Safety and efficacy of 3D-printed templates assisted CT-guided radioactive iodine-125 seed implantation for the treatment of recurrent cervical carcinoma after external beam radiotherapy

Abstract

Objective: To investigate the safety and efficacy of 3-dimensional (3D) printing noncoplanar templates (PNCT) assisted computer tomography (CT) guided radioactive 125 I seed implantation (RISI) for the treatment of recurrent cervical carcinoma (RCC) after external beam radiotherapy (EBRT). Methods: A total of 103 patients with inoperable post-EBRT RCC were included in this retrospective study. A total of 111 lesions received RISI. Eight lesions were at the pelvic center, 75 lesions were at the pelvic lateral, and 28 lesions were extra-pelvic metastasis. The median prescription dose was 120 Gy. The primary end points were adverse events and local control (LC), and the secondary end points were overall survival (OS) and progression-free survival. Results: Grade 2 adverse events of acute nausea, diarrhea, and pollakiuria occurred in 1, 2, and 1 patient, respectively. One patient suffered from grade 3 acute proctitis. Late toxicity was observed in 2 patients with rectovaginal fistula. No grade 5 toxicity occurred. The 3-year LC and OS rates were 75.1% and 20.8%, respectively. The median OS was 17 months. The multivariate analysis showed that the minimum dose received by the "hottest" 90% of the gross tumor volume (D 90) ≥130 Gy, squamous cell carcinoma, hemoglobin ≥80 g/L and good short-term efficacy (complete response or partial response) were independent predictors of LC and OS (all p<0.05). Conclusions: 3D-PNCT assisted CT-guided RISI is a safe, effective, and minimally invasive modality for RCC. The hemoglobin level, pathological type, dose distribution and short-term efficacy are considered as independent factors for clinical outcomes.

PD-1 Inhibitor Maintenance Therapy Combined Iodine-125 Seed Implantation Successfully Salvage Recurrent Cervical Cancer after CCRT: A Case Report

“…Accumulating evidence showed its good efficacy in various recurrent cancers, including rectal cancer, head and neck cancer, and pancreatic cancer [ 17 , 34 , 35 , 36 , 37 , 38 ]. Moreover, our previous studies demonstrated that 3D-PNCT-assisted CT-guided RISI is a safe, effective, and minimally invasive modality to treat recurrent cervical cancer after radiotherapy [ 16 , 20 ]. Other centers showed similar results [ 21 ].…”

“…According to our previous study [ 16 ], which included 111 lesions from 103 patients, the response (complete response, CR/PR/stable disease, SD) of tumors after RISI was 99.1%. The local control (LC) for one year and three years was 87.4% and 75.1%, respectively.…”

“…After seed implantation, a CT scan was performed again to check the distribution of actual 125I seeds in the targets, and additional seeds would be implanted if the distribution of 125I seeds was not satisfactory. The CT image dataset was transferred to the BT-TPS for post-planning dose evaluation [ 16 , 20 ]. The evaluated doses were GTV D90 = 126.9 Gy, GTV V100 = 94.7%, and CTV D90 = 100.2 Gy, CTV V100 = 87.0%.…”

“…A low-dose-rate (LDR) with the computer tomography (CT) guidance and 3-dimensional (3D)-printing non-coplanar template (PNCT) assistance, RISI can achieve an accurate dose delivery and spare the normal tissues. Up to now, 3D PNCT-assisted RISI has presented promising results in the salvage treatment of several kinds of recurrent tumors [ 15 , 16 , 17 , 18 ] and has been referenced in the National Comprehensive Cancer Network guidelines for the management of a locally recurrent rectal cancer [ 19 ]. Meanwhile, existing studies have preliminarily confirmed the efficacy and safety of RISI in the treatment of cervical cancer [ 16 , 20 , 21 ].…”

“…Up to now, 3D PNCT-assisted RISI has presented promising results in the salvage treatment of several kinds of recurrent tumors [ 15 , 16 , 17 , 18 ] and has been referenced in the National Comprehensive Cancer Network guidelines for the management of a locally recurrent rectal cancer [ 19 ]. Meanwhile, existing studies have preliminarily confirmed the efficacy and safety of RISI in the treatment of cervical cancer [ 16 , 20 , 21 ]. Meanwhile, recent studies indicated that radiotherapy induces immunomodulatory effects [ 22 , 23 , 24 , 25 ]; therefore, we expect the combination of PD-1 immune checkpoint inhibitor and RISI radiotherapy would improve prognosis compared with monotherapy and presented this case.…”