidence rate of aerothorax was 27.7％. Totally 16 patients occurred hemoptysis and theincidence rate was 12.5％. Conclusions 125 I radioactive seed implantation therapy showed good effecacy in the treatment of LS-SCLC. Age, PS, hemoglobin≥120 g/L before treatment, the maximum diameter of tumor, number of chemotherapy cycle, chemotherapy response, and remedial model might be the main prognostic factors for LS-SCLC patients.

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 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.

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.