Clinical efficacy of computed tomography-guided iodine-125 seed implantation therapy in patients with advanced spinal metastatic tumors

125I brachytherapy: a useful treatment to control painful osteoblastic bone metastases

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.

One case of iodine-125 therapy – A new minimally invasive treatment of intrahepatic cholangiocarcinoma

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer associated with a poor prognosis. ICC accounts for about 10% of primary liver malignancies but with increasing incidence in recent years. Recently, some studies suggested that minimally interventional therapy can be used in the treatment of ICC. However, there are few references on interventional therapy for the clinical treatment of ICC. Herein we reported a case of a 48-year-old man who suffered from ICC. The patient was diagnosed with ICC by computerized tomography scan and pathological biopsy. The patient was completely cured by minimally interventional therapy with iodine-125 seed implantation. These results provide an important reference for the treatment option of ICC.

Palliative local treatment of bone metastases by 125I seed brachytherapy under DynaCT guidance: single-center experience

PURPOSE

We aimed to evaluate the clinical benefit of 125I seed brachytherapy under DynaCT guidance for palliative local treatment of bone metastases.

METHODS

From December 2014 to September 2017, 82 patients with painful bone metastases, who experienced treatment failure using standard strategies or rejected treatment were enrolled in this retrospective study. All patients underwent 125I seed brachytherapy under DynaCT guidance. Technical success, visual analogue scale (VAS), numerical rating scale (NRS), verbal rating scale (VRS), Karnofsky performance status (KPS) and complications were analyzed.

RESULTS

The success rate of 125I seed implantation was 100%. The VAS and NRS scores for the most severe pain were 7.0 (5.0-9.0) and 8.0 (6.0-9.0) before brachytherapy. The pain scores assessed every 2 hours gradually decreased within 12 hours (p < 0.001). A comparison of KPS scores showed that patients had significantly better quality of life on weeks 1, 4, and 8 than on week 0 (p < 0.001). The associated complications were mild subcutaneous hemorrhage 25.6% (21/82), fever 7.3% (6/82), minor displacement of radioactive seeds 5.0% (4/82), pathologic fracture 2.4% (2/82), and local skin reaction 2.4% (2/82). After symptomatic treatment, all complications were relieved. Minor displacement of radioactive seeds did not cause damage to adjacent tissues. No serious life-threatening complications occurred in the study group.

CONCLUSION

DynaCT-guided 125I seed implantation is a safe and effective method for palliation of painful bone metastases from cancer after failure or rejection of conventional treatments.

Multidisciplinary Management of Spinal Metastasis and Vertebral Instability: A Systematic Review

OBJECTIVE

The aim of this systematic literature review is to evaluate recent attempts in creating a standardized multidisciplinary approach combining tumor treatment with current vertebral stabilization techniques for palliative treatment of vertebral metastasis in patients who do not fall into the NOMS (neurologic, oncologic, mechanical, systemic) framework.

METHODS

We performed a systematic literature search for studies using a tumor modality in conjunction with kyphoplasty or vertebroplasty. In addition, the bibliographies of selected articles were examined for additional studies not viewed in database searches, which led to the use of additional search terms.

RESULTS

A total of 563 articles were found after our database search. Eighteen studies fulfilled our inclusion criteria. Articles were then divided into categories based on combinations of tumor modality. Multiple studies reported significant decreases in visual analog scale scores after combined procedures with very low rates of symptomatic complications. Studies that compared their combination with control treatment groups showed greater clinical efficacy.

CONCLUSIONS

Although multidisciplinary management of spinal metastasis using a combination of tumor ablation techniques with vertebral stabilization has been recommended in the previous literature, this review shows that no combination of treatment carried demonstrably different results in pain score reduction, reduced analgesic intake, or improved quality of life. In addition, there is no consensus of standardized variables to evaluate efficacy of treatment, limiting the efficacy of treatment results for the analyzed studies. Although not explicitly included in the initial NOMS framework, our results support the consideration of concomitant percutaneous kyphoplasty or vertebroplasty in these patients on a case-by-case basis.

Iodine-125 seed implantation combined with arterial chemoembolization therapy for pain palliation in metastatic bone cancer: a retrospective study

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.

CT-Guided 125I Seed Interstitial Brachytherapy as a Salvage Treatment for Recurrent Spinal Metastases after External Beam Radiotherapy

The aim of this study is to evaluate the feasibility, safety, and clinical efficacy of CT-guided ¹²⁵I seed interstitial brachytherapy in patients with recurrent spinal metastases after external beam radiotherapy (EBRT). Between August 2003 and September 2015, 26 spinal metastatic lesions (24 patients) were reirradiated by this salvage therapy modality. Treatment for all patients was preplanned using a three-dimensional treatment planning system 3-5 days before ¹²⁵I seed interstitial brachytherapy; dosimetry verification was performed immediately after seed implantation. Median actual D₉₀ was 99 Gy (range, 90-176), and spinal cord median D_max was 39 Gy (range, 6-110). Median local control (LC) was 12 months (95% CI: 7.0-17.0). The 6- and 12-month LC rates were 52% and 40%, respectively. Median overall survival (OS) was 11 months (95% CI: 7.7-14.3); 6-month and 1-, 2-, and 3-year OS rates were 65%, 37%, 14%, and 9%, respectively. Pain-free survival ranged from 2 to 42 months (median, 6; 95% CI: 4.6-7.4). Treatment was well-tolerated, with no radiation-induced vertebral compression fractures or myelopathy reported. Reirradiation with CT-guided ¹²⁵I seed interstitial brachytherapy appears to be feasible, safe, and effective as pain relief or salvage treatment for patients with recurrent spinal metastases after EBRT.