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Objectives: Treatment methods of local residual or recurrent hepatocellular carcinoma (HCC) after thermal ablation are limited. Therefore, our study aimed to explore the efficacy and prognostic factors of 125I brachytherapy for local residual or recurrent lesion after thermal ablation. Methods: A total of 114 patients with 212 local residual or recurrent HCC tumors after thermal ablation underwent 125I brachytherapy. Local progression-free survival (LPFS) and prognostic factors were analyzed by Kaplan–Meier curves and the Cox model. Results: After a 6-month follow-up, the percentage of patients who achieved complete response (CR), partial response (PR), and stable disease (SD) was 57%, 13.2%, and 5.2%, respectively. The 1-, 2-, and 3-year LPFS rates were 58.7%, 50.0%, and 41.2%, respectively. Portal vein tumor thrombus (PVTT) (p = 0.03), the number of intrahepatic tumors (p = 0.01), and AFP level (p = 0.02) were independent risk factors for local tumor progression (LTP). The median LPFS in patients without PVTT (22 months) was much longer compared to those with PVTT (10 months). The median LPFS in patients with less than three intrahepatic lesions improved from 17 to 24 months. The median LPFS was only 5 months in the high AFP group, but was prolonged with a decrease in AFP level (24 months). No severe complications were recorded. All complications were controllable and treatable. Conclusions: CT-guided 125I brachytherapy was a safe and effective treatment for patients with local residual or recurrent HCC after thermal ablation to improve local control rate. Key points: 125I brachytherapy is a treatment for locally recurrent HCC after ablation. 125I brachytherapy combined with ablation may improve tumor control. Vascular invasion, multiple lesions, and AFP are prognostic risk factors. 125I brachytherapy is a safe method with a curative effect. [ABSTRACT FROM AUTHOR]

This article presents a personalized mixed reality (MR) surgical assistance system for brachytherapy. Using a novel, modified multi-information fusion method, the fusion of virtual organs and a preoperative plan for an actual patient and the real-time tracking of surgical tools were achieved. Using the quaternion-based iterative closest point (QICP) algorithm and a hand-eye calibration method, the preoperative plan can be fused into individual patients. Using the electromagnetic (EM) tracker, users can track the surgery tools in real time, without multiple CT scans, and doctors can immediately perform the surgery. We performed a series of experiments, including phantom and animal experiments, to test the accuracy and efficiency of the system. In the phantom experiment, the average needle location error was 0.957 mm. Based on the results of animal experiments, the needle insertion error was 2.416 mm. All experimental results indicated that the procedure could be applied in further clinical studies. [ABSTRACT FROM AUTHOR]

Iodine‐125 (125I) brachytherapy, a promising form of radiotherapy, is increasingly applied in the clinical treatment of a wide range of solid tumors. However, the extremely hypoxic microenvironment in solid tumors can cause hypoxia‐induced radioresistance to 125I brachytherapy, resulting in therapeutic inefficacy. In this study, the aim is to sensitize hypoxic areas in solid tumors using ultrasound‐activated oxygen microbubbles for 125I brachytherapy. A modified emulsion freeze‐drying method is developed to prepare microbubbles that can be lyophilized for storage and easily reconstituted in situ before administration. The filling gas of the microbubbles is modified by the addition of sulfur hexafluoride to oxygen such that the obtained O2/SF6 microbubbles (OS MBs) achieve a much longer half‐life (>3×) than that of oxygen microbubbles. The OS MBs are tested in nasopharyngeal carcinoma (CNE2) tumor‐bearing mice and oxygen delivery by the OS MBs induced by ultrasound irradiation relieve hypoxia instantly. The post‐treatment results of brachytherapy combined with the ultrasound‐triggered OS MBs show a greatly improved therapeutic efficacy compared with brachytherapy alone, illustrating ultrasound‐mediated oxygen delivery with the developed OS MBs as a promising strategy to improve the therapeutic outcome of 125I brachytherapy in hypoxic tumors. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to explore the feasibility and clinical effectiveness of percutaneous CT-guided iodine-125 (¹²⁵I) brachytherapy combined with chemotherapy for the treatment of patients with unresectable or locally advanced pancreatic carcinoma (PC).Methods: We retrospectively reviewed 66 patients with Stage III and IV PC who had received chemotherapy. A total of 35 (53%) patients receiving 125I brachytherapy and chemotherapy (gemcitabine + cisplatin, GP) were classified as Group A, and 31 (47%) patients who received GP chemotherapy alone were categorized as Group B. The evaluated indications were local control rate (LCR), local progression-free survival (LPFS), overall survival (OS), treatment-related complications, and the degree of symptom relief. Kaplan-Meier curves, log-rank test and Cox regression models were generated and used for further analysis to identify predictors of outcomes.Results: The median follow-up time was 6.00±0.84 months. The 1-, 3-, 6-, 12- and 18-month LCRs for Group A were 100% (35/35), 89.3% (25/28), 71.4% (15/21), 37.5% (3/8) and 33.3% (1/3), respectively; and those for Group B were 87.1% (27/31), 69.6% (16/23), 41.2% (7/17), 14.3% (1/7) and 0% (0/3), respectively. The LCR differed at 1-, 3- and 6-months (P = 0.032; P = 0.009; P = 0.030; respectively). The median LPFS was 7.00±0.30 months and 5.00±0.75 months for Groups A and B (P = 0.023), respectively; however, the median OS of the groups were not significantly different (8.00±0.77 months vs. 6.00±1.04 months. P = 0.917). No life-threatening complications occurred during or after the procedures. Patients in Group A experienced better pain control and relief of abdominal distension than those in Group B.Conclusion: CT-guided 125I brachytherapy is a feasible, safe, and valuable treatment for patients with unresectable PC. [ABSTRACT FROM AUTHOR]

Purpose: An accurate position of the needle is vitally important in low‐dose‐rate seed implantation brachytherapy. Our paper aims to implement a mixed reality navigation system to assist with the placement of the I125 seed implantation thoracoabdominal tumor brachytherapy needle and to validate the accuracy and quality of this type of method. Methods: With the surgical navigation system, based on mixed reality through a novel modified multi‐information fusion method, the fusion of virtual organs and a preoperative plan for a real patient and the tracking of surgical tools in real time were achieved. Personalized image recognition and pose estimation were used to track needle punctures in real time and to perform registration processes. After a one‐time registration with a hexagonal prism tracker that used an iterative closest point algorithm, all information, including medical images and volume renderings of organs, needles, and seeds, was precisely merged with the patient. Doctors were able to observe the tumor target and to visualize the preoperative plan. This system was validated in both phantom and animal experiments. The accuracy of this system was validated by calculating the positional and rotational error of each needle insertion. The accuracy of implantation of each seed was determined in an animal experiment to test the accuracy in low‐dose‐rate brachytherapy. The efficiency of this system was also validated through time consumption assessments. Results: In the phantom experiment, the average error of the needle locations was 0.664 mm and the angle error was 4.74°, average time consumption was 16.1 min with six needles inserted. Based on the results of the animal experiment, the accuracy of the needle insertion was 1.617 mm, while the angle error was 5.574° and the average error of the seed positions was 1.925 mm. Conclusions: This paper describes the design and experimental validation of a novel surgical navigation system based on mixed reality for I125 seed brachytherapy for thoracoabdominal tumors. This system was validated through a series of experiments, including phantom experiments and animal experiments. Compared with the traditional image‐guided system, the procedure presented here is convenient, displays clinically acceptable accuracy and reduces the number of CT scans, allowing doctors to perform surgery based on a visualized plan. All the experimental results indicated that the procedure is ready to be applied in further clinical studies. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and efficacy of 125I brachytherapy to treat bilateral lung recurrences from hepatocellular carcinoma (HCC) after resection or ablation. Materials and methods: We retrospectively recruited 95 patients with bilateral lung recurrences from hepatocellular carcinoma (HCC) after resection or ablation who had received 3–6-month sorafenib with or without stereotactic body radiotherapy (SBRT), from October 2011 to January 2015; patients were then randomly divided into two groups, 44 patients received computed tomography (CT)-guided 125I brachytherapy (group A), and 51 patients were treated with supportive and symptomatic treatments (group B). Results: The median survival time was 19 months (range of 3–36 months). The local response rate (LRR) at 3, 6, 12, 18, 24, 30 and 36 months in group A was 81.8%, 65.9%, 59.1%, 45.0%, 38.6%, 22.7%, 11.4%, respectively, and 64.7%, 47.1%, 33.3%, 25.4%, 15.7%, 11.7%, 7.8%, respectively, in group B (P < 0.05). The mean progression-free survival time (PFST) and overall survival (OS) of group A were significantly longer than those of group B. Alpha fetoprotein (AFP) and tumor size were independent factors that affected the PFST and OS, normal AFP levels and less than 1-cm tumor diameter had better PFST and OS (P < 0.05). No massive bleeding or serious complications occurred. Conclusion: CT-guided 125I brachytherapy is safe and effective for the treatment of bilateral lung recurrences from HCC after resection or ablation. [ABSTRACT FROM AUTHOR]

Surgery remains the first choice of cure for early stage lung cancer. However, many patients are diagnosed at advanced stage, and thus miss the opportunity to undergo surgery. As such patients derive limited benefits from chemotherapy or radiotherapy, alternatives focusing on local control have emerged, including iodine‐125 seed implantation. The Interstitial Brachytherapy Society, Committee of Minimally Invasive Therapy in Oncology, Chinese Anti‐Cancer Association organized a group of multidisciplinary experts to develop guidelines for this treatment modality. These guidelines aim to standardize iodine‐125 seed implantation procedures, inclusion criteria, and outcome assessment to prevent and manage procedure‐related complications. [ABSTRACT FROM AUTHOR]

Pancreatic cancer, also known as exocrine pancreatic carcinoma or pancreatic ductal adenocarcinoma, is one of the most challenging tumor entities worldwide, which is characterized as a highly aggressive disease with dismal overall prognosis. Treatment options for patients with locally advanced pancreatic cancer include surgery, chemotherapy, and radiotherapy. In many cases, surgical resection is not possible due to the advanced stage at diagnosis and poor responses to current treatments, therefore, treatment alternatives have to be performed. However, brachytherapy through radioactive 125I seeds (RIS) implantation into pancreatic cancer has been first applied in unresectable carcinoma and made accuracy curative effects. Therapeutic procedures of RIS implantation for pancreatic carcinoma were not identical in domestic medical centers, making it hard to achieve homogeneity and affecting the efficacy seriously at last. To maximize the benefits of RIS for patients with pancreatic cancer, Chinese Medical Doctor Association of Radioactive Seed Implantation Technology Expert Committee and Committee of Minimally Invasive Therapy in Oncology, Chinese Anti-Cancer Association, Radioactive Seed Therapy Branch organized and helped establish China expert consensus on RIS implantation for the treatment of pancreatic cancer, to provide a reference for clinical practices. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the outcomes of 125I seed brachytherapy versus external beam radiation therapy (EBRT) for the palliation of painful bone metastases of lung cancer after one cycle of chemotherapy progression.Materials and methods: We analyzed retrospectively 158 patients with painful bone metastases secondary to lung cancer after one cycle of chemotherapy progression treated between June 2013 and May 2016. Seventy-six patients with 96 lesions received 125I brachytherapy (Group A), whereas 82 patients with 98 metastases received EBRT (Group B). Pain intensity on Brief Pain Inventory, percentage of patients with pain severity, and quality of life were recorded prior to treatment (T0), 2, 4, 6, 8, 12, 16, 20, and 24 weeks (T2, T4, T6, T8, T12, T16, T20, and T24) after treatment during a 24-hour period. Cost-effectiveness and number of treatment appointments were also compared between groups.Results: One hundred and fifty-eight patients had been treated. Visual analog scale for worst pain in Group A was significantly lower than in Group B at T2, T4, T6, T16, T20, and T24. Group A was superior to group B concerning quality of life scores (T2, T4, T20, and T24), cost-effectiveness, and number of treatment appointments. No significant differences were observed for complications.Conclusion: Compared with EBRT, 125I seed brachytherapy can be an alternative method for painful bone metastases from lung cancer after one cycle of chemotherapy progression. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the feasibility and usefulness of computed tomography (CT)-guided iodine125 (125I) brachytherapy for patients with metastatic soft tissue sarcoma (STS) after first-line chemotherapy failure.Methods: We recruited 93 patients with metastatic STS who had received first-line chemotherapy 4-6 times but developed progressive disease, from January 2010 to July 2015; 45 patients who had combined 125I brachytherapy and second-line chemotherapy (Group A), and 48 patients who received second-line CT only (Group B).Result: In Group A, 49 125I seed implantation procedures were performed in 45 patients with 116 metastatic lesions; the primary success rate was 91.1% (41/45), without life-threatening complications. Local control rates at 3, 6, 12, 24 and 36 months were 71.1%, 62.2%, 46.7%, 28.9% and 11.1% for Group A, and 72.9%, 54.2%, 18.8%, 6.3% and 0% for Group B. Mean progression-free survival differed significantly (Group A: 7.1±1.3 months; Group B: 3.6 ±1.1 months; P<0.001; Cox proportional hazards regression analysis), but overall survival did not significantly differ (Group A: 16.9 ±5.1 months; Group B: 12.1 ± 4.8 months). Group A showed better symptom relief and quality of life than Group B.Conclusion: CT-guided 125I brachytherapy is a feasible and valuable treatment for patients with metastatic STS.Key Points: • 125 I brachytherapy is feasible and valuable for treating metastatic soft tissue sarcoma. • 125 I brachytherapy represents a prominent activity in disease control. • 125 I brachytherapy can achieve better symptom relief and quality of life. [ABSTRACT FROM AUTHOR]

Radioactive 125I seeds (RIS) interstitial implantation brachytherapy has been a first-line treatment for early-stage cancer of the prostate gland. However, its poor accuracy and homogeneity has limited its indication and hampered its popularization for a long time. Intriguingly, scholars based in China introduced computed tomography (CT)-guided technology to improve the accuracy and homogeneity of RIS implantation and broadened the indications. Then, they creatively designed and introduced three-dimensional printing coplanar template (3D-PCT) and 3D printing noncoplanar template (3D-PNCT) into the practice of RIS implantation. Use of such templates makes RIS implantation more precise and efficacious and aids preoperative planning, real-time dose optimization, and postoperative planning. However, studies on the standard workflow for 3D-PT-assisted CT-guided RIS implantation have not been published. Therefore, the China Northern Radioactive Seeds Brachytherapy Group organized multidisciplinary experts to formulate the guideline for this emerging treatment modality. This guideline aims at standardizing 3D-PT-assisted CT-guided RIS implantation procedures and criteria for selecting treatment candidates and assessing outcomes and for preventing and managing postoperative complications. [ABSTRACT FROM AUTHOR]

Aim Certain metastasis-containing middle mediastinal lymph nodes cannot be approached by standard CT-guided brachytherapy. We here describe a novel trans-superior vena cava approach for such nodes. The aim of this prospective study was to assess the safety and clinical value of 125iodine (I) brachytherapy via a trans-superior vena cava approach in patients with metastases in middle mediastinal lymph nodes. Methods From February 2008 to October 2011, 32 patients with 43 pathologically confirmed metastasis-containing mediastinal middle lymph nodes underwent CT-guided percutaneous 125I brachytherapy via a trans-superior vena cava approach. Their complications and treatment responses were analyzed. Variations in blood pressure, heart rate, hemoglobin concentration and oxyhemoglobin saturation before, during and after the procedure were recorded, as were complications, including hemorrhage, pneumothorax and development of Breuer's reflex. Treatment response was assessed according to the response evaluation criteria for solid tumors Version 1.1. Results According to follow-up CT examination after 6 months, 22 patients (68.75%) achieved complete responses and four (12. 5%) partial responses. One patient died of myocardial infarction. Overall response rate was 81.25%, with a local control rate of 87.5%. The median survival was 25.7 months, with progression-free survival of 19.74 ± 0.81 months. The 1-year and 3-year overall survival rates were 53.13% and 28.13%. There were minimal immediate or delayed complications; no complications were severe. Conclusion We consider this novel approach a safe means of treating certain mediastinal middle lymph node metastases. [ABSTRACT FROM AUTHOR]