Chinese expert consensus on radioactive <sup>125</sup>I seeds interstitial implantation brachytherapy for pancreatic cancer

Gai, Baodong; Zhang, Fujun

doi:10.4103/jcrt.jcrt_96_18

Cited by 22 publications

(16 citation statements)

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“…Based on the CT findings, the radiation oncologist and surgeons outlined the gross tumor volume (GTV) and areas at risk for subclinical disease. The planning treatment volume (PTV) included the GTV and a 0.5–1.0 cm margin, and the prescribed dose was usually 110–130 Gy [ 14 ]. The distribution and dose of iodine-125 seeds were calculated using a computerized treatment planning system (TPS) (University of Beijing Aeronautics and Astronautics) (Fig.…”

Section: Methodsmentioning

confidence: 99%

Locally advanced pancreatic carcinoma with jaundice: the benefit of a sequential treatment with stenting followed by CT-guided 125I seeds implantation

Chen

Wang

et al. 2021

Eur Radiol

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Objectives To evaluate the role of sequential therapy with percutaneous biliary stenting and CT-guided iodine-125 seed implantation for locally advanced pancreatic carcinoma with concomitant obstructive jaundice. Methods Between January 2016 and December 2018, 42 patients diagnosed with locally advanced pancreatic carcinoma with concomitant obstructive jaundice were enrolled retrospectively. All patients received biliary stenting via percutaneous transhepatic biliary drainage (PTBD) to alleviate obstructive jaundice. Thereafter, twenty-two patients underwent CT-guided iodine-125 seed implantation (treatment group), and 20 did not (control group). The prescribed dose in the treatment group was 110–130 Gy. The clinical data, duration of biliary stent patency, and overall survival (OS) were evaluated. Results Overall, the total bilirubin level decreased from 275.89 ± 115.44 to 43.08 ± 43.35 μmol/L (p < 0.001) 1 month after percutaneous biliary stenting. In the treatment group, the postoperative median dose covering 90% of the target volume was 129.71 Gy. Compared with the control group, the treatment group had a long mean duration of biliary stent patency and median OS (11.42 vs. 8.57 months, p < 0.01; 11.67 vs. 9.40 months, p < 0.01, respectively). The overall positive response rates 6 months post-treatment in the treatment and control groups were 72.7% (16/22) and 30% (6/20), respectively. Adverse events of more than grade 3 were not observed during the follow-up. Conclusion Sequential therapy with percutaneous biliary stenting and CT-guided iodine-125 seed implantation is an effective and safe treatment alternative for locally advanced pancreatic carcinoma with concomitant obstructive jaundice, which is worthy of clinical application. Key Points • Obstructive jaundice was alleviated after biliary stent placement in all patients, and the total bilirubin level decreased. • The overall positive response rates at 6 months post-treatment were higher in the treatment group than in the control group, and adverse events of more than grade 3 were not observed during the follow-up period. • Sequential therapy with percutaneous biliary stenting and CT-guided iodine-125 seed implantation can prolong biliary stent patency and improve survival.

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Section: Methodsmentioning

confidence: 99%

Locally advanced pancreatic carcinoma with jaundice: the benefit of a sequential treatment with stenting followed by CT-guided 125I seeds implantation

Chen

Wang

et al. 2021

Eur Radiol

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“…Iodine-125 ( 125 I) seed implantation is a form of brachytherapy, or internal radiation, and has been used in the treatment of PDAC for several decades. The seeds contain the radioactive material and can be placed inside the tumor using an implantation needle and gun [88]. The radioactive material causes direct cell death by damaging its DNA and indirect damage by producing free radicals, resulting in a mixture of lethal and sublethal damage [89].…”

Section: Brachytherapy: Iodine-125 Seed Implantationmentioning

confidence: 99%

Locally Advanced Pancreatic Cancer: Percutaneous Management Using Ablation, Brachytherapy, Intra-arterial Chemotherapy, and Intra-tumoral Immunotherapy

et al. 2021

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Purpose of Review Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive neoplasms, bearing a terrible prognosis. Stage III tumors, also known as locally advanced pancreatic cancer (LAPC), are unresectable, and current palliative chemotherapy regimens have only modestly improved survival in these patients. At this stage of disease, interventional techniques may be of value and further prolong life. The aim of this review was to explore current literature on locoregional percutaneous management for LAPC. Recent Findings Locoregional percutaneous interventional techniques such as ablation, brachytherapy, and intra-arterial chemotherapy possess cytoreductive abilities and have the potential to increase survival. In addition, recent research demonstrates the immunomodulatory capacities of these treatments. This immune response may be leveraged by combining the interventional techniques with intra-tumoral immunotherapy, possibly creating a durable anti-tumor effect. This multimodality treatment approach is currently being examined in several ongoing clinical trials. Summary The use of certain interventional techniques appears to improve survival in LAPC patients and may work synergistically when combined with immunotherapy. However, definitive conclusions can only be made when large prospective (randomized controlled) trials confirm these results.

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“…Some advantages of interest to translate and use in other tumors have included image guidance, minimal invasion, local dose escalation, and organ preservation. Moreover, the expert consensus and standardized procedure of 3D-PT-assisted I-125 BT on pancreatic cancer and lung cancer have popularized this interventional strategy ( 17 , 18 ). Other usages of I-125 BT have included salvage for recurrent rectal cancer after multiple lines of treatment as recommended by National Comprehensive Cancer Network (NCCN) guidelines ( 19 , 20 ) and the use of I-125 seed stents successfully in esophageal cancer that have presented fresh opportunities for mitigating cancer-related symptoms ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Radioactive Iodine-125 in Tumor Therapy: Advances and Future Directions

Wei

Mengyuan

et al. 2021

Front. Oncol.

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Radioactive iodine-125 (I-125) is the most widely used radioactive sealed source for interstitial permanent brachytherapy (BT). BT has the exceptional ability to deliver extremely high doses that external beam radiotherapy (EBRT) could never achieve within treated lesions, with the added benefit that doses drop off rapidly outside the target lesion by minimizing the exposure of uninvolved surrounding normal tissue. Spurred by multiple biological and technological advances, BT application has experienced substantial alteration over the past few decades. The procedure of I-125 radioactive seed implantation evolved from ultrasound guidance to computed tomography guidance. Compellingly, the creative introduction of 3D-printed individual templates, BT treatment planning systems, and artificial intelligence navigator systems remarkably increased the accuracy of I-125 BT and individualized I-125 ablative radiotherapy. Of note, utilizing I-125 to treat carcinoma in hollow cavity organs was enabled by the utility of self-expandable metal stents (SEMSs). Initially, I-125 BT was only used in the treatment of rare tumors. However, an increasing number of clinical trials upheld the efficacy and safety of I-125 BT in almost all tumors. Therefore, this study aims to summarize the recent advances of I-125 BT in cancer therapy, which cover experimental research to clinical investigations, including the development of novel techniques. This review also raises unanswered questions that may prompt future clinical trials and experimental work.

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Chinese expert consensus on radioactive ¹²⁵I seeds interstitial implantation brachytherapy for pancreatic cancer

Cited by 22 publications

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Locally advanced pancreatic carcinoma with jaundice: the benefit of a sequential treatment with stenting followed by CT-guided 125I seeds implantation

Locally advanced pancreatic carcinoma with jaundice: the benefit of a sequential treatment with stenting followed by CT-guided 125I seeds implantation

Locally Advanced Pancreatic Cancer: Percutaneous Management Using Ablation, Brachytherapy, Intra-arterial Chemotherapy, and Intra-tumoral Immunotherapy

Radioactive Iodine-125 in Tumor Therapy: Advances and Future Directions

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Chinese expert consensus on radioactive 125I seeds interstitial implantation brachytherapy for pancreatic cancer

Cited by 22 publications

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Locally advanced pancreatic carcinoma with jaundice: the benefit of a sequential treatment with stenting followed by CT-guided 125I seeds implantation

Locally advanced pancreatic carcinoma with jaundice: the benefit of a sequential treatment with stenting followed by CT-guided 125I seeds implantation

Locally Advanced Pancreatic Cancer: Percutaneous Management Using Ablation, Brachytherapy, Intra-arterial Chemotherapy, and Intra-tumoral Immunotherapy

Radioactive Iodine-125 in Tumor Therapy: Advances and Future Directions

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Chinese expert consensus on radioactive ¹²⁵I seeds interstitial implantation brachytherapy for pancreatic cancer