Long-Term Safety and Efficacy of CT-Guided I125 Radioactive Seed Implantation as a Salvage Therapy for Recurrent Head and Neck Squamous Carcinoma: A Multicenter Retrospective Study

Abstract

PurposeTo investigate the safety and efficacy of CT-guided I125 radioactive seed implantation (RSI) as a salvage therapy for recurrent head and neck squamous carcinoma (rHNSC) after external beam radiotherapy (EBRT) or surgery.Materials and MethodsThis is a multicenter retrospective study of 113 patients (83 males; median age 57 years) with rHNSC who underwent CT-guided I125 RSI between February 2003 and December 2017. Of the included patients, 107 patients previously received EBRT and 65 patients received surgery and all were ineligible or rejected for salvage surgery and/or repeat EBRT.ResultsDuring a median follow-up duration of 20 months (range, 3-152 months), 87 patients died. The 1-, 2-, 3-, and 5-year local control rate were 57.4%, 41.8%, 29.3%, and 15.2%, respectively. The median time to progression was 15 months [95% confidence interval (CI), 6.1-23.9 months]. The median overall survival (OS) was 20 months (95% CI, 12.4-27.6 months). The 1-, 2-, 3-, and 5-year OS rate were 63.6%, 44.6%, 29.9%, and 21.7%, respectively. Univariate and multivariate analyses revealed that KPS score and postoperative D90 were significantly associated with patients’ OS. The complications were mainly grade I/II skin and mucosal reactions: 18 cases (15.9%) of grade I/II and eight cases (7.0%) of grade III radiation dermatitis, and 14 cases (12.4%) of grade I/II and three cases (2.7%) grade III mucosal reactions. No grade IV or severer complications were found.ConclusionCT-guided I125 RSI may be safe as a salvage therapy for rHNSC after EBRT/surgery, yielding promising efficacy compared with historical data. KPS score and postoperative D90 may be significantly associated with OS.

A Case of Iodine 125 Seeds (I-125) Responding to Lung Squamous Cell Carcinoma

“…I-125 seeds could be a salvage therapy for recurrent head and neck squamous carcinoma after external beam radiotherapy or surgery. 21 Therefore, I-125 seeds were implanted into the lung lesion on March 10th, 2021. Chemotherapy was also performed subsequently.…”

The efficacy and safety of 125I brachytherapy combined with pre-operative transarterial chemoembolization in patients with locally advanced head and neck cancer

“…Previous studies have shown that the incidence of short-term and long-term complications of head and neck tumor surgery with seed implantation is low ( 35 , 36 ). The majority of adverse events associated with particle implantation therapy in this study were mild, only one patient progressed from preoperative grade II to III during the follow-up, and the patient had preoperative tumor invasion of brachial plexus accompanied by paresthesia and weak lifting power (grade 4 muscle strength).…”

A retrospective study on unresectable or inoperable head and neck cancers treated with stereotactic ablative brachytherapy

“…However, no serious adverse reactions above grade 5 were observed [ 9 ]. Previous study demonstrated CT-guided 125 I implants in recurrent head and neck cancer patients with an average of 20 months, and no serious adverse reactions of grade 4 or higher were noted [ 10 ]. Consistent with these findings, in this study, grade 1-2 radiological skin or oral mucosal reactions were seen in 11 patients.…”

“…Classic brachytherapy for head and neck tumors consist of lip, oral mucosa, mobile tongue, floor of mouth, oropharynx, nasopharynx, and paranasal sinuses. According to our previous studies, SABT is mostly applicable to patients who cannot receive external irradiation (patients who have local recurrence after previous external irradiation), and patients who refuse surgery for head and neck local lesions [ 9 , 10 ]. In this technique, a radioactive source with a short range and strong penetrating power is applied in contrast to conventional radiation therapy.…”