Postoperative radiotherapy results in 192 epithelial thymic tumours patients with 10 years of follow-up.

PURPOSE: To assess the prognostic factors and patterns of failure of patients consecutively treated with surgery and postoperative radiation therapy (PORT) for thymic epithelial tumours (TET). PATIENTS AND METHODS: Data from 192 TET patients who were operated and received PORT at a single centre from 1990 to 2019 was retrospectively analysed. RESULTS: Most patients had thymoma (77 %, B247%), were classified Masaoka-Koga stage III (35 %) or IV (32 %) and had a R0 (75 %) resection. Radiotherapy was delivered at a median dose of 50.4 Gy (range, 42-66 Gy; ≥ 60 Gy in 17 %), 63 (33 %) patients were treated by intensity-modulated radiation therapy and elective nodal radiotherapy was used for 37 %. At a median follow-up of 10.9 years, the 10-year overall survival (OS) and progression-free survival (PFS) rates were 62 % (95 % CI: 54-70 %) and 47 % (95 % CI: 39-55 %), respectively. Locoregional recurrence (LRR) occurred in 72/192 (38 %) patients, distributed as 6 local, 45 regional and 21 both local and regional. LRR were mainly located to the pleura: 66/72 (92 %) and 16/72 (22 %; 16/192 in total, 8 %) were in-field. Distant relapse (DR) were observed in 30 patients (16 %), resulting in 10-year locoregional (LRC) and distant control rates of 58 % (95 % CI: 50-66 %) and 82 % (95 % CI: 77-88 %), respectively. In the multivariate analysis, Masaoka-Koga stage (HR [hazard ratio]: 1.9; p = 0.001), thymic carcinomas/neuroendocrine tumours (TC) (HR: 1.6; p = 0.045) and ECOG PS > 1 (HR: 1.9; p = 0.02) correlated with poorer OS. Higher Masaoka-Koga stage (HR: 2.6; p < 0.001) associated with a decreased LRC but not R1 status (HR: 1.2; p = 0.5) or WHO histology classification. TC (HR: 3.4; p < 0.001) and a younger age (HR: 2.5; p = 0.02) correlated with DR. CONCLUSION: Approximately one-third of the TET in our study experienced a LRR, mainly to the pleura, and 8% in total were in-field. The place of radiotherapy should be better defined in higher risk thymoma patients within prospective randomized studies.

Thymic epithelial tumour radiotherapy in the UK: A survey of current clinical practice.

Significant variation in treatment centre setup and radiotherapy practice for thymic epithelial tumours (TET) was identified through a comprehensive survey of current UK Clinical (Radiation) Oncology practice. Multi-centre collaboration and wider TET specific multidisciplinary team meetings are needed and will be essential for developing expertise in TET radiotherapy.

Radiologic response of chemotherapy alone versus radiation and chemotherapy in the treatment of locally-advanced or advanced thymic epithelial tumors.

BACKGROUND: Here, we investigated radiological responses following chemotherapy alone as compared to both radiation/chemotherapy (chemoRT) in patients with thymic epithelial tumors (TETs) who did not receive upfront surgery. METHODS: TETs treated at a tertiary academic cancer center between January 2007 and July 2018 were identified. Patients received chemotherapy or chemoRT as initial therapy and pre- and post-treatment scans were available. Student's t-test, Wilcoxon rank-sum tests, and Cox proportional hazards method were used to compare clinical details and survival between groups. The primary outcome was change in tumor size, which was compared between groups using linear mixed-effects regression models, adjusting for baseline tumor size, age, and histology. RESULTS: A total of 24 of 114 patients with TETs identified met the inclusion criteria. The majority of patients had 67% thymoma (67%, n = 16) and AJCC8 III-IVA disease (58%, n = 14). Median age was 58.5 years (range: 33-76), median initial tumor volume was 187.1 cc (range: 28.7-653.6) and diameter was 8.5 cm (range: 4.5-14.3). Half of the patients received upfront chemotherapy (n = 12: 83% cisplatin/adriamycin/cyclophosphamide) or chemoRT (n = 12: 58% carboplatin/paclitaxel; median RT dose: 63 Gy [range: 60-70 Gy]). At a median imaging follow-up of 15 months (range: 0-86): ChemoRT was associated with increased average radiological response compared to chemotherapy alone (volume: -47.0 cc more, P < 0.001; diameter: -0.8 cm more, P = 0.03). In eight patients who received chemotherapy, 33% saw further tumor shrinkage (median volume: -42.3%, P = 0.03; diameter: -3.0%, P = 0.049) with additional radiation/chemoradiation. Median survival increased for patients ultimately receiving surgery versus those who did not (46 month, range: 16-127 vs. 14 month, range: 6-82; P < 0.01). CONCLUSIONS: ChemoRT produced a greater radiologic response compared to chemotherapy alone in patients with TETs not suitable for upfront resection. KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: We found that chemoRT was associated with a greater radiologic response compared to patients who received chemotherapy alone. WHAT THIS STUDY ADDS: What this study adds: In patients with TET not amenable to upfront resection, chemoRT may be a feasible strategy for cytoreduction.

Definitive-intent radiotherapy for sinonasal carcinoma in cats: A multicenter retrospective assessment.

Treatment of epithelial sinonasal tumours in cats is not commonly reported. In the newer reports, palliative radiation protocols have been described more often than definitive-intent protocols. In this multi-institutional retrospective study, we included 27 cats treated with single-modality radiotherapy. Cats were irradiated using 10 daily fractions of 4.2 Gy. Three cats (11.1%) experienced a complete clinical response and 17 (63%) had a partial clinical response. Stable clinical disease was noted in three cats (11.1%). Four cats (14.8%) showed progression within 3 months following treatment. The median time to progression for all cases was 269 days (95 % confidence intervals [CI]: 225; 314). The proportion of cats free of progression at 1 and 2 years was 24% (95% CI: 22%; 26%) and 5% (95% CI: 5%; 6%), respectively. None of the prognostic factors evaluated were predictive of outcome (anaemia, tumour volume at the time of staging, modified Adams stage, intracranial involvement, facial deformity, epistaxis, inappetence or weight loss). Median overall survival (OS) for all deaths was 452 days (95% CI: 334; 571). The proportion of cats alive at 1 and 2 years was 57% (95% CI: 37%; 77%) and 27% (95% CI: 25%; 29%), respectively. Surprisingly, cats with epistaxis had a longer median OS of 828 days (95% CI: 356; 1301) compared to 296 days (95% CI: 85; 508) in cats without epistaxis, (P = .04, Breslow). Radiation therapy used as a single modality for the treatment of feline sinonasal carcinoma improved clinical signs and was well tolerated but progression within a year was common.

Intensity Modulated Radiation Therapy Plus Etoposide/Cisplatin for Patients With Limited Advanced Unresectable Thymic Epithelial Tumors: A Prospective Phase 2 Study.

PURPOSE: This prospective phase 2 study evaluated the efficacy and safety of intensity modulated radiation therapy plus etoposide/cisplatin (EP) for patients with unresectable thymic epithelial tumors (TETs). METHODS AND MATERIALS: Patients with limited advanced unresectable TETs whose lesions could be encompassed within radiation fields were enrolled in this study. Two cycles of EP (75 mg/m2 etoposide and 25 mg/m2 cisplatin on days 1-3 and days 29-31) were administered concurrently with radiation therapy, followed by 2 cycles after radiation therapy. The primary endpoint was the objective response rate. The secondary endpoints were the progression-free survival rate, overall survival rate, and incidence of adverse events. RESULTS: Fifty-six patients were enrolled between June 2011 and May 2018. Twenty-two and 34 patients had thymomas and thymic carcinomas, respectively. The median age was 52 (range, 21-76) years, and 30 patients (53.6%) were men. Eight patients (14.3%) had stage III tumors, 6 (10.7%) had stage IVA tumors, and 42 (75.0%) had stage IVB tumors. The objective response rate was 85.7% (95% confidence interval, 76.3%-95.2%). With a median follow-up of 46 (range, 7-101) months, the 1-, 2-, and 5-year progression-free survival rates were 66.1%, 48.0%, and 29.5%, and the 1-, 2-, and 5-year overall survival rates were 91.0%, 76.2%, and 56.2%, respectively. The most common grade 3 to 4 adverse event was leukopenia (42.9%). Pulmonary fibrosis was also observed (5.3%). CONCLUSIONS: Because intensity modulated radiation therapy with EP is effective and safe for limited advanced unresectable TETs, it could be a suitable treatment option for such patients.

[Clinical evaluation of prosthesis-like applicators with radioactive seeds for treatment of eleven palatal glandular malignancies].

PRUPOSE: To evaluate the clinical efficacy of prosthesis-like applicators with radioactive seeds in treatment of palatal glandular malignancy. METHODS: Eleven patients with palatal glandular malignant tumors were treated with surgical resection and postoperative 125I radioactive seed brachytherapy. After resection of the palatal tumors, a prosthesis denture was fabricated for each patient. According to the design of treatment plan system, several 125I radioactive seeds were embedded in the tissue surface of the prosthesis at the same time. All the patients were followed-up for 6 to 24 months and the results were evaluated. SPSS 21.0 software package was used for statistical analysis. RESULTS: Eleven patients could wear prosthesis-like applicators all the time and neither tumor recurrence nor metastasis were found around the target area during the follow-up period. Furthermore, significant improvement was shown in terms of speech, mastication and facial appearance for all patients after prosthesis-like applicator restorations. CONCLUSIONS: For patients with palatal glandular malignant tumors, prosthesis-like applicators with 125I radioactive seed brachytherapy may be effective for preventing recurrence and metastasis of the malignancies and improving the patients'quality of life.

Synergy theory for murine Harderian gland tumours after irradiation by mixtures of high-energy ionized atomic nuclei.

Experimental studies reporting murine Harderian gland (HG) tumourigenesis have been a NASA concern for many years. Studies used particle accelerators to produce beams that, on beam entry, consist of a single isotope also present in the galactic cosmic ray (GCR) spectrum. In this paper synergy theory is described, potentially applicable to corresponding mixed-field experiments, in progress, planned, or hypothetical. The "obvious" simple effect additivity (SEA) approach of comparing an observed mixture dose-effect relationship (DER) to the sum of the components' DERs is known from other fields of biology to be unreliable when the components' DERs are highly curvilinear. Such curvilinearity may be present at low fluxes such as those used in the one-ion HG experiments due to non-targeted ('bystander') effects, in which case a replacement for SEA synergy theory is needed. This paper comprises in silico modeling of published experimental data using a recently introduced, arguably optimal, replacement for SEA: incremental effect additivity (IEA). Customized open-source software is used. IEA is based on computer numerical integration of non-linear ordinary differential equations. To illustrate IEA synergy theory, possible rapidly-sequential-beam mixture experiments are discussed, including tight 95% confidence intervals calculated by Monte-Carlo sampling from variance-covariance matrices. The importance of having matched one-ion and mixed-beam experiments is emphasized. Arguments are presented against NASA over-emphasizing accelerator experiments with mixed beams whose dosing protocols are standardized rather than being adjustable to take biological variability into account. It is currently unknown whether mixed GCR beams sometimes have statistically significant synergy for the carcinogenesis endpoint. Synergy would increase risks for prolonged astronaut voyages in interplanetary space.

Patterns of Failure Following Postoperative Radiation Therapy Based on "Tumor Bed With Margin" for Stage II to IV Type C Thymic Epithelial Tumor.

PURPOSE: The study purpose was to report failure patterns in Masaoka-Koga stage II to IV type C thymic epithelial tumor (TET) after postoperative radiation therapy (PORT) and to evaluate the suitability of PORT target volume confined to the "tumor bed only with margin." METHODS AND MATERIALS: A retrospective review of 53 patients with stage II to IV type C TET was performed. The clinical outcomes, failure patterns in relation to PORT target volume, and prognostic factors were analyzed. RESULTS: During a median follow-up period of 69 months, 14 deaths and 25 recurrences were observed. The 5-year rates of overall survival, disease-specific survival, and freedom from recurrence were 81.0%, 91.5%, and 49.7%, respectively. The failure patterns in relation to PORT target volume were in-field failure in 2 patients (3.8%), marginal in 2 (3.8%), and out of field in 23 (43.4%), respectively. The most common failure site was the pleura (12 patients), followed by the lung parenchyma (8 patients). Relapse involving the regional lymph nodes was observed in 6 patients, of whom 4 had synchronous distant failure and only 2 had isolated ipsilateral supraclavicular lymph node failure. CONCLUSIONS: The policy of PORT target volume confined to only the tumor bed seems reasonable in treating patients with stage II to IV type C TET. The development of a more effective systemic therapy regimen is warranted.

Involved-field radiation therapy for recurrent ovarian cancer: Results of a multi-institutional prospective phase II trial.

OBJECTIVE: To evaluate the efficacy and safety of involved-field radiation therapy (IFRT) in patients with locoregionally confined recurrent or persistent epithelial ovarian cancer. METHODS: This study included patients with recurrent epithelial ovarian cancer eligible for IFRT either during diagnosis of the recurrence or after salvage therapies. IFRT was performed at a dose of ≥45 Gy for all tumors with 10-15-mm margins as seen on standard imaging. The primary endpoint was progression-free survival (PFS); the secondary endpoints were safety, response rate, local control, and overall survival (OS). RESULTS: Thirty patients with a mean number of 5.7 metastatic lesions each were enrolled between 2014 and 2016. Seventeen were treated with 3-D conformal radiation therapy (RT) and 13 with intensity-modulated RT. IFRT was well tolerated in all patients, and acute toxicity ≥ grade 2 was not observed. One case of grade 3 abdominal pain was reported 10 months post-RT. The overall and complete response rates were 85.7% and 50%, respectively. After a median follow-up of 28 (range, 17-42) months, the median PFS was 7 months. The 2-year PFS rate was 39.3%. Six of the 16 patients who developed outfield disease progression after IFRT were successfully treated with repeat IFRT as salvage treatment. The 3-year local control and OS rates were 84.4% and 55.8%, respectively. CONCLUSIONS: Although the primary endpoint was not met, IFRT might be safe and effective for in-field tumor control in patients with persistent epithelial ovarian cancer with a limited number of metastatic foci. We plan to conduct a larger scale multi-center phase II prospective study.

Palliative Radiation Therapy for Recurrent Ovarian Cancer: Efficacy and Predictors of Clinical Response.

OBJECTIVE: This study aimed to report response rates and predictors of response to palliative radiotherapy (RT) for recurrent ovarian cancer. METHODS/MATERIALS: Database review identified 64 patients with symptomatic ovarian cancer recurrence who received a total of 76 courses of RT for 103 indications from March 2003 to August 2014. Radiotherapy indications were pain (44%), bleeding (32%), obstruction (15%), and other (9%). Responses were categorized as complete, partial, or none; all response (AR) was the sum of complete and partial responses. Response rates were compared using a χ test. Multivariate analysis was performed using logistic regression. Patients were followed up for symptom recurrence and death. RESULTS: Response rates were significantly higher for pain (AR, 87%) and bleeding (93%) than for obstruction (62%) and other (60%; P < 0.01). Patients treated for pain at nonbony sites had higher response rates (AR 96%) compared with those treated at bony sites (75%; P = 0.04). Patients with clear cell histology had the lowest response rates (AR, 60%) compared with those with serous (82%), endometrioid (95%), or other Müllerian histology (85%; P = 0.01). Platinum status at diagnosis or the time of RT was not associated with response, nor was tumor size or number of prior chemotherapy regimens. On multivariate analysis, histology, RT indication, and RT dose were independent predictors of response (all P < 0.01). CONCLUSIONS: Palliative RT provides relief of pain and bleeding in most patients with ovarian cancer recurrence. Patients with symptomatic obstruction, bony involvement, and clear cell histology may experience lower clinical response rates.

Multidisciplinary Tumor Board Decision Making for Postoperative Radiotherapy in Thymic Epithelial Tumors: Insights from the RYTHMIC Prospective Cohort.

INTRODUCTION: Thymic epithelial tumors (TETs) are rare intrathoracic malignancies for which surgery represents the mainstay of the treatment. Current practice for postoperative radiotherapy (PORT) is highly variable, and there is a lack of prospective, high level evidence. Réseau Tumeurs Thymiques et Cancer (RYTHMIC) is the nationwide network for TETs in France. Established in 2012, it prospectively collects data on all TET patients, for whom management is discussed at a national multidisciplinary tumor board (MTB). We assessed whether PORT decisions at the MTB were in accordance with RYTHMIC guidelines and ultimately implemented in patients. METHODS: All consecutive patients for whom PORT was discussed at the MTB from 2012 to 2015 were identified from the RYTHMIC prospective database, and a complete review of their medical records was performed. RESULTS: A total of 274 patients, including 243 with thymoma (89%) and 31 with thymic carcinoma (11%), were analyzed. The decision of the MTB was in accordance with guidelines in 221 patients (92%) of the 241 with stage I or III TET. An MTB decision to deliver PORT was made for 117 patients (43%). PORT was ultimately initiated in 101 patients. The most frequent reason for not delivering PORT was excessive (>3 months) delay after surgery. Dose-volume constraints defined by the International Thymic Malignancy Interest Group were followed in all but four patients. CONCLUSION: Our data provide a unique insight into the decision-making process for PORT in TETs, highlighting the need for systematic discussion at an expert MTB, while stressing the value of current available guidelines.

Role of radiation therapy.

Because most patients with epithelial ovarian cancer have advanced disease at the time of initial diagnosis, radiation therapy usually does not play a major role in their treatment. Although ovarian carcinomas appear to be no less sensitive to radiation therapy than Müllerian carcinomas arising in other sites, the dose of radiation required to control gross disease, typically at least 60 Gy, cannot be safely delivered to the entire abdomen or even to large partial volumes of the pelvis and abdomen. Moreover, in most cases, localized radiation is ineffective because of the high risk of disseminated recurrence in peritoneal and extraperitoneal sites. There is strong evidence that radiation therapy can be used to achieve prolonged disease-free intervals and even cure selected patients with epithelial ovarian cancer. The challenge is to determine the select few who stand to benefit from radiation therapy. In all cases, the potential benefits of treatment must be carefully weighed against the risks, particularly for patients who are referred after multiple operations and courses of chemotherapy. For patients with incurable ovarian cancer, radiation therapy can also be very effective as a tool for improving symptoms and quality of life.

Systemic treatment for thymic malignancies.

PURPOSE OF REVIEW: The management of thymic epithelial tumors is a paradigm of multidisciplinary collaboration. Chemotherapy may be administered as part of curative-intent sequential strategy integrating subsequent surgery or radiotherapy, or as an exclusive treatment if local treatment is not achievable. Recurrences of thymic epithelial tumors should be managed according to the same strategy as newly diagnosed tumors. RECENT FINDINGS: More options have become available for advanced, refractory, and recurrent thymic epithelial tumors, which include cytotoxic agents such as carboplatin-paclitaxel, pemetrexed, and oral etoposide. Angiogenesis targeting is a standard in advanced lines of treatment, after results of a phase II trial with sunitinib were reported. Ongoing studies are assessing the opportunity of targeting the immune-response checkpoint programmed death-1/programmed death ligand-1, with preliminary promising results whereas safety, with a higher risk of auto-immunity, may represent a concern. SUMMARY: Overall, a dramatic improvement in our knowledge of the management of thymic tumors has occurred in the past few years, resulting in the development of databases, translational research programmes, and clinical trials. Although access to innovative strategies represents a major challenge, as the rarity of the tumor precludes specific approval of drugs to be obtained, patient-centered initiatives, such as the establishment of dedicated networks, are warranted.

Paraaortic node recurrence 25 years after removal of epithelial ovarian carcinoma.

In epithelial ovarian carcinoma, very late (more than 20 years) recurrence is an unusual event. In patients experiencing such a recurrence, the effectiveness of platinum/taxane chemotherapy has been questioned. A 54-year old woman presented with paraaortic node swelling that appeared 25 years after treatment of stage I epithelial ovarian carcinoma. She underwent a partial resection of the nodes and histologic examination showed high-grade serous carcinoma. She received paclitaxel and carboplatin chemotherapy and a partial response was initially observed on imaging studies; however, serum cancer antigen125 levels increased thereafter. She received radiation therapy to the paraaortic nodal disease with doses of 45 Gy and achieved a complete response. She was disease-free more than eight years after the detection of recurrence. In conclusion, radiation therapy may be an effective treatment option in patients with very late recurrence of epithelial ovarian carcinoma refractory to platinum/taxane chemotherapy.

Nuclear medicine for imaging of epithelial ovarian cancer.

Cancer is one of the leading causes of mortality worldwide. Usually, the diagnosis of cancer at an early stage is important to facilitate proper treatment and survival. Nuclear medicine has been successfully used in the diagnosis, staging, therapy and monitoring of cancers. Single-photon emission computed tomography and PET-based companion imaging agents are in development for use as a companion diagnostic tool for patients with ovarian cancer. The present review discusses the basic and clinical studies related to the use of radiopharmaceuticals in the diagnosis and management of ovarian cancer, focusing on their utility and comparing them with other imaging techniques such as computed tomography and MRI.

Analysis of SEER Glassy Cell Carcinoma Data: Underuse of Radiotherapy and Predicators of Cause Specific Survival.

BACKGROUND: This study used receiver operating characteristic curve to analyze Surveillance, Epidemiology and End Results (SEER) for glassy cell carcinoma data to identify predictive models and potential disparities in outcome. MATERIALS AND METHODS: This study analyzed socio-economic, staging and treatment factors. For risk modeling, each factor was fitted by a generalized linear model to predict the cause specific survival. Area under the receiver operating characteristic curves (ROCs) were computed. Similar strata were combined to construct the most parsimonious models. A random sampling algorithm was used to estimate modeling errors. Risk of glassy cell carcinoma death was computed for the predictors for comparison. RESULTS: There were 79 patients included in this study. The mean follow up time (S.D.) was 37 (32.8) months. Female patients outnumbered males 4:1. The mean (S.D.) age was 54.4 (19.8) years. SEER stage was the most predictive factor of outcome (ROC area of 0.69). The risks of cause specific death were, respectively, 9.4% for localized, 16.7% for regional, 35% for the un-staged/others category, and 60% for distant disease. After optimization, separation between the regional and unstaged/others category was removed with a higher ROC area of 0.72. Several socio-economic factors had small but measurable effects on outcome. Radiotherapy had not been used in 90% of patients with regional disease. CONCLUSIONS: Optimized SEER stage was predictive and useful in treatment selection. Underuse of radiotherapy may have contributed to poor outcome.

Postoperative radiotherapy is effective for thymic carcinoma but not for thymoma in stage II and III thymic epithelial tumors: the Japanese Association for Research on the Thymus Database Study.

BACKGROUND: The efficacy of postoperative radiotherapy (PORT) for thymic epithelial tumors is still controversial. Using the Japanese Association for Research on the Thymus (JART) database, this study was aimed at clarifying the efficacy of PORT for Masaoka stage II and III thymic carcinoma and thymoma. METHODS: The JART database registered the records of 2835 patients collected from 32 Japanese institutions from 1991 to 2010. Thymic carcinoma and thymoma at stage II or III were extracted. The efficacy of PORT with respect to relapse-free survival (RFS) and overall survival (OS) was evaluated with the Kaplan-Meier method and Cox regression analysis. RESULTS: There were 1265 patients in all: 155 thymic carcinoma cases (12.3%) and 1110 thymoma cases (87.7%). Eight hundred ninety-five (70.8%) were at stage II, and 370 (29.2%) were at stage III. Four hundred three cases (31.9%) underwent PORT. PORT for stage II and III thymic carcinoma was associated with increasing RFS (hazard ratio, 0.48; 95% confidence interval, 0.30-0.78; P = .003) but was not associated with OS (hazard ratio, 0.94; 95% confidence interval, 0.51-1.75; P = .536). PORT for stage II and III thymoma was not associated with RFS or OS (P = .350). A subgroup analysis of stage III thymoma showed no factor associated with the efficacy of PORT. CONCLUSIONS: In this study, PORT did not increase RFS or OS for stage II or III thymoma but increased RFS for stage II and III thymic carcinoma.

Cerebrospinal fluid cytology of an endolymphatic sac tumor.

Endolymphatic sac tumor (ELST) is a rare neoplasm which is seldom evaluated by cytopathology. We report the clinicopathologic course and cytologic cerebrospinal fluid (CSF) findings in a 58-year-old patient with brainstem lesions who originally presented with vertigo but progressed to having left 7th, 8th, 9th, and 10th cranial nerve palsies, right-sided weakness, and occipital headaches. Cytospin of the CSF revealed large epithelioid cells similar to cells seen in a surgical resection of a brain mass three months previously. Review of the surgical specimen revealed a well-differentiated glandular and papillary neoplasm, most consistent with an endolymphatic sac tumor.

Computed tomography-guided 125I seed interstitial implantation in the treatment of recurrent ovarian cancer.

OBJECTIVE: The aim of this study was to evaluate the effectiveness and safety of percutaneous interstitial implantation with (125)I seed under computed tomographic (CT) guidance for recurrent ovarian cancer (ROC). MATERIALS AND METHODS: A retrospective review was performed on 17 patients with ROC who were treated with (125)I seed brachytherapy. Treatment planning system was used preoperatively to determine the estimated seeds number and distribution; (125)I seeds were implanted into recurrent lesions under CT guidance. Therapeutic effectiveness and complications were noted during follow-up time. RESULTS: Months are counted from the time of (125)I seed brachytherapy, and the median duration of follow-up was 10.5 months (3-23 months). The objective response rates after 1, 3, 6, 12, and 18 months were 76.5%, 75.0%, 61.5%, 42.9%, and 40%, respectively. The pain relief rate was 61.5%, and the general living quality was improved dramatically. The median progression-free survival time was 5.4 months, the median overall survival time was 11.3 months, and the 1-year survival rate was 41.2%. Complications in this study were very mild; severe adverse events such as massive bleeding, intestinal fistula, and treatment-related deaths did not occur. CONCLUSIONS: Our initial experience showed that CT-guided (125)I seed interstitial implantation is safe and feasible in the treatment of patients with ROCs after multiple therapies.