| PurposeThe full name of the Radio-active seed implantation radiotherapy is “Radioactive particles implantation technology”. The technology is used in destroying tumor by persistently releasing a low dose rate of ?-rays. The vast majority of the radiation energy can be absorbed by tumor cells, thus maximum of tumor cells eliminated, meanwhile the surrounding normal tissues and vital organs can't be injured or only minor damaged. Recently, 125 I radioactive particles are widely used in clinical therapy. Radioactive seeds interstitial brachytherapy was used in the tumor over a hundred years. With the continuous progress of new nuclide discovery and implantation technique, this technology has been developed and improved rapidly. The indications gradually increased. and used as one of the main means of treatment of malignant tumors. Although there are relevant reports about eye implantation in domestic and abroad, such as The American Brachytherapy Society consensus guidelines for plaque brachytherapy of uveal melanoma and retinoblastoma, however, in the orbital tumor area, the efficacy and complications of the technology are rare. The aim of this study was to evaluate the efficacy and complications of 125 I radioactive particles implantation radiotherapy on eye tumor. Materials and Methods clinical informationA total of 19 cases collected in our hospital during the period from July 2008 to January 2016 received 125 I seed implantation operation treatment of patients with ocular tumors.7males and 12 females, aging from 2 months to 59 years old. The average age was(25.47±4.87)years old. Tumor in the orbital apex were 8 cases,including 4 cases of extra-ocular RB, 3 cases of Binocular retinoblastoma,1 case of Rhabdomyosarcoma. Tumor in the lacrimal gland area were 8 cases. Tumor before the equator were 3 cases(basal cell carcinoma ? interdigitating dendritic cell sarcoma and breast cancer metastasis). MethodsAll of the patients have been taken the orbital CT scan before treatment, definitude the position, size of the tumor etc. According to the seed's effective rang and the tumor's shape,design the implantation method. Nineteen patients received 125 I seed implanting through intra-operative direct vision and 4 patients who had tumor spread received 125 I seed implantation again through CT or MRI guided. Follow-up and observeAfter 2 weeks, 1, 3, 6, 12, 18, 24, 36, 72 and 96 months, the conditions of lesion area and complications were observed. Observe the following items.(1) Response evaluation criteria in tumor,effective control:decrease or not increase;partial control: expand or surrounding thickening; metastasis: appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions.(2) complication associated with the operation of implantation surgery,such as Hemorrhage ? hyperemia ? infection etc.(3) later complication,for example the patient's appearance?visual function etc. ResultsNineteen patients received the operation successfully according to the preoperative plan. Fourteen cases were implanted once, three cases received twice implantation, one case received implantation for three times and one case received implantation for four times. Efficacy19 cases follow up for 6~92months,the average time was(26.55±5.46) months. local lesion was controlled without recurrence in 14 cases. The discovery of new lesions or lesions spreading was in 5 cases and after replanting the seeds the disease was controlled. No metastasis occurred.ComplicatiosThere was no complication associated with the operation of implantation surgery.(1) Before placing the seeds on the equator, conjunctival hyperemia and epithelialization, tearing, increase of secretion and eyelashes(eyebrow) loss occurred within 1 to 3 months and 6 months later these symptoms disappeared.(2) Lacrimal gland area: one case developed dry eye and 6 months later was recovered. One case suffered skin ulceration and fistulas because the implantation location of the seed was close to the skin.(3) orbital apex: 9 months later, fibrosis, sclerosis and skin pigmentation happened. Complicatios were recoverable. ConclusionRadioactive seed brachytherapy for the treatment of ocular tumor can reserve the visual function and appearance which has exact effect and safety with fewer complication. |
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