Side effects of CT-guided implantation of 125I seeds for recurrent malignant tumors of the head and neck assisted by 3D printing non co-planar template

Abstract

BackgroundFor the recurrence of head and neck cancer after operation and radiotherapy, the local control of radioactive seed implantation is good, and it has a certain palliative effect. This study aims to investigate the acute and late side effects of a three-dimentional printing non co-planar template (3D–PNCT) for computed tomography (CT)-guided radioactive 125I seed (RIS) implantation in recurrent cancer of the head and neck.MethodsBetween January 2016 and December 2016, forty-two patients with local recurrent malignant tumors of the head and neck received 3D–PNCT-assisted RIS implantation. The prescribed dose was 110–160 Gy. Preoperative planning design, production of individual guide plates, RIS implantation, postoperative dose evaluation, and follow-up were completed for all patients. Side effects in the skin, mucous membranes, blood and spinal cord were evaluated.ResultsAll patients underwent surgery successfully. Duration of follow-up was 4–14 (median, of 8.5) months. The activity of a single RIS was 0.34–0.7 (median, 0.6) mCi. The number of RIS was 10–126 (median, 34). The number of implantation needles was 4–31 (median, 11). The mean D2cc (dose to the most exposed 2-cc volume) and D0.1cc (dose to the most exposed 0.1-cc volume) of the skin were 24.9 (7.1–85.5) and 47.5 (9.4–167.2), respectively, whereas those of the spinal cord were 8.4 (4.5–33.3) and 14.2 (13.6–63.0), mucosa were 35.1 (4.2–82.8) and 87.0 (6.6–214.1), parotid glands were 16.2 (12.8–19.7) and 29.8 (26.1–33.4) and those of the trachea were 17.9 (2.5–45.9) and 32.7 (3.9–83.9), respectively. No case had an acute reaction of grade ≥ 3. Three cases had a grade-1 skin reaction. Blood toxicity did not occur, nor spinal-cord injury. Xerostomia was not aggravated than that of before brachytherapy. One case had a grade-3 nerve response.Conclusions3D–PNCT-assisted RIS implantation can provide good accuracy for positioning. For local recurrent malignant tumor of head and neck, there were no obvious adverse reactions.

Efficacy and Safety Aiming at the Combined-Modality Therapy of External Beam Radiotherapy (40Gy) and Iodine-125 Seed Implantation for Locally Advanced NSCLC in the Elderly

“…Except for grade 2 irradiation-related myelosuppression (1 case), there were no other grade 3 or higher toxicity effects. According to the reports of Jiang et al, there were no evident toxicity effects of grade 3 or higher (35). The incidence of radiation pneumonitis with grade ≥ 2 was 7.0 to 32.0% in patients receiving EBRT therapy, while that with grade ≥ 3 was 2.6 to 18.0% according to some authorized studies (36)(37)(38).…”

Efficacy and safety of CT-guided 125I seed implantation as a salvage treatment for locally recurrent head and neck soft tissue sarcoma after surgery and external beam radiotherapy: A 12-year study at a single institution

“…Ji et al (9) reported that Grade 3 skin/mucosal toxicities were 7.9% and Grade 4 were 2%. A study by Jiang et al (27) specifically explored the side effects of RIS implantation in the treatment of recurrent head and neck cancer showing that 14.4% of patients had Grade 1/2 skin/mucosal toxicities and no patients suffered from Grade 3/4 skin/mucosal side effects. Conversely, the toxicities of re-EBRT to head and neck cancers seemed much more severe than RIS brachytherapy.…”

The Accuracy of Individualized Three Dimensional-printing Template Assisted I125 Radioactive Seed Implantation for Recurrent head and Neck Cancer

“…eyes, major vessels and nerve) in head and neck region, the accuracy of I 125 RSI and post-plan dosimetry was extremely critical for patients with head and neck cancer. Individualized three dimensional-printing template (3D-PT) was developed to facilitate I 125 RSI for head and neck cancer in order to improve the accuracy, optimize post-plan dosimetry, and shorten the RSI duration [8][9][10][11].…”

“…However, most of the previous studies involving 3D-PT assisted I 125 RSI were focused on the e cacy and safety pro les, mainly including local control, survival and complications [7,[11][12][13]. As the mean entrance deviation, planned and intraoperative deviation of needle depth and angular were deemed to represent the accuracy of needle related interventions, only 2 studies involving these parameters were published to described the accuracy of 3D-PT assisted I 125 RSI for head and neck cancer [9,14].…”

“…As the mean entrance deviation, planned and intraoperative deviation of needle depth and angular were deemed to represent the accuracy of needle related interventions, only 2 studies involving these parameters were published to described the accuracy of 3D-PT assisted I 125 RSI for head and neck cancer [9,14]. Indicated by existed evidence, 3D-PT assisted I 125 RSI may provide satis ed accuracy with consistent planed and post-plan dosimetry without additional complications [9,11,14], while cases reported in these studies was limited.…”