Efficacy And Safety Of CT-Guided ¹²⁵I Brachytherapy As The Salvage Treatment For Locoregional Lymph Node Recurrence Of Esophageal Cancer

Purpose:To investigate the clinical efficacy and safety of computed-tomography（CT）-guided iodine-125(¹²⁵I)brachytherapy as a salvage treatment for esophageal cancer with locoregional lymph node recurrence（LLNR）.Materials and Methods:This retrospective study included patients with esophageal cancer who developed LLNR after initial curative resection followed by CT-guided ¹²⁵I brachytherapy as a salvage treatment（January 2014-January 2020）.Local tumor progression-free survival（LTPFS）was assessed with Response Evaluation Criteria in Solid Tumors version 1.1.Clinical response was evaluated with the Numerical Rating Scale pain score,and adverse events were evaluated with the Common Terminology Criteria for Adverse Events（v5.0）.A layered Cox proportional hazards model was used to determine the independent factors affecting LTPFS.Results:A total of 52 patients（mean age,60 years）were included in this study.The median follow-up was 9.3（range,4.3-12）months.The median LTPFS was 7.0months（IQR,5-9.5）.The local control rates were 100%at 1 month,94.2%at 3months,59.6%at 6 months,and 13.4%at 12 months.Overall survival rates were100%,100%,82.6%,and 36.5%at 1-,3-,6-,and 12-month,respectively.The number of LLNR（HR,2.38[95%CI:1.11-5.10];P=0.026）,clinical stage at diagnosis（HR,8.12[95%CI:3.19-20.66];P<0.001）,and pathologic stage（HR,5.74[95%CI:2.14-15.39];P=0.001）were independent factors for LTPFS.The rate of pain relief was 96.4%（27 of 28）.Treatment-related death was not observed.Conclusion:CT-guided 125I radioactive seed implantation resulted in pain relief and short-to mid-term local control.