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125I brachytherapy: a useful treatment to control painful osteoblastic bone metastases. Clin Transl Oncol 2022; 25:1297-1306. [PMID: 36472748 PMCID: PMC10119221 DOI: 10.1007/s12094-022-03025-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
Abstract
Backgrounds
125I brachytherapy is effective in relieving cancer pain due to osteolytic bone metastases. However, fewer studies focused on painful osteoblastic bone metastases (OBMs), we conducted a retrospective study to evaluate the efficacy of 125I brachytherapy for the treatment of painful OBMs.
Methods
From April 2017 to April 2019, clinical data of a total of 65 patients with OBMs who underwent CT/cone beam CT -guided 125I brachytherapy were collected and analyzed. The primary study endpoints were technical success, relief of pain (RoP), and quality of life (QoL). The secondary study endpoints were treatment-related complications, local tumor control (LCR), and overall survival (OS). The logistic regression analysis was performed to predict RoP.
Results
Technical success rate was 100%. Visual analog scale scores and daily morphine consumption continuously decreased significantly at 2 weeks, 6 weeks, and 10 weeks (all P < 0.05). The RoP at 6 weeks was 84.62%. QoL presented improvement at 6 and 10 weeks. Only minor complications occurred in 12 patients (18.46%). LCR was 93.85% at 10 weeks. The OS was 29.80 months. Two factors were significantly associated with the RoP: max diameter (MD, < 3 cm vs. ≥ 3 cm, P = 0.019) and serum levels of bone alkaline phosphatase (B-ALP, ≥ 100 U/L vs. < 100 U/L, P = 0.016).
Conclusions
125I brachytherapy is an effective treatment in relieving painful OBMs and improving patients’ QoL.
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2
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Mao G, Theodore N. Spinal brachytherapy. Neuro Oncol 2022; 24:S62-S68. [PMID: 36322097 PMCID: PMC9629484 DOI: 10.1093/neuonc/noac094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Brachytherapy remains an underrecognized and underutilized radiation therapy modality for the treatment of spinal tumors. This article summarizes the existing body of medical literature on the usage, indications, techniques, and outcomes of brachytherapy for the treatment of spine tumors. The disease pathology most commonly treated with brachytherapy is metastatic spine cancer, rather than primary bone tumors of the spine. Brachytherapy can be used alone, as percutaneous needle injections; however, it is more often used in conjunction with open surgery or cement vertebral body augmentation. Although the data are still relatively sparse, studies show consistent benefit from brachytherapy in terms of improvements in pain, function, local recurrence rate, and overall survival. Brachytherapy is also associated with a favorable complication profile.
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Affiliation(s)
- Gordon Mao
- Department of Neurological Surgery, The Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Nicholas Theodore
- Department of Neurological Surgery, The Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Neurological Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Lin X, Zhou S, Wen T, Jiang S, Wang C, Chen J. A novel multi-DoF surgical robotic system for brachytherapy on liver tumor: Design and control. Int J Comput Assist Radiol Surg 2021; 16:1003-1014. [PMID: 33934286 PMCID: PMC8166720 DOI: 10.1007/s11548-021-02380-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/13/2021] [Indexed: 12/24/2022]
Abstract
Purpose Radioactive seed implantation is an effective invasive treatment method for malignant liver tumors in hepatocellular carcinomas. However, challenges of the manual procedure may degrade the efficacy of the technique, such as the high accuracy requirement and radiation exposure to the surgeons. This paper aims to develop a robotic system and its control methods for assisting surgeons on the treatment. Method We present an interventional robotic system, which consists of a 5 Degree-of-Freedom (DoF) positioning robotic arm (a 3-DoF translational joint and a 2-DoF revolute joint) and a needle actuator used for needle insertion and radioactive seeds implantation. Control strategy is designed for the system to ensure the safety of the motion. In the designed framework, an artificial potential field (APF)-based motion planning and an ultrasound (US) image-based contacting methods are proposed for the control. Result Experiments were performed to evaluate position and orientation accuracy as well as validate the motion planning procedure of the system. The mean and standard deviation of targeting error is 0.69 mm and 0.33 mm, respectively. Needle placement accuracy is 1.10 mm by mean. The feasibility of the control strategy, including path planning and the contacting methods, is demonstrated by simulation and experiments based on an abdominal phantom. Conclusion This paper presents a robotic system with force and US image feedback in assisting surgeons performing brachytherapy on liver tumors. The proposed robotic system is capable of executing an accurate needle insertion task with by optical tracking. The proposed methods improve the safety of the robot’s motion and automate the process of US probe contacting under the feedback of US-image.
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Affiliation(s)
- Xiaofeng Lin
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, GD, 518055, People's Republic of China.,University of Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Shoujun Zhou
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, GD, 518055, People's Republic of China.
| | - Tiexiang Wen
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, GD, 518055, People's Republic of China. .,National Innovation Center for Advanced Medical Devices, Shenzhen, GD, 518110, People's Republic of China.
| | - Shenghao Jiang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, GD, 518055, People's Republic of China
| | - Cheng Wang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, GD, 518055, People's Republic of China
| | - Jingtao Chen
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, GD, 518055, People's Republic of China
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Shi X, Liu Y, Cui Y, Qin H, Yang S, Lei M. A Comparative Study on the Effects of Postoperative 125I Brachytherapy and Irradiation After Surgical Decompression and Stabilization for Metastatic Spinal Cancers. J Multidiscip Healthc 2020; 13:1245-1256. [PMID: 33122911 PMCID: PMC7591013 DOI: 10.2147/jmdh.s279677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/06/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The study aims to investigate and compare the efficacy and safety of intraoperative 125I implantation and postoperative irradiation after surgical decompression and stabilization in the treatment of patients with metastatic epidural spinal cord compression (MESCC). Methods The study retrospectively enrolled 122 MESCC patients treated with surgical decompression and pedicle stabilization combined with 125I brachytherapy (the brachytherapy group) or postoperative radiotherapy (the irradiation group). Operation time, intraoperative blood loss, pain relief, postoperative ambulatory status, postoperative survival outcome, complications, and length of hospitalization were collected and compared between the two groups. Ten potential risk factors were analyzed for postoperative survival outcome. Results No significant difference was found in baseline characteristics between the two groups (P>0.05). Postoperative VAS score was significantly decreased, as compared with preoperative scores in both groups (P˂0.001). The VAS in the brachytherapy group was significantly lower than that in the irradiation group at postoperative 1 month, 3 months, and 6 months (P˂0.05). The postoperative ambulatory rates were 90.0% (54/60) in the brachytherapy group and 83.9% (52/62) in the irradiation group (P=0.32). The median overall survival time was similar between the two groups (7.43 months vs 7.27 months, P=0.37). Of all patients in the brachytherapy group, 25.0% (15/60) of patients suffered from complications, while 46.8% (29/62) of patients had complications in the irradiation group (P=0.0086). According to the multiple Cox regression, primary sites (P=0.038), ECOG performance status (P=0.014), and visceral metastases (P=0.0016) showed significance for postoperative survival outcome. Conclusion Surgical decompression and spine stabilization combined with 125I brachytherapy is a relatively safe and useful method in MESCC patients.
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Affiliation(s)
- Xuedong Shi
- Department of Orthopedic Surgery, Peking University First Hospital, Beijing, People's Republic of China
| | - Yaosheng Liu
- Department of Orthopedic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yunpeng Cui
- Department of Orthopedic Surgery, Peking University First Hospital, Beijing, People's Republic of China
| | - Haifeng Qin
- Department of Pulmonary Neoplasms Internal Medicine, The Fifth Medical Center of the Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Shaoxing Yang
- Department of Pulmonary Neoplasms Internal Medicine, The Fifth Medical Center of the Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Mingxing Lei
- Department of Orthopedic Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, People's Republic of China
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Kelly PD, Zuckerman SL, Yamada Y, Lis E, Bilsky MH, Laufer I, Barzilai O. Image guidance in spine tumor surgery. Neurosurg Rev 2019; 43:1007-1017. [PMID: 31154546 DOI: 10.1007/s10143-019-01123-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/03/2019] [Accepted: 05/23/2019] [Indexed: 12/15/2022]
Abstract
Beginning with basic stereotactic operative methods in neurosurgery, intraoperative navigation and image guidance systems have since become the norm in that field. Following the introduction of image guidance into spinal surgery, there has been a dramatic increase in its utilization across disciplines and pathologies. Spine tumor surgery encompasses a wide range of complex surgical techniques and treatment strategies. Similarly to deformity correction and trauma surgery, spine navigation holds potential to improve outcomes and optimize surgical technique for spinal tumors. Recent data demonstrate the applicability of neuro-navigation in the field of spinal oncology, particularly for spinal stabilization, maximizing extent of resection and integration of minimally invasive therapies. The rapid introduction of new, less invasive, and ablative surgical techniques in spine oncology coupled with the rising incidence of spinal metastatic disease make it imperative for spine surgeons to be familiar with the indications for and limitations of imaging guidance. Herein, we provide a practical, current concepts narrative review on the use of spinal navigation in three areas of spinal oncology: (a) extent of tumor resection, (b) spinal column stabilization, and (c) focal ablation techniques.
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Affiliation(s)
- Patrick D Kelly
- Department of Neurological Surgery, Vanderbilt University Medical Center, T-4224 Medical Center North, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, T-4224 Medical Center North, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Eric Lis
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Mark H Bilsky
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68 Street, Box 99, New York, NY, 10065, USA
| | - Ilya Laufer
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68 Street, Box 99, New York, NY, 10065, USA
| | - Ori Barzilai
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA. .,Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68 Street, Box 99, New York, NY, 10065, USA.
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Sierko E, Hempel D, Zuzda K, Wojtukiewicz MZ. Personalized Radiation Therapy in Cancer Pain Management. Cancers (Basel) 2019; 11:cancers11030390. [PMID: 30893954 PMCID: PMC6468391 DOI: 10.3390/cancers11030390] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 12/11/2022] Open
Abstract
The majority of advanced cancer patients suffer from pain, which severely deteriorates their quality of life. Apart from analgesics, bisphosphonates, and invasive methods of analgesic treatment (e.g., intraspinal and epidural analgesics or neurolytic blockades), radiation therapy plays an important role in pain alleviation. It is delivered to a growing primary tumour, lymph nodes, or distant metastatic sites, producing pain of various intensity. Currently, different regiments of radiation therapy methods and techniques and various radiation dose fractionations are incorporated into the clinical practice. These include palliative radiation therapy, conventional external beam radiation therapy, as well as modern techniques of intensity modulated radiation therapy, volumetrically modulated arch therapy, stereotactic radiosurgery or stereotactic body radiation therapy, and brachytherapy or radionuclide treatment (e.g., radium-223, strontium-89 for multiple painful osseous metastases). The review describes the possibilities and effectiveness of individual patient-tailored conventional and innovative radiation therapy approaches aiming at pain relief in cancer patients.
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Affiliation(s)
- Ewa Sierko
- Department of Oncology, Medical University of Bialystok, 15-027 Białystok, Poland.
- Department of Radiation Therapy, Comprehensive Cancer Center of Białystok, 15-027 Bialystok, Poland.
| | - Dominika Hempel
- Department of Oncology, Medical University of Bialystok, 15-027 Białystok, Poland.
- Department of Radiation Therapy, Comprehensive Cancer Center of Białystok, 15-027 Bialystok, Poland.
| | - Konrad Zuzda
- Student Scientific Association Affiliated with Department of Oncology, Medical University of Bialystok, 15-027 Bialystok, Poland.
| | - Marek Z Wojtukiewicz
- Department of Oncology, Medical University of Bialystok, 15-027 Białystok, Poland.
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Yang Z, Chen G, Cui Y, Su T, Yu J, Xiao G, Han Y, Jin L. Iodine-125 seed implantation combined with arterial chemoembolization therapy for pain palliation in metastatic bone cancer: a retrospective study. Cancer Biol Ther 2018; 20:212-218. [PMID: 30296196 DOI: 10.1080/15384047.2018.1523847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Bone metastases are the most common sites for malignant tumors. Patients who failed to respond to initial first-line treatment with bisphosphonates usually suffer from extreme pain. The aim of this study was to observe the efficacy of arterial chemoembolization combined with Iodine-125 seed implantation in the treatment of bone metastatic cancer pain. All 14 patients with metastatic bone tumor wo failed first-line treatment underwent arterial chemoembolization the day before the implantation of the particles. A computer stereoscopic TPS was used to design the treatment plans, the number and dose of particles required for implantation. Pain relief was evaluated using several parameters such as Visual Analog Scale (VAS) and Verbal Rating Scales (VRS). Pain intensity was measured pre-operation and 1-week, 1-month, 3-month after the treatment. Meanwhile, we also assessed tumor size using computer tomography (CT). Pain palliation was observed in 35.7% (5/14), 57.1% (8/14), and 78.6% (11/14) of all patients at 1-week, 1-month and 3-month post treatment. Likewise, our analysis showed that the combination therapy resulted in a significant decrease of VAS score (6.71 ± 0.49 before treatment vs 3.36 ± 0.40 at 3 month post treatment) and overall responding rate of 92.0% using VRS pain assessment. Consistently, tumor size was reduced from 42.16 ± 10.32 before treatment to 29.11 ± 8.73 at 3 months post treatment. No serious complications were detected. Our study demonstrate that the combination of arterial chemoembolization and 125I particles resulted in evident pain relief and reduction of tumor burden, suggesting that the combination treatment could be a feasible and promising therapy for bone tumor management.
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Affiliation(s)
- Zeran Yang
- a Interventional Radiology, Beijing Friendship Hospital , Capital Medical University , Beijing , China
| | - Guang Chen
- a Interventional Radiology, Beijing Friendship Hospital , Capital Medical University , Beijing , China
| | - Ye Cui
- b The Department of Immunology, School of Basic Medical Sciences , Capital Medical University , Beijing , China
| | - Tianhao Su
- a Interventional Radiology, Beijing Friendship Hospital , Capital Medical University , Beijing , China
| | - Jianan Yu
- a Interventional Radiology, Beijing Friendship Hospital , Capital Medical University , Beijing , China
| | - Guowen Xiao
- a Interventional Radiology, Beijing Friendship Hospital , Capital Medical University , Beijing , China
| | - Yanjing Han
- a Interventional Radiology, Beijing Friendship Hospital , Capital Medical University , Beijing , China
| | - Long Jin
- a Interventional Radiology, Beijing Friendship Hospital , Capital Medical University , Beijing , China
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8
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Han T, Yang X, Xu Y, Zheng Z, Yan Y, Wang N. Therapeutic value of 3-D printing template-assisted 125I-seed implantation in the treatment of malignant liver tumors. Onco Targets Ther 2017; 10:3277-3283. [PMID: 28740402 PMCID: PMC5505618 DOI: 10.2147/ott.s134290] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective To explore the therapeutic value of 3-D printing template-assisted 125I-seed implantation in the treatment of malignant liver tumors. Materials and methods Fifteen liver cancer patients with 47 total lesions were treated with 3-D printing template-assisted radioactive seed implantation (group A), and 25 liver-tumor patients with 66 total lesions were treated with 125I-seed implantation without a template auxiliary (group B). Operation time, in-hospital time, operation complications, dose distribution, and response rate (number) were compared between the two groups. Results Shorter operation times and better dose distribution were observed in group A than in group B, and the differences were statistically significant. The response rate after 2 months was 86.7% (13 of 15) in group A and 84% (21 of 25) in group B; differences between the two groups were not significant. Conclusion Application of 3-D printing template-assisted radioactive seed implantation in the treatment of malignant liver tumors can help shorten operation time and optimize radiation-dose distribution, is worthy of further study, and has clinical significance.
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Affiliation(s)
| | | | - Ying Xu
- Department of Radiotherapy, General Hospital of Shenyang Military Region, Shenyang, China
| | | | - Ying Yan
- Department of Radiotherapy, General Hospital of Shenyang Military Region, Shenyang, China
| | - Ning Wang
- Department of Radiotherapy, General Hospital of Shenyang Military Region, Shenyang, China
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