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Objective:To investigate the value of the virtual monoenergetic image (VMI) obtained by a new dual-layer detector spectral CT combined with metal artifact reduction algorithms(O-MAR) in reduction of different types of artifacts caused by 125I seeds implantation and in improvement of the post-operative CT image quality. Methods:This was a cross-sectional study. Thirty-five patients who underwent dual-layer detector spectral CT scanning of the chest and abdomen after 125I seeds implantation were retrospectively included at the First Affiliated Hospital of Zhengzhou University from March to September 2022. The spectral data were collected and reconstructed into conventional CT image (CI), VMI image (50-150 keV, 20 keV/level), CI+O-MAR image, and VMI+O-MAR image (50-150 keV, 20 keV/level). The artifacts′ removal effects and image quality improvement in each group were evaluated. Two slices with the strongest artifacts were selected for analysis for each patient, resulting in a total of 70 slices. Objective indicators including artifact index (AI), signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of soft tissue regions affected by artifacts were measured and calculated. Subjective indicators including the overcorrected artifacts and new artifacts, the different forms of artifacts, the diagnosis of artifacts, and the image quality were assessed. One-way analysis of variance was used for comparisons among multiple groups. Paired t test was used to compare the quantitative indicators between the combined O-MAR group and the non-O-MAR group. Kappa statistics was used to evaluate the consistency between observers. Results:In high/low-density artifacts (ROI H/L), the AI values in all groups showed decrease with increasing VMI keV. In artifact-affected tissue (ROI T), SNR of the CI/VMI (70-150 keV)+O-MAR group were significantly higher than those of the CI/VMI group ( P<0.05), CNR of the CI/VMI(50-150 keV)+O-MAR group were significantly higher than those of the CI/VMI group ( P<0.05). Both overcorrection and new artifacts mainly presented in VMI 50 keV and VMI 70 keV groups; Compared with VMI (50-70 keV) group, significantly less numbers of overcorrection and new artifacts were found in VMI (50-70 keV)+O-MAR group ( P<0.05); regarding the comparison of artifact types, with the VMI keV increasing, the number of a-type banded artifacts gradually decreased on images with high-density artifacts, reaching a minimum of 3 in the VMI 150 keV+O-MAR group; while the number of e-type artifacts with little or no artifacts increased, with the highest number of 23 in the VMI 150 keV+O-MAR group. The total number of high-density artifacts in each type decreased with increasing VMI keV. As VMI keV increased, the diagnostic and image quality scores of high-density artifacts in each group were significantly higher than those of low-density artifacts in the VMI+O-MAR group ( P<0.05). Conclusions:VMI combined with O-MAR can significantly improve the objective and subjective image quality of follow-up CT imaging after 125I seed implantation, enhancing lesion visibility and diagnostic confidence. Additionally, VMI+O-MAR showed more pronounced correction effect on high-density artifacts.
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Esophageal cancer is one of the most common malignant tumors in China and dysphagia caused by malignant stenosis is the most common symptom of advanced esophageal cancer. The inability to eat orally seriously affects the quality of life of patients with advanced esophageal cancer, and poor nutritional status caused by dysphagia limits the implementation of standard treatment programs such as radiotherapy and chemotherapy, resulting in a decline in survival. The 125I radioactive stent is a novel treatment for malignant stenosis. Studies have shown that it can relieve dysphagia and prolong patients' survival compared to traditional esophageal stents. In this article, the treatment of malignant stenosis in advanced esophageal cancer and the clinical application progress of 125I radioactive stents were reviewed.
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Objective To discuss the role of empowerment management mode in radiation protection after 125I seed implantation.Methods A total of 66 patients,who received first-time 125I seed implantation at the authors'hospital from October 2020 to October 2022,were randomly divided into control group(n=33)and study group(n=33).The patients of the control group received traditional health education,while the patients of the study group received the empowerment management mode on the basis of the traditional health education.The self-efficacy,health education effect,and protection compliance were compared between the two groups.Results The self-efficacy,health education effect,and protective compliance of patients in the study group were better than those in the control group,and the differences were statistically significant(P＜0.05).Conclusion The implementation of health education by empowerment management mode can improve the effect of health education in patients after 125I seed implantation,and the patients can get better understanding about 125I seed therapy,which can strengthen their sense of self-efficacy and improve postoperative protection compliance,ensuring the safety of the surrounding crowd.The empowerment management mode is worthy of clinical promotion.(J Intervent Radiol,2024,32:82-85)
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Objective To investigate the value of single photon emission computed tomography/computed tomography(SPECT/CT)fusion imaging for post-implantation dose verification of 125I particles in patients with bone metastases.Methods Forty patients with metastatic bone tumors treated with 125I particles implantation were selected.Within 24 h after 125I particles implantation,patients underwent SPECT/CT fusion imaging and the radioactivity per unit(RPU)was calculated.The treatment planning system(TPS)was then used to obtain the isodose profiles of SPECT/CT fusion imaging results and to calculate the tumor target coverage.The patient's preoperative and postoperative 1 month clinical outcomes,including local tumour remission,pain assessment,quality of life and serum alkaline phosphatase(ALP)levels were compared,and a receiver operating characteristic(ROC)curve was applied to evaluate the predictive value of tumor target coverage on postoperative outcomes.Results The mean number of particles implanted in the target area was 32.52±12.87.Within 24 h of 125I particles implantation,SPECT/CT fusion imaging analysis confirmed a strong positive correlation between the RPU of the radioactive concentration area and the mean dose received by the patient(r=0.786,P<0.05).The predicted area under the curve(AUC)for local tumor remission,pain relief,quality of life improvement and change in ALP levels was 0.789,0.757,0.804 and 0.833,respectively.Conclusion SPECT/CT fusion imaging can be used for postoperative dose verification of 125I particles for metastatic bone tumors and has some predictive value for clinical outcomes.
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Objective To investigate the short-term efficacy of celiac plexus block combined with the interstitial permanent implantation of 125I seeds in the treatment of advanced pancreatic cancer (inoperable locally advanced and metastatic pancreatic cancers). Methods A total of 100 patients with advanced pancreatic cancer were selected and treated with celiac plexus block combined with the interstitial permanent implantation of 125I seeds under CT guidance. Pain relief and changes in the tumor marker CA19-9 were assessed on the seventh day, the first and third months after surgery. In the third month after surgery, tumor size was assessed by CT. Results Among the 100 patients with advanced pancreatic cancer, complete response (CR) was found in 12 cases, partial response (PR) in 78 cases, stable disease in five cases, and progression of disease in five cases three months after surgery. The CA19-9 level and the sum of short and long tumor diameters were significantly decreased (both P<0.01). A total of 100 patients had severe pain before treatment (visual analogue scale (VAS)): 7–10 points), 59 patients reported pain disappearance (VAS: 0 points), 35 patients had mild pain (VAS: 1–3 points), and six patients experienced moderate pain (VAS: 4–6 points) in the third month after treatment. The pain relief rate was 100%. Conclusion Celiac plexus block combined with the interstitial permanent implantation of 125I seeds has good short-term efficacy and can effectively improve short-term pain in patients with advanced pancreatic cancer.
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Objective To analyze the short-and long-term efficacy and influencing factors of 125I seed implantation for relapsed primary lung cancer.Methods Forty patients who received 125I seed implantation for relapsed primary lung cancer were retrospectively included.CT examination was performed 3 months after surgery to evaluate the short-term efficacy.Patients were divided into the effective group(complete remission and partial remission)or the ineffective group(stable disease and progressive disease).Patient deaths and survival times were documented through telephone or electronic case inquiry.Factors influencing short-term efficacy and long-term survival were evaluated using logistic and Cox regression analysis,respectively.Results Among the 40 patients,16 cases were effective and 24 were ineffective.Multivariate logistic regression analysis indicated that postoperative dose delivered to 100%gross tumor volume(D100)(OR= 0.944,95%CI:0.898-0.992,P= 0.023)was an independent factor for short-term efficacy.The median duration of follow-up was 12 months.Twenty-five patients died,ten survived,and five were lost to follow-up.Multivariate Cox regression analysis suggested that the longest tumor diameter(HR= 1.310,95%CI:1.010-1.698,P= 0.042)was an independent factor for long-term survival.Conclusion 125I seed implantation has improved the short-and long-term efficacy of treatment for relapsed primary lung cancer.Postoperative D100 is an independent factor influencing short-term efficacy,and longest tumor diameter is an independent factor for long-term survival,in patients receiving 125I seed implantation for relapsed primary lung cancer.
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Objective To discuss the clinical value of systemic immune-inflammation index(SII)in predicting the prognosis of patients with extrahepatic cholangiocarcinoma(ECCA)treated with biliary stenting combined with 125I seeds implantation.Methods A total of 128 patients with unresectable ECCA,who received biliary stenting combined with 125I seeds implantation at the Interventional Department of the Affiliated Hospital of Xuzhou Medical University of China between August 2018 and August 2021,were enrolled in this study.The peripheral blood routine testing was performed within 3 days before operation,based on which the SII was calculated.Receiver operating characteristic(ROC)curve was applied to determine the optimal cut-off value of SII,based on which the patients were divided into high-SII group and low-SII group.Cox regression model was used to analyze the independent factors affecting patient prognosis.The Kaplan-Meier curve was plotted to analyze the one-year survival.Results The optimal cut-off value of SII was 1 050,the sensitivity was 66.0％,the specificity was 69.3％,and the area under ROC curve of SII was 0.676.The one-year survival rate of patients with ECCA in the high-SII group was significantly lower than that in the low-SII group(P＜0.05).Univariate Cox regression analysis indicated that vascular invasion,T stage,adjuvant chemotherapy,CA19-9,and preoperative SII were the important factors affecting the prognosis of patients with ECCA.Multivariate Cox regression analysis revealed that T stage,CA19-9,and preoperative SII were the independent risk factors for patient prognosis,while adjuvant chemotherapy was a protective factor.The Kaplan-Meier curves showed that the one-year survival rate in high-SII group was remarkably lower than that in the low-SII group.Conclusion Preoperative SII has an important value in evaluating the prognosis of patients with ECCA who are treated with biliary stenting combined with 125I seed implantation.(J Intervent Radiol,2023,32:1221-1225)
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Interstitial implantation of 125I seeds is a kind of continuous low-dose-rate internal irradiation therapy,and it has been used in the treatment of various malignant tumors.In recent years,molecular biology research on the treatment of malignant tumors with 125I seeds has been gradually carried out and deepened.In addition to damaging DNA,125I seeds also act on the endoplasmic reticulum and mitochondria,and then,through multiple signaling pathways,induce tumor cells apoptosis and paraptosis,promote cytoprotective autophagy,and inhibit epithelial-mesenchymal transition of tumor cells.Moreover,125I seeds can also improve the tumor microenvironment.125I seeds can suppress tumor growth by inhibiting tumor microvessels and activating the immune response.This paper reviews the above-mentioned biological effects and related molecular mechanisms induced by 125I seeds,aiming to provide ideas for future mechanism research and combination therapy.(J Intervent Radiol,2023,32:1263-1268)
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Radioactive 125I seed implantation has definite curative effect in the treatment of local liver cancer. Currently, percutaneous implantation guided by CT, nuclear magnetism or ultrasound can be adopted, which is safe and minimally invasive. However, the images of some patients with metastatic liver cancer show isodensity or iso-echo imaging under CT or ultrasound, which is easy to miss diagnosis and treatment, seriously affecting the quality of life of patients. A case of terminal cholangiocarcinoma of the biliary tract with metastasis to the liver was admitted to China-Japan Union Hospital of Jilin University. Ultrasound image showed iso-echo, and radio 125I seed implantation was performed under the guidance of contrast-enhanced ultrasound. The operation was completed according to the preoperative treatment plan.
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Objective:To investigate the safety and dose of 4D template (real-time adjustable angle template) in the treatment of advanced malignant tumors with 125I seeds. Methods:98 patients with advanced malignant tumors admitted to Department of Thoracic Surgery of Shaanxi Provincial Tumor Hospital were treated with 4D template-navigated radioactive 125I seed implantation from June 2018 to December 2019. Preoperative TPS plan, intraoperative optimization, postoperative verification of immediate dose and postoperative evaluation of implantation dose were performed. The treatment results were observed. Results:All 98 patients completed the seed implantation. The implantation dose of GTV of implantation site receiving external irradiation was (12 489±414) cGy and the dose of no external irradiation was (15 036±514) cGy. V 100% was 84.7%-94.1%, and 88.2%-93.7%. The implantation dose of CTV was (7 450±621) cGy, and (9 080±761) cGy. The quality of dose implantation was evaluated as: excellent in 89 cases (91%, 89/98), good in 7 cases (7%, 7/98), fair in 2 cases (2%, 2/98), and poor in 0 case, respectively. The symptom relief rate of patients with pain was 92%(36/39). The 1-and 2-year local control rates were 61%, 36% and 82%, 54% in patients treated with and without external irradiation, respectively. The difference was statistically significant ( P=0.02). The incidence rates of pneumothorax and hemoptysis were 19%(9/48) and 10%(5/48). No corresponding complications were observed in other parts of the patients. Conclusion:4D template-assisted 125I seed therapy is safe and effective for malignant tumors, and intraoperative adjustment of needle angle and dose optimization can realize the precise control of implantation dose.
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Objective:To investigate the relationship between dosimetric parameters and tumor volume change after 125I implantation for thyroid cancer and obtain better dosimetric parameters that predict the curative effect more accurately. Methods:A total of 22 consecutive patients with thyroid cancer (23 targets) who received 125I interstitial brachytherapy in Department of Oncology, Hebei General Hospital were retrospectively analyzed. All the patients received post-operative dose verification, and the D 90 (Minimum dose received by 90% target volume) was calculated. After a regular follow-up, the tumor volume reduction ratio after t months (R t) , actual absorbed dose (D 1m) , efficacy corrected absorbed dose (D 1e) , and sensitivity corrected absorbed dose (D 1s) of the first month were calculated according to the actual follow-up CT images. The statistical test was carried out by SPSS21.0. The Spearman linear analysis was applied to analyze the relationship between D 90, D 1m, D 1e, D 1s and R t, and the curve fitting was also completed. Results:The post-operative D 90, D 1m, D 1e, D 1s and R t were (129.73±14.22) Gy, (36.95±7.35) Gy, (43.45±11.32) Gy, (41.78±13.39) Gy, and (32.00±19.00) %, respectively. And the correlation coefficient were 0.692, 0.551, 0.728, and 0.858, respectively, which showed significant positive relevance between dosimetric parameters and tumor volume change ( P<0.01) , the curve fitting presented cubic function. Conclusion:The post-operative D 90, D 1m, D 1e, and D 1s can be predictors for curative effect, and D 1s is the best predictor.
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Ultrasound-guided radioactive 125I particle implantation for the treatment of advanced gallbladder cancer is susceptible to factors such as ribs, respiratory activity, and biliary reflex, which brings great inconvenience to the operation. We reported one case of gallbladder cancer patients with unclear ultrasound imaging under general anesthesia mechanical ventilation and successful transplantation after sustained inflation with general anesthesia in order to providing basis of clinical diagnosis and treatment.
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Objective:To investigate the clinical efficacy of 125I seed implantation combined with anlotinib hydrochloride in the treatment of non-small cell lung cancer (NSCLC). Methods:61 cases of NSCLC patients were enrolled, of which 30 cases (observation group) received 125I seed implantation combined with anlotinib treatment, and 31 cases (control group) received 125I seed implantation only. To evaluate the curative effect and adverse reactions of all patients, the carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA21-1), neuroendocrine enolase (NSE), squamous cell carcinoma antigen (SCC) in the peripheral blood of the two groups was measured before the treatment and at 1 and 3 months after the treatment. Results:The effective rates in the observation group were 90.00% and 93.33%, the effective rates in the control group were 67.74% and 74.19% at 1 and 3 months after the treatment, respectively, and the difference in efficacy between the two groups was statistically significant ( χ2=4.504, P=0.034 vs. χ2=4.075, P=0.044). There was no significant difference in the incidence of adverse reactions between the two groups of patients after treatment ( P=0.785). At 1 and 3 months after the treatment, the levels of CEA, CYFRA21-1, NSE and SCC in the peripheral blood of the two groups of patients were lower than those before the treatment (all P<0.05). Conclusions:125I seed implantation combined with anlotinib hydrochloride is safe for the treatment of advanced non-small cell lung cancer, and has promotion value.
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Objective:To analyze the target design and dosimetric parameters of patients with recurrent adenoid cystic carcinoma (ACC) in the parotid gland who were treated with 125I interstitial brachytherapy alone. Methods:A retrospective analysis was conducted for 25 patients with recurrent adenoid cystic carcinoma in parotid gland who were histopathologically diagnosed between January 2015 and October 2019. These patients were treated with 125I interstitial brachytherapy alone, with prescribed doses of 100-120 Gy. The target volume was designed according to the pathological characteristics of ACC and recurrence sites. The pre- and post-operation dosimetric parameters (i.e., local control rates) were calculated using the treatment planning system. Results:In this study, the local recurrence sites included the superficial lobe (10/25) and deep lobe (7/25) of the parotid gland primarily and the skull base region (four patients) and mastoid posterior region (four patients) secondarily. The number of 125I seeds ranged from 16 to 111, with a median number of 59. The activity of radioactive particles was 18.5-25.9 MBq. The 3- and 5-year local control rates were 81.5% and 61.5%, respectively. No significant differences were found between pre- and post-operative dosimetric parameters such as D90, V100, and V150. There was no significant difference in local control rates among the four different recurrence sites. Conclusions:125I interstitial brachytherapy is proven to be an effective approach in the treatment of recurrent adenoid cystic carcinoma in the parotid gland. Satisfying local control rates can be achieved through target delineation performed according to recurrence sites and perineural invasion characteristics of ACC.
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Objective:To investigate the effect of radioactive 125I seed on angiogenesis of subcutaneously transplanted hepatocellular carcinoma in nude mice and underlying mechanism. Methods:The subcutaneous transplanted tumor model of human hepatocellular carcinoma Huh7 cells was established in nude mice. Twelve nude mice were randomly divided into observation group and control group with 6 mice in each group. The 125I seed with activity of 2.96×10 7Bq was implanted into the transplanted tumor of observation group and another with 0 Bq as control group, respectively. The volume of the transplanted tumor was measured every 4 d and the growth curve of the tumor was recorded. The microvessel density (MVD) of the transplanted tumor was evaluated by immunohistochemical detection of CD31. VEGF-A and HIF-1α protein and mRNA were detected by immunohistochemistry and RT-PCR, respectively. Results:The growth rate of tumor in the observation group was slower than that in the control group, and the difference of tumor volume between two groups at 12 d after 125I seed implantation was significantly different( t=3.167, P<0.05). At 28 d after transplantation, the tumor volumes of control and observation group approached to (963.61 ± 89.56) mm 3and (602.10±75.98) mm 3, respectively. The MVD of the observation group was significantly lower than that of the control group ( t=6.361, P<0.05). The relative expression of VEGF-A and HIF-1α mRNA in the observation group was significantly lower than that in the control group ( t=10.480, 6.414, P<0.05). Protein expression levels of VEGF-A and HIF-1α in the observation group were lower than those in the control group ( t=10.890, 12.250, P<0.05). Conclusions:Radioactive 125I seed can inhibit the growth of HCC xenografts by reducing tumor microvessels, which may be related to the decrease of VEGF-A and HIF-1α expression.
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Objective:To investigate the impacts of the composition and physical density of tissue on the dose distribution of implanted 125I seeds, in order to provide references for the clinical dose calculation and assessment of implanted radioactive particles. Methods:The OncoSeed 6711 physical model of 125I seeds was established using thes of twareegs_brachy and was validated through the calculation of dose rate constant and the radial dose function [ g( r)] in water. Then, based on the element composition and physical density of different types of tissue, the g( r) and absorbed dose ratein water, prostate, breast, muscle, and bone were calculated. Results:The calculated dose rate constant (0.950 cGy·h -1·U -1) and g( r)in water approached the values in related literature. The absorbed dose in bone was 6.042 times than that in water at a distance of 0.05 cm from the implanted source. The difference between the absorbed doses in breast and water was more than 10% at a distance of less than 1.7 cm from the implanted source. The difference between the absorbed doses in prostate/muscle and water was less than 5% at the same radial location. Conclusions:The dose distribution of 125I seeds in some types of human tissue is significantly different from that in water, which should be carefully considered in clinical dose calculation.
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Objective:To study the radiation dose rate and effective dose in ambient environment due to 125I seed implantation in the treatment of the patients suffering abdominal and pelvic tumors, so as to provide reference for occupational protection of different groups. Methods:Within 24 hours after operation, the radiation dose rate to 42 patients with abdominal and pelvic tumor with 125I seed implantation was monitored by using pocket dosimeter. The relationships between the total activity in the implanted particles and the measured dose rate, as well as between the implanted depth and the dose rate under the standard activity, were obtained by curve fitting. According to the formula, the relationship between the dose rate and the warning time was calculated. Results:The dose rates at 30 cm, 50 cm and 100 cm of vertical particle implantation site were (6.92±2.87), (4.10±1.62) and (1.30±0.48) μSv/h, respectively ( χ2=73.71, P<0.05). The dose rates on the left and right sides were (0.378±0.156) and (0.384±0.153) μSv/h at 30 cm, (0.170±0.089) and (0.17±0.086) μSv/h at 50 cm, (0.039 ±0.014) and (0.043±0.017) μSv/h at 100 cm, respectively ( χ2=76.19, 76.33, P<0.05). There was a linear relationship between the dose rate at the vertical particle implantation site and the total activity in the implanted particles, and between the dose rate and the implantation depth under the standard activity. The relationship between the warning time and the dose rate to adults in the same bed, co-workers, minors in the same bed and pregnant women were as follows: t ( d)=-106.616+ 83.779ln D( t), t ( d)=26.556+ 85.933ln D ( t), t( d)=3.088+ 85.017ln D( t). Conclusions:After 125I seed implantation, the radiation dose in the ambient environment is low, ensuring the radiation safety; and the measured dose rate decreases with the decrease in the total activity in the implanted particle and the increase in the implantation depth; at the same time, the warning time for different groups is calculated according to the measured dose rate or the total activity in the implanted particle and the depth of the implanted particle, so as to carry out individualized protection.
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Objective:To study the use of radioactive I-125 seed implantation in the treatment of transarterial chemoembolization (TACE)-refractory hepatocellular carcinoma (HCC).Methods:A retrospective study was conducted on 70 patients with HCC who were initially treated with TACE between July 1, 2016 and August 31, 2019 at the Second Affiliated Hospital of Guangzhou Medical University. After these patients were found to be refractory to TACE, 29 patients were converted to radioactive I-125 seed implantation (the 125I seed group), and 41 patients were continued with TACE (the TACE group). The objective response rate, progression-free survival (PFS), overall survival (OS), total overall survival (TOS) of the two groups were compared. Results:There were 59 males and 11 females, aged (60.5±11.9 ) years in this study. At 1, 3, 6 months after treatment, the objective response rates of the 125I seed group were 20.7%, 40.7%, 34.6%, respectively, which were significantly higher than that of the TACE group of 2.6%, 3.3%, 5.0%, respectively. The PFS, OS, TOS in the 125I seed group were 7.6, 21.1, 32.1 months, respectively, which were significantly better when compared with the TACE group (3.5, 8.5, 14.8 months, respectively, all P<0.05). There was no significant difference in the embolization syndrome between the two groups [93.1%(27/29) vs 100.0%(41/41), P>0.05]. Child-Pugh B grading ( HR=0.311, 95% CI: 0.160-0.603, P=0.005) and TACE ( HR=0.308, 95% CI: 0.159-0.597, P=0.002) were independent risk prognostic factors for survival. Conclusion:This study showed better treatment efficacy and safety using radioactive I-125 seed implantation in TACE-refractory HCC and this treatment significantly improved survival of patients when compared with TACE alone.
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Objective:To evaluate the clinical value of 125I seed implantation guided by CT in treatment of advanced pancreatic cancer. Methods:The data of 63 patients with advanced pancreatic cancer in the Affiliated Cancer Hospital of Zhengzhou University from Jun. 2015 to Jun. 2018 (48 males and 15 females) were retrospectively analyzed. All patients underwent CT-guided 125I seed implantation, and regular follow-up after operation. All patients were followed up for 3 to 36 months to evaluate the clinical efficacy, including the volume of cancer before and after treatment, tumor marker CA199 and changes in complications such as abdominal pain and jaundice, and the survival status of the patients. Results:Three months after seed implantation, 9 cases (14.3%) had complete remission of cancer in 63 patients, 33 cases had partial remission (52.4%) , 15 cases had no change (23.8%) , and 6 cases had disease progression (9.5%) . The total effective rate was 67.7%. Three months after treatment, the volume of cancer was (31.92±14.93) cm 3, which was significantly smaller than that before treatment [ (44.88±16.19) cm 3; t=6.79, P<0.01]. Three months after treatment, Serum CA199 (77.21±58.69 U/ml) was significantly lower than that before treatment (327.76±110.42) U/ml ( t=16.56, P<0.05) . 125I seed implantation for advanced pancreatic cancer had an average survival period of (13.04±0.92) months and a median delivery period of 11 months. Of the 57 patients with different degrees of abdominal pain, 49 were better than before, and the pain relief rate was 85.9%. Among 42 patients with jaundice symptoms of varying degrees, 31 were better than before, and the jaundice remission rate was 73.8%. There were no serious complications related to treatment in any patients. Conclusion:125I seed implantation therapy can safely and effectively treat advanced pancreatic cancer, and improve related clinical symptoms such as abdominal pain and jaundice.
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Retroperitoneal leiomyosarcoma is relatively uncommon. Leiomyosarcoma has accounted for about 5%-10% of soft-tissue sarcoma, and 1/2–2/3 of the primary lesions were retroperitoneal, with a cumulative 5-year survival rate of only 35%.Leiomyosarcoma is one kind of soft-tissue sarcoma with the lowest survival rates due to the invasive growth, difficult treatment, and poor prognosis.The present study reported a case of a 78-year-old male diagnosed as left retroperitoneal leiomyosarcoma, who had received three operations. Computed tomography (CT) demonstrated a mass of approximately 12.9 cm × 6.9 cm × 6.6 cm in his retroperitoneal region. The Eastern cooperative oncology group and numerical rating scale scores of pain were 1 and 5, respectively. Multiple treatment strategies were administered, including the application of drainage and125I seed implantation. A total of 90125I seeds were implanted into the tumor through repetitious operations, with 30 seeds each time. Treatment planning system was involved to calculate the source distribution.125I seeds with the activity of 0.5 mCi were implanted under the guidance of CT, and dosimetric verification was performed after the operation. D90 (90% minimum prescription dose received by target volume) was 40 Gy. Follow-up was performed after 6 months, and complete response was achieved in the local lesions. However, there was no evidence-based treatment currently and the majority of our knowledge was based on results from case reports, thus further studies would be required