The Clinical Observation Of ¹²⁵I Plaque Brachytherapy For The Malignant Tumors And Mixed Tumor Of Lacrimal Gland

Background and purposeThe lacrimal gland tumor is a relatively common tumor in the external condyle of the eyelid,accounting for 8%to 10%of orbital tumors,of which the benign tumors of the lacrimal glands account for 55%and the malignancy accounts for 45%.Primary lacrimal gland epithelial tumors account for 20%to 28%.Epithelial tumors are often invasive.The rate of recurrence after lacrimal gland malignancy is high,and benign tumors of the lacrimal gland tend to relapse and malignant after resection.The current treatment options for lacrimal gland tumors are mainly surgical treatment,internal irradiation,extracorporeal irradiation,and chemotherapy,but there is still the possibility of recurrence and metastasis after resection.¹²⁵I plaque is a new method of local precise radiotherapy.¹²⁵I plaque is a radionuclide implanted in a titanium shell and implanted in tumor tissue using TPS or image navigation.The source of low-energy gamma-rays emitted continuously from the source for the treatment of malignant tumors has less damage to the surrounding tissues and thus achieve therapeutic goals.It has been widely used clinically since the1980s.Currently used in the treatment of prostate cancer,cervical cancer,osteosarcoma,head and neck cancer,lung cancer,pancreatic cancer and other tumors.In the field of ophthalmology,¹²⁵I plaque is often used abroad for the treatment of retinoblastoma and choroidal melanoma.There are many reports and consensus has been reached.However,there are few reports about ¹²⁵I plaque implantation treatment of orbital tumors at home and abroad.In this study,¹²⁵I plaque implantation was performed after retrospective analysis of lacrimal gland malignant epithelial tumors and recurrent pleomorphic adenomas.The control and complications of the tumors were observed.The feasibility and safety of ¹²⁵I plaques in treatment of lacrimal gland epithelial tumors were evaluated.Materials and methodsClinical informationFollow-up of 16 patients with lacrimal gland epithelial tumors treated with ¹²⁵I plaques from July 2008 to February 2016 in our hospital,including 7 males and 9females,aged 32 to 70 years old.The median age is 50 years old.There are 5 cases of recurrent adenoid cystic carcinoma,3 cases of non-recurrent adenoid cystic carcinoma,1 case of mucoepidermoid carcinoma,2 cases of pleomorphic adenoma,and 5 cases of recurrent pleomorphic adenoma.Tumor TNM staging:T1N0M0 7cases,T2N0M0 5 cases,T3aN0M0 2 cases,T3bN0M0 2 cases.All patients were diagnosed by surgery and pathological examination.All patients were implanted with¹²⁵I plaque approximately one month after operation.Therapeutic methodAll patients underwent orbital CT and MRI before operation to determine the extent of lacrimal gland tumor and its relationship with optic nerve,extraocular muscle,levator palpebral muscle and orbital bone wall.5 cases were underwent lateral orbital surgery and 11 cases underwent anterior excision of orbital masses.All cases were confirmed by routine pathological and immunohistochemical examination.Orbital CT examination was performed one month after operation.The tumor bed area was observed?most of them were located in the supraorbital upper crescent shape?,and the extent of lesion,the margin and the depth of the lesion were referred to the preoperative radiography,and the puncture point of plaque implantation was designed.The depth of the puncture and the number of particles implanted per puncture passage.The procedure of implantation:routine disinfecting and laying towel,marking puncture site with methylene blue.Each puncture site was implanted with 2⁴ plaques according to the depth of the lesion.Local compression and hemostasis were performed under pressure bandage.After 2⁵ days of operation,the patients were discharged from hospital.Follow-up and observeAfter 6 months of plaque implantation,they were reviewed every month for 6months.During 6 months to 2 years,they were reviewed every 3 months.During 2-5years,they were reviewed every 6 months.For 5 years,they were reviewed 1 or 2times a year.The tumor control and radiotherapy complications were observed.Diagnosis of tumor control:?1?Effective control:no local recurrence and spread sign;?2?Local spread:for the expansion or local spread of the original focus,found a new local focus of metastasis;?3?Transfer:the lesion through lymphatic,blood route metastasis,to the ear,submaxillary and cervical lymph nodes,or lung,liver,brain and other areas of metastasis.¹²⁵I plaque local radiotherapy complications:?1?Complications of puncture implantation:intraoperative puncture bleeding,eyeball,optic nerve and craniocerebral puncture injury;whether eyelid orbital congestion and hematoma occur within a few days after operation,and whether there is postoperative infection.?2?Early complications of radiotherapy:observation of ocular surface irritation,corneal and conjunctival surface,eyelid skin,loss of eyelashes and eyebrows,dry eyes,etc.?3?Late complications of radiotherapy:after 6 months,the radiation effect was basically attenuated,and the residual effects of late radiotherapy,including orbital skin sclerosis,dry eye disease,cataract,fundus ischemic lesion,etc.Supplementary implantation and implantation:Routine CT scan 2 to 7 days after particle implantation.If the particle implantation is not in place?without covering the tumor bed range?,the implantation can be supplemented.As the follow-up,found suspicious lesion recurrence or local spread,again or multiple plaque implantation control lesions.ResultParticle implantationAll 16 patients were implanted with ¹²⁵I plaques approximately 1 month after surgical resection of the tumor and pathology.In 11 cases,no recurrence and spread were observed in one plaque implantation follow-up.In 5 cases,more than 2 times of plaque implantation control the lesion.The 5 cases with more than 2 times of plaque implantation were recurrent adenoid cystic carcinomas,of which 3 cases were performed with 2 times of plaque implantation:1 case 7 years after the first plaque implantation,1 case 4 months and 1 case 5 months,the suspicious local spread was followed up,and there was no recurrence and spread after more than 2 years of follow-up after secondary implantation.One case of adenoid cystic carcinoma was performed with 3 times of plaque implantation:5 months and 1 year and a half after the first time of plaque implantation.Local sprawl was found after follow-up,and two additional implantations were performed.Follow-up 4 years of disease control,no recurrence and metastasis.1 case for 4 times of plaque implantation:a recurrence of adenoid cystic carcinoma of the lacrimal gland with a wide range.Four years,five years,and six years after the first plaque implantation,have had supplementary plaque implantation 3 times because of local spread.No recurrence was found after 2years followed up.Evaluation of curative effectFollow up time and condition:The longest follow-up was 9 years,the shortest follow-up was 18 months,the average follow-up time was 3.6 years.11 cases were implanted in place and control lesions;local spread was observed in 5 cases,3 cases of 2 times of particle implantation,1 case of 3 times,and 1 case of 4 times to control lesions.16 cases were not found local lymph node and systemic blood metastasis.ComplicationComplications of puncture and implantation:No invasive injury was found in16 cases to the globe,optic nerve and brain.There were no cases of puncture infection.Early complications of radiotherapy:Ocular surface irritating symptoms and signs were seen in 13 cases within 1³ months,1 cases with severe irritation.There were 8 cases with xerophthalmia,6 cases with mild conjunctival hyperemia,pachyblepharon,eyelashes or eyebrows off,corneal edema,corneal epithelial loss,and 4 cases with skin stigmata and chromatosis.Some of these complications were gradually relieved after 3 months.Late complications of radiotherapy:Vision loss and visual field damage occurred in 1 case,xerophthalmia in 2 cases,pigmentation of eyelid in 1 case,no radioactive cataract,retinopathy and atrophy of eyeball.Conclusion¹²⁵I plaque implantation for treating malignant tumors and recurrent mixed tumor of lacrimal gland has an effective local tumor control and less complications.It is recognised an effective method for treatment of recurrent lacrimal epithelial tumors.