Recent Efficacy On¹²⁵I Seed Implantation In Treatment Of Recurrent Neck Metastatic Carcinoma After Radiotherapy

Background and objective： Radioactive125I interstitial implantation,asa method of brachytherapy treatment, can obviously improve target dose, andreduce the amount of the surrounding normal tissues by advantage. It hasbeen widely used in clinical treatment of various kinds of solid tumors andachieved good clinical curative effect because of its low emission pollutionand liabitity to protection, such as head and neck, chest, abdominal, pelvic andsoft tissue malignant tumors. As the most important ways of lymphaticsummary for the whole body, the neck lymph nodes are the high transfer ofvarious solid tumors. Because of their special neck dissection relations, andmetastases are not usually detected early and other factors, neck metastasislymph nodes surgery is often not satisfactory. The clinical effect ofcombined treatment is not ideal, two-year local recurrence rate was30%.For the local distribution of chemotherapy drugs was poor caused by tissuefibrosis after radiotherapy, and radiation dose was not improved for the limitedrange of dose in organs at risk such as spinal cord,the treatment of relapsebecame a tough clinical problem. Complications such as pain, breathing andswallowing difficulties, seriously affect the patients’ quality of life(QL), mostpatients were difficult to tolerate long-term complications caused by high-doseapplication of analgesic drugs. Radioactive125I particle implantation has theadvantages of improving ratio of gains, safety and effectiveness, lesscomplications, and has achieved remarkable curative effect in clinic treatment.This experiment aims to study on the efficacy and safety on the treatment ofrecurrent neck lymph node metastasis carcinomas after radiotherapy with125Iseed interstitial implantation.Methods:32patients with recurrent neck lymph node metastasiscarcinoma were divided into2groups according to the patient’s wishes, seed implantation group (n=17) and support treatment group (n=15), from March2012to December2013.Seed implantation group:125I seeds’distribution, activity and quantitytargeted with CT lesions as reference were applied brachytherapy planningsystem.The matched peripheral dose (MPD) was60-100Gy. The radioactiveactivity ranged from0.3-0.7mCi(1.30×107-2.96×107Bq). All the patientswere guided by ultrasound B and CT under local anesthesia. PostoperativeCT and quality evaluations were routinely observed for all the patients in24hours.Postoperative D90was55-100Gy.Support treatment group: The purpose to the patients were anti-infectiontreatment and analgesic therapy to alleviate the pain, following the principle ofthe WHO three-step criteria.The variation of tumor size, the changs of QL and complications wereobserved in both groups.Results：Followed up from4to24months, the median follow-up time of7months.Seed implantation group: PR was76.5%(13/17cases), SD was11.7%(2/17cases), PD was11.7%(2/17cases),RR was76.5%, DCR were88.2%.The case of PR of less than4cm of lymph nodes was100%, and larger than4cm of lymph nodes was50%, P=0.003, the difference was statisticallysignificant.8cases had degreeⅡ acute radiation skin reactions,6cases haddegreeⅠ acute radiation skin reactions, no other serious radiationcomplications.Support treatment group: SD was40%(6/15cases), PD was60%(9/15cases), disease control rate is40%.9cases had constipation, and4cases hadgastrointestinal side effects such as nausea and vomiting.The median pain score in two groups was basically stable from2to3, butthe score of support group fluctuated more seriously than seed implantationgroup. In addition, seed implantation group had slight complications.theresult of response rate: X2=19.32, P=0.000, disease control rate: X2=8.22,P=0.004, the difference was statistically significant. Conclusion：1The short-efficacy of125I seed implantation was better to treat recurrentneck metastatic carcinomas after radiotherapy, QL of the patients had beenobviously improved. Less than4cm and isolated, lear boundary lymphnodes were more suitable for particle implantation treatment.2For the treatment of pain caused by recurrent or metastatic head andneck cancers, interstitial implantation of125I seeds has more reliable effect inreducing pain, less complications and faster onset of action.3The complications of125I seed implantation was less to treat recurrentneck metastatic carcinomas after radiotherapy,125I seed implantation hasprovided an effective and safe method for advanced malignant tumors.