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Objectives To evaluate the dosimetry, efficacy, and safety of radioactive 125I seed implantation (RISI) assisted by three-dimensional printing noncoplanar template (3D-PNCT) and CT for recurrent retroperitoneal lymphatic metastasis (RRLM) after previous external beam radiotherapy. Methods and Materials From June 2016 to August 2018, 32 patients with RRLM successfully underwent 3D-PNCT–assisted and CT-guided RISI. The dosimetry, pain relief rate, performance improvement rate, overall response rate, disease control rate, local control time (LCT), overall survival (OS), and safety profiles were evaluated. Results Dosimetric results showed that the D90, D100, V100, V150, V200, and homogeneity index were consistent in preoperation and postoperation (p > 0.05), except for the external index and conformal index (p = 0.048, p = 0.034). After RISI, 81.3% of the patients achieved pain relief, and 71.9% achieved an improvement of performance. The overall response rate and disease control rate were 85.3% and 94.1%, respectively. The LCT rates reached 66.2% and 43.2% in 1 year and two years, respectively, with a median LCT of 15.8 months. The OS rates were 74.1% and 28.1% in 1 year and two year, respectively, with a median OS reaching 17.6 months. Univariate analysis showed that when D90 > 130 Gy or D100 > 63 Gy or tumor size ≤49.8 cm3, LCT was extended significantly, but not for OS. Except for two patients developing Grade 1 retroperitoneal hematomas, no other severe adverse events were observed. Conclusions 3D-PNCT and CT guidance provide excellent accuracy for RISI, which can be an effective and safe alternative for RRLM after external beam radiotherapy. Radiation dose and tumor size seem to significantly influence the local control.

Objectives The objective of this study was to evaluate the efficacy and safety of CT-guided radioactive 125I seed implantation as a salvage treatment for locally recurrent head and neck soft tissue sarcoma (HNSTS) after surgery and external beam radiotherapy. Methods and Materials From December 2006 to February 2018, 25 patients with locally recurrent HNSTS after surgery and external beam radiotherapy were enrolled. All the patients successfully underwent CT-guided 125I seed implantation. The primary end points included the objective response rate (ORR) and local progression-free survival (LPFS). The secondary end points were survival (OS) and safety profiles. Results After 125I seed implantation, the ORR was 76.0%. The 1-, 3-, and 5-year LPFS rates were 65.6%, 34.4%, and 22.9%, respectively, with the median LPFS of 16.0 months. The 1-, 3-, and 5-year OS rates were 70.8%, 46.6%, and 34.0%, respectively, with the median OS of 28.0 months. Furthermore, univariate analyses showed that the recurrent T stage and histological grade were prognostic factors of LPFS, whereas only the histological grade was a predictor of OS. The major adverse events were skin/mucosal toxicities, which were generally of lower grade (≤Grade 2) and were well tolerated. Conclusions Radioactive 125I seed implantation could be an effective and safe alternative treatment for locally recurrent HNSTS after failure of surgery and radiotherapy. Recurrent T stage and histological grade were the main factors influencing the efficacy.

To evaluate the dosimetry, efficacy, and safety of radioactiveFrom June 2016 to August 2018, 32 patients with RRLM successfully underwent 3D-PNCT-assisted and CT-guided RISI. The dosimetry, pain relief rate, performance improvement rate, overall response rate, disease control rate, local control time (LCT), overall survival (OS), and safety profiles were evaluated.Dosimetric results showed that the D90, D100, V100, V150, V200, and homogeneity index were consistent in preoperation and postoperation (p0.05), except for the external index and conformal index (p = 0.048, p = 0.034). After RISI, 81.3% of the patients achieved pain relief, and 71.9% achieved an improvement of performance. The overall response rate and disease control rate were 85.3% and 94.1%, respectively. The LCT rates reached 66.2% and 43.2% in 1 year and two years, respectively, with a median LCT of 15.8 months. The OS rates were 74.1% and 28.1% in 1 year and two year, respectively, with a median OS reaching 17.6 months. Univariate analysis showed that when D90130 Gy or D10063 Gy or tumor size ≤49.8 cm3D-PNCT and CT guidance provide excellent accuracy for RISI, which can be an effective and safe alternative for RRLM after external beam radiotherapy. Radiation dose and tumor size seem to significantly influence the local control.

The objective of this study was to evaluate the efficacy and safety of CT-guided radioactiveFrom December 2006 to February 2018, 25 patients with locally recurrent HNSTS after surgery and external beam radiotherapy were enrolled. All the patients successfully underwent CT-guidedAfterRadioactive

Purpose To evaluate the feasibility, efficacy, and safety of permanent 125 I seed interstitial brachytherapy reirradiation in patients with retroperitoneal lymph node recurrence under CT guidance. Methods and Materials Seventeen patients with 19 retroperitoneal lymph node recurrence after external beam radiotherapy underwent CT-guided 125 I seed implant brachytherapy from October 2007 to August 2014. Treatment for all patients was preplanned using a three-dimensional radiation therapy planning system 3–5 days before brachytherapy; dosimetry verification was performed immediately after brachytherapy. Results The actuarial D90 (dose delivered to 90% of the target volume) was 100–198 Gy (median, 126.5 Gy). In 9 patients, pain intensity decreased to mild pain 1–3 weeks after brachytherapy. Pain-free survival ranged 2–15 months (median, 5 months; 95% confidence interval [CI]: 0.1, 9.9). The overall response rate was 19 of 19 (100%). The median local control time was 15 months (95% CI: 2.3, 27.7). The 6-, 12-, and 24-month local control rate was 88.0%, 63.2%, and 42.1%, respectively. Twelve patients (70.6%) developed distant metastases and died. Two patients (11.8%) are alive with distant metastases but no evidence of local recurrence. Three patients (17.6%) are alive with no evidence of local recurrence. Median overall survival was 10 months (95% CI: 5.7, 14.3); the 1- and 2-year survival rates were 38.1% and 15.3%, respectively. No major complications related to the procedure occurred during or after brachytherapy. Conclusions Reirradiation with CT-guided permanent 125 I seed interstitial brachytherapy is feasible, safe, and effective as pain relief or salvage treatment for patients with recurrent retroperitoneal lymph nodes.

well meet the treatment requirement. The mean entrance point positioning deviation was 0.883 mm (range 0.002 to 2.943 mm) in different sites. The mean orientation deviation were 1.977 (range 0.536 to 4.566 ). All needles arrived the preplanned position in 1 attempt manually. The mean time to insert one needle is 7.5 seconds. Conclusions: This study demonstrates that 3D printing individual templates can acurately confirm the position and direction of needles in brachytherapy, and achieve effectively transfer from preplan to clinical operations. 3D printing individual template can enhance implantation accuracy, as well as simplifying the procedure. It is a simple and effective way to guide needle insertion in head and neck, because of the complex structures and existence of many organs at risk.

relief, 5 patients received local reduce swelling or nasal congestion. A total of 24.0% of patients (6/25) died of local recurrence, 48.0% of patients (12/ 25) died of metastases, 8.0% of patients (2/25) died of pneumonia, 12.0% of patients (3/25) died of cachexia, 4.0% of patients (1/25) died of coronary artery heart disease and 4.0% of patients (1/25) died of cerebrovascular disease. Two suffered from a grade 1 skin complication. Conclusions: Iodine-125 seed implantation is feasible and safe as a salvage treatment for patients with recurrent head and neck cancers. That provided excellent palliation of pain relief and other local symptoms, high local control and low complication. But in these patients, nearly half of patients (12/25) died of metastases and we have received no significant survival benefit from them. It should be necessary to perform further studies with