Search

Abstract Background Currently, there is no consensus on the treatment of recurrent hepatocellular carcinoma (HCC) after hepatectomy. It is necessary to assess the efficacy and safety of radiofrequency ablation (RFA) combined with iodine-125 seeds implantation (RFA-125I) in the treatment of recurrent HCC. Methods This study retrospectively analyzed the clinical data of patients with postoperative recurrence of HCC receiving RFA-125I or RFA treatment from January 2013 to January 2023. Both RFA and 125I seeds implantation were performed under dual guidance of ultrasound and CT. Overall survival (OS), progression-free survival (PFS), recurrence, and complications were compared between the two groups. Results A total of 210 patients with recurrent HCC were enrolled in this study, including 125 patients in the RFA-125I group and 85 patients in the RFA group. The RFA-125I group showed a significantly better survival benefit than RFA group (median OS: 37 months vs. 16 months, P

Background: Currently, there is no consensus on the treatment of recurrent hepatocellular carcinoma (HCC) after hepatectomy. It is necessary to assess the efficacy and safety of radiofrequency ablation (RFA) combined with iodine-125 seeds implantation (RFA-125I) in the treatment of recurrent HCC. Methods: This study retrospectively analyzed the clinical data of patients with postoperative recurrence of HCC receiving RFA-125I or RFA treatment from January 2013 to January 2023. Both RFA and 125I seeds implantation were performed under dual guidance of ultrasound and CT. Overall survival (OS), progression-free survival (PFS), recurrence, and complications were compared between the two groups. Results: A total of 210 patients with recurrent HCC were enrolled in this study, including 125 patients in the RFA-125I group and 85 patients in the RFA group. The RFA-125I group showed a significantly better survival benefit than RFA group (median OS: 37 months vs. 16 months, P < 0.001; median PFS: 15 months vs. 10 months, P = 0.001). The uni- and multivariate analysis showed that RFA-125I was a protective factor for OS and PFS. There were no procedure-related deaths and no grade 3 or higher adverse events in both groups. Conclusions: RFA combined with 125I seeds implantation under dual guidance of ultrasound and CT is effective and safe for the treatment of HCC patients with recurrence after hepatectomy. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of iodine-125 seed brachytherapy (ISB) on the overall survival (OS) of patients with heterochronous pulmonary metastasis (HPM) secondary to hepatocellular carcinoma (HCC). Materials and Methods: The clinical and imaging data of 123 patients with HPM secondary to HCC treated at a single center from July 2012 to July 2020 were analyzed retrospectively. The patients were divided into ISB and non-ISB groups based on ISB treatment. Propensity score matching yielded 46 pairs of patients. A total of 191 lesions were treated, and the data were evaluated for 6 months after ISB. The OS rates of the two groups were compared using the Kaplan--Meier method. Independent prognostic factors were determined using a Cox proportional hazards regression model. Results: The percentages of lung lesions in complete remission, partial remission, disease stable, and disease progression stages were 49.2%, 32.8%, 9.6%, and 8.4%, respectively. The disease control rate was 91.6%. The median follow-up time from the initial diagnosis was 47 months and 33 months for the ISB and non-ISB groups, respectively. Patients in the ISB group had a longer OS than those in the non-ISB group (1-year: 95.7% vs. 80.3%; 3-year: 62.9% vs. 45.7%; 5-year: 37% vs. 20.9%; P < 0.05). Multivariate analysis demonstrated that ISB treatment, tumor differentiation, vascular invasion, and Child -- Pugh score were independent prognostic factors for survival. Conclusion: ISB improves local control and OS rates of HPM secondary to HCC; thus, it is an effective and feasible option for patients with HPM secondary to HCC. [ABSTRACT FROM AUTHOR]

Simple Summary: The results of this multidisciplinary study can function as a clinician's guide for determining the preferred surgical localization technique for breast-conserving surgery in pregnant women with breast cancer and its timing, without avoiding the use of a 125I-seed. The maximum exposure to the fetus remains well below 100 millisieverts (mSv), the threshold value for tissue damage caused by radiation. If the exposure should remain below 1 mSv, the implantation and surgical removal of the 125I-seed should occur within two weeks after a GA of 26 weeks, and within one week after a GA of 32 weeks. The contribution of an axillary seed is negligible (at maximum, 2.3% of the seed implanted in the breast). Introduction: Some aspects of the treatment protocol for breast cancer during pregnancy (PrBC) have not been thoroughly studied. This study provides clarity regarding the safety of the use of 125I-seeds as a localization technique for breast-conserving surgery in patients with PrBC. Methods: To calculate the exposure to the fetus of one 125I-seed implanted in a breast tumor, we developed a model accounting for the decaying 125I-source, time to surgery, and the declining distance between the 125I-seed and the fetus. The primary outcome was the maximum cumulative fetal dose of radiation at consecutive gestational ages (GA). Results: The cumulative fetal dose remains below 1 mSv if a single 125I-seed is implanted at a GA of 26 weeks. After a GA of 26 weeks, the fetal dose can be at a maximum of 11.6 mSv. If surgery takes place within two weeks of implantation from a GA of 26 weeks, and one week above a GA of 32 weeks, the dose remains below 1 mSv. Conclusion: The use of 125I-seeds is safe in PrBC. The maximum fetal exposure remains well below the threshold of 100 mSv, and therefore, does not lead to an increased risk of fetal tissue damage. Still, we propose keeping the fetal dose as low as possible, preferably below 1 mSv. [ABSTRACT FROM AUTHOR]

To assess the safety and feasibility of anterior percutaneous trans-organ puncture path in iodine-125 seeds interstitial brachytherapy (BT) in patients with para-aortic lymph node metastasis (PALNM). 41 patients (22 male and 19 female) who underwent iodine-125 seeds BT through anterior percutaneous trans-organ puncture path were enrolled between Jan 2017 and May 2022. The level of PALNM were divided into 5 levels. The puncture path was designed individualized according to the surrounding normal organs. Technical and clinical success, complications, uniformity of dosimetric parameters were retrospectively evaluated. The percutaneous trans-organ puncture was clinically successful in all patients. And the detial were as follows: Level 1: Transhepatic (1 case), Trans-gastric (5 cases), Trans-enteric or paraintestinal (2 cases), Level 2: Transhepatic (2 cases), Trans-gastric (3 cases), Trans-enteric or paraintestinal (7 cases), the puncture path of Level 3,Level 4 and Level 5 were all Trans-enteric or paraintestinal with the cases of 8, 7 and 6. For complications, only one case of intraperitoneal hemorrhage and haematemesis seperately observed. The seeds number, target volume and dosimetry parameters showed no significant differences before or after iodine-125 seeds operation. The anterior Percutaneous trans-organ puncture path in iodine-125 seeds BT in patients with PALNM include transhepatic, trans-gastric, trans-enteric or paraintestinal. The selection of puncture path should take the target level and normal organs into account. [ABSTRACT FROM AUTHOR]

Radioactive iodine-125 ( 125 I) seed implantation, a brachytherapy technique, effectively kills tumor cells via X-rays and gamma rays, serving as an alternative therapeutic option following the failure of frontline treatments for various solid tumors. However, tumor radioresistance limits its efficacy. Hydrogen gas has anticancer properties and can enhance the efficacy of immunotherapy. However, its role in radiotherapy sensitization has rarely been reported. Many current hydrogen delivery methods involve hydrogen-generating nanomaterials, such as magnesium-based nanomaterials. This study introduces an AZ31 magnesium alloy 125 I seed strand (termed AMASS) with pH-dependent slow-release hydrogen characteristics and excellent mechanical properties. AMASS can be implanted into tumors via minimally invasive surgery, releasing hydrogen around the 125 I seeds. In vitro experiments showed that hydrogen from AMASS degradation significantly inhibited tumor proliferation, increased apoptosis, disrupted redox homeostasis and mitochondrial membrane potential, reduced adenosine triphosphate levels, and induced DNA damage due to 125 I radiation. In mouse xenograft and rabbit liver tumor models, hydrogen from AMASS showed superior therapeutic effects compared with 125 I seeds alone, with no noticeable side effects. In addition, AMASS has a uniform radiation dose distribution and simple implantation. Therefore, hydrogen from AMASS enhanced 125 I seed efficacy, supporting the further promotion and application of 125 I seed implantation in cancer therapy., (© 2024 The Author(s). Advanced Science published by Wiley‐VCH GmbH.)

Purpose: This study aimed to evaluate the efficacy and safety of transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) and iodine-125 (125I) seed implantation (TACE-RFA-125I) for recurrent hepatocellular carcinoma (HCC) after hepatectomy., Methods: The study retrospectively analyzed patients with recurrent HCC who received TACE-RFA-125I or TACE-RFA treatment in our institution between January 2013 and January 2023. Overall survival (OS), progression-free survival (PFS), and recurrence were compared between the two groups., Results: A total of 187 patients were enrolled in this study, with 105 in the TACE-RFA-125I group and 82 in the TACE-RFA group. There were 67 men and 15 women in the TACE-RFA group, with an average age of 55.4 ± 10.9 years, and 93 men and 12 women in the TACE-RFA-125I group, with an average age of 55.5 ± 10.7 years. The TACE-RFA-125I group exhibited a significantly improved survival benefit compared with the TACE-RFA group (median OS: 49 months vs. 32 months, P < 0.001; median PFS: 24 months vs. 16 months, P < 0.001). The univariate and multivariate analyses revealed that TACE-RFA-125I was a protective factor for OS and PFS. A total of 32 patients in the TACE-RFA group experienced recurrence during follow-up, with local recurrence in 12 cases, intrahepatic recurrence in 10 cases, and extrahepatic metastases in 10 cases. A total of 28 patients in the TACE-RFA-125I group experienced recurrence, 6 with local recurrence, 12 with intrahepatic recurrence, and 10 with extrahepatic metastases. No procedure-related deaths occurred in this study., Conclusion: In patients with recurrent HCC, TACE-RFA-125I demonstrates promising tumor control and acceptable safety., Clinical Significance: This study provides promising clinical guidance for patients with recurrent HCC after hepatectomy and is expected to provide beneficial strategies for the treatment of this disease.

Abstract Background There is currently no widely-accepted consensus for the management of hepatocellular carcinoma with portal vein tumor thrombus. We evaluate the safety and efficacy of ultrasound-guided percutaneous brachytherapy with iodine-125 seeds for the treatment of hepatocellular carcinoma with portal vein-branch tumor thrombus (PVBTT). Methods Sixty-nine hepatocellular carcinoma patients with PVBTT were enrolled; 34 received transarterial chemoembolization (TACE) combined with iodine-125 seeds implanted in the PVBTT; 35 were treated with TACE alone. Adverse events, objective response rate, disease control rate, progression-free survival, and overall survival were compared between the two groups. Tumor responses of PVBTT and intrahepatic tumor were correlated. Multivariate and subgroup analyses were conducted for overall survival. Results No grade 3 or 4 adverse events were recorded, and there was no difference in grade 1 or 2 adverse events between the two groups. Objective response rate and disease control rate for PVBTT were 58.9 and 91.2%, respectively, in the combined treatment group, which were significantly greater than the 5.7 and 54.3% rates, respectively, in the TACE-alone group (both p’s ≤ 0.001). Intrahepatic tumor response was positively correlated with the PVBTT response (γ = 0.782, p

Purpose: The purpose of this research was to evaluate the feasibility and efficacy of 125I seed brachytherapy as salvage treatment for recurrence from non-anaplastic thyroid cancer refractory to other modalities. Methods: Between June 2006 and September 2019, fifteen patients with recurrent non-anaplastic thyroid cancer were treated with 125I seed brachytherapy. 125I seeds were implanted into the tumor under the guidance of CT and/or ultrasound images with the median prescription dose of 120 Gy (range, 100-140 Gy). The median seed number was 80 (range 10-214). Clinical efficacy was evaluated with Response Evaluation Criteria in Solid Tumors. Findings: Fifteen patients were selected, eleven of whom had papillary carcinoma, two suffered from follicular carcinoma, and two were diagnosed with medullary carcinoma. These patients had twenty-four nodes in total. After they received salvage surgery and/or radioactive iodine (RAI) therapy, local recurrence was detected in all of them. No less than one node was observed in everyone's cervical or supraclavicular areas, and four patients had lung metastatic. The median follow-up period lasted 48 months (range, 5-93 months). All patients did not develop locoregional recurrence after experiencing 125I seed brachytherapy. Only three of them formed new metastases in nontarget regional nodes after brachytherapy, and additional brachytherapy can solve all regional failure problems. No significant adverse events were observed in any patient. Implications: For the chosen patients, 125I seed brachytherapy is feasible for treating refractory local recurrence from non-anaplastic thyroid cancer. Further studies are required to determine the role of 125I seed brachytherapy in the treatment of thyroid cancer. [ABSTRACT FROM AUTHOR]

Abstract Background This long-term retrospective analysis aimed to investigate the outcome and toxicity profile of stereotactic brachytherapy (SBT) in selected low-grade gliomas WHO grade II (LGGII) in a large patient series. Methods This analysis comprised 106 consecutive patients who received SBT with temporary Iodine-125 seeds for histologically verified LGGII at the University of Munich between March 1997 and July 2011. Investigation included clinical characteristics, technical aspects of SBT, the application of other treatments, outcome analyses including malignization rates, and prognostic factors with special focus on molecular biomarkers. Results For the entire study population, the 5- and 10-years overall survival (OS) rates were 79% and 62%, respectively, with a median follow-up of 115.9 months. No prognostic factors could be identified. Interstitial radiotherapy was applied in 51 cases as first-line treatment with a median number of two seeds (range 1–5), and a median total implanted activity of 21.8 mCi (range 4.2–43.4). The reference dose average was 54.0 Gy. Five- and ten-years OS and progression-free survival rates after SBT were 72% and 43%, and 40% and 23%, respectively, with a median follow-up of 86.7 months. The procedure-related mortality rate was zero, although an overall complication rate of 16% was registered. Patients with complications had a significantly larger tumor volume (p = 0.029). Conclusion SBT is a minimally invasive treatment modality with a favorable outcome and toxicity profile. It is both an alternative primary treatment method as well as an adjunct to open tumor resection in selected low-grade gliomas.

Huzi Li,1– 3 Zhendong Duan,2 Cheng Zhao,2 Wenyan Fang,2 Yingjie Jia,2 Xiaojiang Li,2 Fanming Kong,2 Lujun Zhao1 1Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, and Tianjin’s Clinical Research Center for Cancer, Tianjin, People’s Republic of China; 2Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China; 3Graduate School of Tianjin Medical University, Tianjin, People’s Republic of ChinaCorrespondence: Lujun ZhaoDepartment of Radiology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin, People’s Republic of China, Email tjdoctorzhao@163.comBackground: A proportion of patients with synchronous oligometastatic non-small cell lung cancer (NSCLC) have poor survival, and currently no standard treatment is available, which poses a great challenge to physicians. This study aimed to assess and compare the efficacy and safety of the combination of brachytherapy with iodine-125 seeds and systemic chemotherapy versus systemic chemotherapy alone for synchronous extracranial oligometastatic NSCLC.Materials and Methods: After a systematic retrospective review of the case database between 1st Mar 2014 and 30th Mar 2018, data were obtained on 69 NSCLC patients with extracranial oligometastatic NSCLC. Among them, 32 patients received brachytherapy with iodine-125 seeds combined with systemic chemotherapy (group A), and the remaining 37 patients received chemotherapy alone (group B). The primary endpoint was overall survival (OS), and the secondary endpoints included progression-free survival (PFS), objective response rate (ORR), and complications.Results: The demographic and clinical characteristics were not significantly different between the groups (all p> 0.05). The overall 3-month ORR was significantly higher in group A (65.6% vs 37.8%, p=0.030) than in group B. With a median follow-up time of 23 months, the PFS and OS were 11.6 (95% CI: 7.0– 16.2) months vs 6.3 (95% CI: 3.4– 9.2) months (p=0.036) and 17.6 (95% CI: 13.9– 21.3) months vs 11.2 (95% CI: 7.7– 14.7) months (p=0.042) in groups A and B, respectively. Furthermore, in Cox regression analysis, local brachytherapy was an independent prognostic factor for both PFS (HR=0.416, 95% CI: 0.246– 0.702, p=0.001) and OS (HR=0.375, 95% CI: 0.216– 0.653, p=0.001). Severe complications were not observed in either of the groups.Conclusion: The combination of brachytherapy with iodine-125 seeds and systemic chemotherapy is superior to chemotherapy alone for synchronous extracranial oligometastatic NSCLC.Keywords: brachytherapy, iodine-125 seeds, NSCLC, oligometastatic, chemotherapy

PurposeThe purpose of this research was to evaluate the feasibility and efficacy of 125I seed brachytherapy as salvage treatment for recurrence from non-anaplastic thyroid cancer refractory to other modalities.MethodsBetween June 2006 and September 2019, fifteen patients with recurrent non-anaplastic thyroid cancer were treated with 125I seed brachytherapy. 125I seeds were implanted into the tumor under the guidance of CT and/or ultrasound images with the median prescription dose of 120 Gy (range, 100-140 Gy). The median seed number was 80 (range 10-214). Clinical efficacy was evaluated with Response Evaluation Criteria in Solid Tumors.FindingsFifteen patients were selected, eleven of whom had papillary carcinoma, two suffered from follicular carcinoma, and two were diagnosed with medullary carcinoma. These patients had twenty-four nodes in total. After they received salvage surgery and/or radioactive iodine (RAI) therapy, local recurrence was detected in all of them. No less than one node was observed in everyone’s cervical or supraclavicular areas, and four patients had lung metastatic. The median follow-up period lasted 48 months (range, 5-93 months). All patients did not develop locoregional recurrence after experiencing 125I seed brachytherapy. Only three of them formed new metastases in nontarget regional nodes after brachytherapy, and additional brachytherapy can solve all regional failure problems. No significant adverse events were observed in any patient.ImplicationsFor the chosen patients, 125I seed brachytherapy is feasible for treating refractory local recurrence from non-anaplastic thyroid cancer. Further studies are required to determine the role of 125I seed brachytherapy in the treatment of thyroid cancer.

Background: There is currently no widely-accepted consensus for the management of hepatocellular carcinoma with portal vein tumor thrombus. We evaluate the safety and efficacy of ultrasound-guided percutaneous brachytherapy with iodine-125 seeds for the treatment of hepatocellular carcinoma with portal vein-branch tumor thrombus (PVBTT).Methods: Sixty-nine hepatocellular carcinoma patients with PVBTT were enrolled; 34 received transarterial chemoembolization (TACE) combined with iodine-125 seeds implanted in the PVBTT; 35 were treated with TACE alone. Adverse events, objective response rate, disease control rate, progression-free survival, and overall survival were compared between the two groups. Tumor responses of PVBTT and intrahepatic tumor were correlated. Multivariate and subgroup analyses were conducted for overall survival.Results: No grade 3 or 4 adverse events were recorded, and there was no difference in grade 1 or 2 adverse events between the two groups. Objective response rate and disease control rate for PVBTT were 58.9 and 91.2%, respectively, in the combined treatment group, which were significantly greater than the 5.7 and 54.3% rates, respectively, in the TACE-alone group (both p's ≤ 0.001). Intrahepatic tumor response was positively correlated with the PVBTT response (γ = 0.782, p < 0.01). Survival outcomes were better in the combined treatment group than in the TACE-alone group: the median progression-free survival for PVBTT was 9 months versus 3 months (HR = 0.187 [95% CI: 0.101, 0.345], p < 0.001), and the median overall survival was 11 months versus 7 months (HR = 0.448 [95% CI: 0.265, 0.758], p = 0.003). Multivariate analysis revealed that application of brachytherapy and lower grade PVBTT (Vp1 + Vp2 vs. Vp3) were protective predictors of overall survival. In stratified analysis, the benefit of overall survival was more significant in the subgroup of PVBTT Vp1 + Vp2 rather than in Vp3.Conclusions: The combination of iodine-125 seed brachytherapy guided by ultrasound and TACE is a convenient, safe, and effective treatment for patients with HCC and PVBTT, conferring a better survival benefit than TACE alone. [ABSTRACT FROM AUTHOR]

To examine medium-term outcomes of hemi-gland low-dose-rate brachytherapy as a primary treatment for intermediate-risk prostate cancer. We recruited intermediate-risk unilateral prostate cancer patients for a prospective trial of hemi-gland brachytherapy. Twenty-four patients underwent hemi-gland iodine-125 seed implantation with a prescribed dose of 160 Gy. Serum prostate-specific antigen (PSA) was measured regularly and follow-up biopsy was scheduled after 2–3 years of treatment. When clinically needed afterward, for-cause biopsy was performed to confirm pathology. Treatment failure (TF)-free survival, which was defined as freedom from radical or systemic therapy, metastases, and cancer-specific mortality, was assessed, as was biochemical failure (BF)-free survival. Urinary and sexual functions were also evaluated. Median follow-up duration was 61 months. Twenty-two patients (92%) exhibited a declining trend or decreased value of PSA for 12 months or longer after the treatment. Follow-up biopsy in the initial triennium and for-cause biopsy in the subsequent triennium were performed in 16 and four patients, respectively, and cancer was found from the treated lobe in one patient (4% of the cohort) and significant cancer was found from untreated lobes in four patients (17%) in total. Secondary treatments were performed in six patients successfully. Five-year freedom from BF, TF, and metastasis was 71%, 90%, and 100%, respectively. The International Prostate Symptom Score significantly deteriorated at 3 months and reversed itself afterward. The International Index of Erectile Function 5 had no significant decrease. Hemi-gland low-dose-rate brachytherapy provides favorable medium-term oncological outcomes with genito-urinary functional preservation for men with intermediate-risk unilateral prostate cancer. [ABSTRACT FROM AUTHOR]

New laboratories for brachytherapy sources production are being implemented in our facility at IPEN, in São Paulo. A great challenge implementing a production laboratory is to comply with the Good Manufacturing Practices (GMPs), which involves process validation and all supporting activities such as cleaning and sanitization. Much more than compliance with regulatory guidelines, required for certification and inspections, a validation builds large process knowledge, provides possibilities for optimization and improvement, increasing the degree of maturity of all people involved and the quality system. The process validation results in a document that certifies that any procedure, process, equipment, material, operation or system leads to the expected results. This work focused on the new laboratory, been assembled to produce small iodine-125 seeds. The process validation was performed three times for evaluation. The parameters evaluated in this study were: the source welding efficiency and the leakage tests results (immersion test). The welding efficiency doesn’t have an established parameter, since is visually evaluated by the operator, and the leakage detection must be under 5 nCi / 185 Bq, accordingly with the ISO 9978. We observed values were average 79-87% production efficiency and leakage tests were under 5 nCi/seed. Although established values for the global efficiency aren’t available in the literature, the results showed high consistency and acceptable percentages, especially when other similar manufacturing processes are used in comparison (average 85-70% found in the literature for other similar metallic structures). Those values will be important data when drafting the validation document and to follow the Good Manufacturing Practices (GMPs).process

Background: This long-term retrospective analysis aimed to investigate the outcome and toxicity profile of stereotactic brachytherapy (SBT) in selected low-grade gliomas WHO grade II (LGGII) in a large patient series.Methods: This analysis comprised 106 consecutive patients who received SBT with temporary Iodine-125 seeds for histologically verified LGGII at the University of Munich between March 1997 and July 2011. Investigation included clinical characteristics, technical aspects of SBT, the application of other treatments, outcome analyses including malignization rates, and prognostic factors with special focus on molecular biomarkers.Results: For the entire study population, the 5- and 10-years overall survival (OS) rates were 79% and 62%, respectively, with a median follow-up of 115.9 months. No prognostic factors could be identified. Interstitial radiotherapy was applied in 51 cases as first-line treatment with a median number of two seeds (range 1-5), and a median total implanted activity of 21.8 mCi (range 4.2-43.4). The reference dose average was 54.0 Gy. Five- and ten-years OS and progression-free survival rates after SBT were 72% and 43%, and 40% and 23%, respectively, with a median follow-up of 86.7 months. The procedure-related mortality rate was zero, although an overall complication rate of 16% was registered. Patients with complications had a significantly larger tumor volume (p = 0.029).Conclusion: SBT is a minimally invasive treatment modality with a favorable outcome and toxicity profile. It is both an alternative primary treatment method as well as an adjunct to open tumor resection in selected low-grade gliomas. [ABSTRACT FROM AUTHOR]

Testicular seminoma is a relatively rare malignant tumor, with the most common site of recurrence and metastasis being the retroperitoneal lymph nodes. Since seminoma is highly sensitive to radiotherapy and chemotherapy, even if it metastasizes, its cure rate is still >95%. However, the long-term toxicity and side effects of radiotherapy and chemotherapy cannot be ignored. Iodine-125 seeds represent a low-energy radioactive source that kills tumor cells while protecting the surrounding normal tissues, and brachytherapy using iodine-125 seeds has been widely used for the treatment of various malignancies. In addition, carboplatin can be used as an alternative to cisplatin-based combination chemotherapy to reduce the incidence of pulmonary toxicity, neurological damage and renal toxicity. In the present study, a case in which iodine-125 seeds were implanted for the treatment of retroperitoneal metastatic seminoma is reported. The patient was diagnosed with postoperative recurrence of seminoma that metastasized to the retroperitoneal lymph nodes. Since the tumor was large and surrounded blood vessels, surgical intervention and external radiotherapy were not considered. Moreover, considering the potential long-term toxic side effects of standard chemotherapy, a treatment plan for the patient using iodine-125 seed implantation combined with carboplatin (AUC7) therapy was finally formulated. No disease recurrence or toxic reactions occurred during the 3-year follow-up after treatment. The present case therefore demonstrated the antitumor efficacy and reduced toxicity of iodine-125 seeds combined with carboplatin for treating seminoma. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility of using PET/CT and diffusion-weighted magnetic resonance imaging (DW-MRI) to monitor the early response of pancreatic ductal adenocarcinoma (PDAC) xenografts to brachytherapy, and to determine whether maximum standardized uptake value (SUVmax) correlate with apparent diffusion coefficient (ADC).Materials and Methods: SW1990 human PDAC were subcutaneously implanted in 20 nude mice. They were randomly divided into 125-Iodine (125I) seeds and blank seeds group. PET/CT and DW-MRI were performed at pretreatment and 5 days after therapy. SUVmax and ADC values were calculated, respectively. The correlation between SUVmax and ADC values was analyzed by the Pearson correlation test.Results: The SUVmax were significantly decreased between pretreatment and 5 days after 125I seeds treatment (p < 0.001) and between two groups (p < 0.001). And the ADC values were significantly increased between pretreatment and 5 days after 125I seeds treatment (p < 0.001) and between two groups (p < 0.001). While in the bank seeds group, there were no significantly difference between pretreatment and after treatment in SUVmax and ADC values (p = 0.057; p = 0.397). SUVmax and ADC correlated significantly and negatively before treatment in both groups (r = − 0.964, R2 = 0.929, p < 0.001; r = − 0.917, R2 = 0.841, p < 0.001) and after treatment in the blank seeds group (r = − 0.944, R2 = 0.891, p < 0.001). But after 125I seeds treatment there was no significant correlation between SUVmax and ADC (r = − 0.388, R2 = 0.151, p = 0.268).Conclusion: The PET/CT and DW-MRI are capable of monitoring the early response of PDAC xenografts to brachytherapy. The significantly inverse correlation between pretreatment SUVmax and ADC suggests that PET/CT and DW-MRI might play complementary roles for therapy assessment. [ABSTRACT FROM AUTHOR]

Background The optimal treatment of recurrent primary central nervous system lymphoma (PCNSL) has not yet been determined. We report a patient with recurrent PCNSL who has been successfully treated with stereotactic brachytherapy (SBT) with iodine-125 seeds plus temozolomide (TMZ). Case Description A 51-year-old man who underwent left occipital lobe tumor resection 11 years earlier presented with a 1-month history of right hand weakness. Magnetic resonance imaging (MRI) revealed a recurrent PCNSL, which was confirmed by pathological examination. He was treated with SBT plus TMZ. At 1 month after surgery, a repeat MRI revealed nearly complete disappearance of the lesion. At 13.5 months postsurgery, the patient was neurologically intact except for right homonymous hemianopia, and follow-up MRI did not reveal a recurrent tumor. Conclusions To our knowledge, this is the first case of recurrent PCNSL successfully treated with SBT plus TMZ. Further randomized studies are needed to confirm the therapeutic impact of this new method. [ABSTRACT FROM AUTHOR]

Objective: To investigate the therapeutic efficacy of Iodine-125 (125I) seeds brachytherapy to pancreatic ductal adenocarcinoma (PDAC) xenografts via multiparametric magnetic resonance imaging (MRI) analysis.Materials and methods: Twenty mice were implanted subcutaneously with SW-1990 PDAC xenografts. The tumor-bearing mice were randomly divided into 125I seeds group (n = 10) and blank control group (n = 10). Treatment response was monitored by diffusion-weighted magnetic resonance imaging (DW-MRI) and dynamic contrast-enhanced MRI (DCE-MRI) obtained 1 day before, 14 and 60 days after treatment. Imaging results were correlated with histopathology.Results: 125I seeds brachytherapy resulted in a significant increase in mean tumor apparent diffusion coefficient (ADC) values compared to the control at 14 and 60 days after treatment (p < 0.05). DCE-MRI showed a significant decrease in the perfusion parameters including Ktrans and Kep (p < 0.05). The mean ADCs within the peripheral region of the tumors were linearly proportional to the mean apoptotic cell density (p = 0.015; Spearman’s coefficient = 0.945). The Ktrans and Kep were linearly proportional to microvessel density (MVD) (p = 0.043, 0.047; Spearman’s coefficient = 0.891, 0.884).Conclusion: 125I seeds brachytherapy leads to effective inhibition of PDAC cell proliferation, higher degree of necrosis and necroptosis, and lower MVD. Both DW-MRI and DCE-MRI are feasible to monitor a response to 125I seeds brachytherapy in the PDAC xenografts. This paper shows an original project concerning about a possible palliative treatment not only in a murine model (preclinical setting) but also in humans. [ABSTRACT FROM AUTHOR]

The present study aimed to evaluate the effects of iodine-125 (125I) seeds on the proliferation of primary esophageal fibroblasts in dogs, and to assess the safety and preventive efficacy of 125I seed-pre-loaded esophageal stents in benign restenosis following implantation. Primary fibroblasts were cultured with various 125I seed activities, which were then evaluated using cell proliferation and apoptosis assays as well as cell cycle analysis using Annexin V/propidium iodide (PI) double staining and PI staining. Prior to sacrification, animals were submitted to esophageal radiography under digital subtraction angiography. Esophageal tissues were collected and examined for macroscopic, microscopic and pathological alterations. The results demonstrated a significant and dose-dependent inhibition of fibroblast proliferation and increased apoptosis following exposure to 125I seeds. G0/G1 fibroblast populations increased in a dose-dependent manner following treatment with 125I seeds, in contrast to cells in S phase. Four weeks following implantation, α-smooth muscle actin and proliferating cell nuclear antigen expression levels in the experimental group were significantly lower compared with those in the control group; in addition, eight weeks following implantation, esophageal inner diameters were increased in the experimental group. 125I seeds inhibited proliferation of dog esophageal fibroblasts via cell cycle arrest and apoptosis. In conclusion, 125I seed-pre-loaded esophageal stents inhibited benign hyperplasia in the upper edge of the stent to a certain extent, which relieved benign restenosis following implantation with a good safety profile. [ABSTRACT FROM AUTHOR]

Purpose of work: Provide a safer way for treating various cancers with PLGA-PEG-PLGA (PPP)-embedded iodine-125. To improve the safety of iodine treatment for colon cancer, iodine-125 solution was embedded into PLGA-PEG-PLGA (PPP) (synthesized by bulk co-polymerization of dl-polylactide glycolide and PEG). Xenograft-carrying nude mice were then treated with iodine-125-PPP. Proliferating cell nuclear antigen and Terminal Transferase dUTP Nick-End Labeling were used to measure proliferation and apoptosis in the tumors, respectively. Simultaneously, immunohistochemistry SP was used to detect the expression levels of p53. In addition, the microvessel density (MVD) of the tumors was recorded. PPP-embedded iodine-125 induced apoptosis by increasing the expression of p53, and by decreasing the levels of VEGF and MVD in the colon cancer tumors ( P < 0.01). Significant inhibition of tumor growth is seen with iodine-125 from 0.4 to 0.8 mCi. PPP-embedded iodine-125 has a similar inhibitory efficiency to using the iodine-125 seeds for the treatment of colon tumors ( P > 0.05). The findings therefore provide a potentially safer method for treating various tumors with radioactive iodine. [ABSTRACT FROM AUTHOR]

The current study investigated the effects of iodine-125 seeds on the gene methylation of SFRP2 and P16 in colorectal cancer. Mouse models of human colorectal cancer were randomly divided into an experimental group (n=25) and a control group (n=25). The control group was implanted with blank seeds (0 MBq) and the experimental group with iodine-125 seeds (14.8 MBq). At 20 days after implantation, the animals were sacrificed. The methylation levels of SFRP2 and P16 were detected using methylation-specific polymerase chain reactions (MSPs). Following iodine-125 seed irradiation, the level of SFRP2 methylation decreased. The methylation index of the experimental group (0.67±0.05) was significantly lower than that of the control group (0.84±0.07; P<0.05). In the experimental group, 10 samples (40%) displayed methylation in the P16 promoter region compared with 14 (56%) in the control group, which was a significant difference (P<0.05). Iodine-125 seeds induce the downregulation of methylated tumor suppressor gene promoters, thereby inhibiting the proliferation and growth of tumor cells. [ABSTRACT FROM AUTHOR]

Purpose: To report on iodine-125 (I125) interstitial irradiation in the treatment of low grade brain stem gliomas in adults. Patients and methods: Ten patients with well-circumscribed lesions of the brainstem and histological confirmation of low grade glioma treated with stereotactically implanted I-125 seed in our department between 1995 and 2012 were retrospectively analyzed. Results: In 9 patients the lesion was treated with one I-125 seed and in one patient, 2 spatial separated lesions were implanted, therefore a total of 11 I-125 seeds were implanted. The mean volume of the 11 lesions was 2.76 ml (range: 0.5-7.2 ml), mean activity of the seeds was 6.23 mCi (range: 1.5-11.1 mCi), mean duration of irradiation was 28.5 days (range: 21-41 days) and mean effective dose rate was 9.16 cGy/h (range: 6.2-12 cGy/h). The 30 days perioperative morbidity and mortality rate was 0%. Median follow up was 72.5 month (range 5-168 months). Six of ten patients were free of progression until last follow up. Conclusion: In our experience at the University Clinic in Freiburg Germany, interstitial radiosurgery based on MRI is a safe and effective method to diagnose and treat low grade gliomas of the brain stem. Furthermore randomized studies are needed to confirm the therapeutic impact of this method in comparison to external beam radiation of brain stem gliomas. [ABSTRACT FROM AUTHOR]

Copyright of Strahlentherapie und Onkologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The presence of foreign bodies in a prostate transurethral resection may pose a histopathological challenge. A 65-year-old white man with urinary obstructive symptoms was subjected to a transurethral resection. Histopathology showed a squamous cell carcinoma affecting prostatic ducts and multiple foreign bodies; their differential diagnosis was between iodine-125 seeds and Schistosoma sp. eggs, as both can show oval morphology and terminal spines. The seeds are irregular, homogeneous and solid, unlike Schistosoma eggs that are heterogeneous, with a lytic appearance and some embryonated or calcified. The seeds are located in prostatic ducts inducing periductal fibrosis whereas the Schistosoma sp. eggs are found in the stroma inducing desmoplasia and granulomas. The seeds are associated with a lymphoplasmacytic infiltrate while the eggs are surrounded by eosinophils., (Copyright © 2018 Sociedad Española de Anatomía Patológica. Publicado por Elsevier España, S.L.U. All rights reserved.)

The treatment methods available for large primary hepatocellular carcinomas (diameter >5 cm) are inadequate. Here, we report the successful management of 80 cases of large hepatocellular carcinoma, using a combination of custom-designed permanent interstitial iodine-125 seed brachytherapy and palliative surgery. Patients were enrolled in the study between 2011 and 2014. All patients underwent surgical treatment along with permanent interstitial iodine-125 seed brachytherapy; for the latter, patients received minimum doses covering 90% of the target (D90 s) of iodine-125 seeds ranging from 100 to 160 Gy (median: 110 Gy). All patients received 6 cycles of chemotherapy and were followed up at 6, 12, 24, and 36 months postoperatively. The clinical symptom remission rate was 95.3% (61 of 64). Alanine aminotransferase and aspartate aminotransferase levels decreased to normal in 80% (50 of 60) and 75% of the patients (45 of 60), respectively. The posttreatment alpha-fetoprotein levels decreased by 50% in 80% of the patients (40 of 50). The effective therapy rates were 80% (76 of 95) for 95 tumor nodules (diameters 5-10 cm) and 78.6% (33 of 42) for 42 tumor nodules (diameters >10 cm). The 3-year disease-free survival rate was 66.6%. Palliative surgery plus permanent interstitial iodine-125 seed brachytherapy appears to be a reasonable therapeutic alternative for large hepatocellular carcinoma.

Supratentorial gliomas WHO grade II and III with an oligodendroglial phenotype are highly infiltrative lesions that preferentially originate in lobar location. Open tumor resection represents one of the mainstays of management as beneficial decompressive effects for large space-occupying lesions and oncologically relevant cytoreductive effects from complete resection can be expected. In patients not eligible for safe tumor resection meticulous histological and molecular-genetic evaluation can be obtained from advanced stereotactic biopsy techniques. In this perspective, important aspects of open tumor surgery and stereotactic biopsy are discussed within the context of diagnosis, prognosis and treatment of oligodendrogliomas and oligoastrocytomas WHO grade II and III. Practical considerations are provided in order to integrate the place of surgery into an increasingly personalized management concept. For highly selected patients interstitial brachytherapy is introduced as an alternative surgically performed treatment option.

It has been proven that radioactive seeds such as Iodine-125 seeds implantation is a highly effective treatment for patients with localized cancer, such as lung cancer. It may increase the effectiveness of cryosurgery for lung cancer with the combination of Iodine-125 seed implantation into edge of the cryoablation zone. Percutaneous cryosurgery and Iodine-125 seed implantation are mutual complementation; both have been proved to be safe and effective modality for unresectable lung cancer, especially for centrally located lung cancer. Well-designed, randomized and control study both in the laboratory and in the clinical about this option are needed before the conclusive evidence submits.