Efficacy Evaluation Of Ultrasound-guided Radioactive ¹²⁵I Seed Implantation In Pelvic Sacral Malignancies

Objective:To investigate the efficacy and safety of ultrasound-guided transrectal/vaginal/perineal puncture radioactive ¹²⁵I seed implantation in pelvic sacral malignancies.Methods:A total of 19 patients with pelvic sacral malignant tumor who met the inclusion criteria and went to the China-Japan Friendship Hospital of Jilin University from April 2012 to December 2022 were collected,including8 males and 11 females,aged 30-82 years old,with an average age of57.7±13.8 years old.There were 29 lesions,6 cases were primary low rectal cancer,13 cases were postoperative recurrence or metastasis of rectal cancer,7 cases were postoperative metastasis of colon cancer,1 case was primary prostate cancer,1 case was postoperative recurrence of cervical cancer,1 case was primary cervical cancer,the maximum diameter range of all lesions was 1.4-13.3cm,and the maximum median diameter was 2.8cm.Ultrasound-guided radioactive ¹²⁵I seed implantation was performed.After clinical and imaging evaluation,transrectal/vaginal/perineal puncture was required for all patients.Postoperative efficacy and safety were evaluated by imaging,laboratory indicators,symptom changes,survival time and complications.Result:1.Local tumor control:There were 29 lesions,0 were CR,9 were PR,17 were SD,3 were PD,and the effective rate（CR+PR+SD）was 89.7%（26/29）after 2 months surgery;11were CR,13 were PR,and 2 were SD,3were PD,and the effective rate was 89.7%（26/29）after 6 months surgery.The median maximum tumor diameter before surgery was 2.8（2.0,3.8）,2months after surgery was 2.3（1.4,3.6）,and 6 months after surgery was1.5（0,2.7）,the difference between the three groups was statistically significant（p<0.001）;Pairwise comparison of the maximum tumor diameter before surgery,2 months after surgery and 6 months after surgery showed statistically significant differences（p<0.05）.2.Relief of clinical symptoms:（1）Pain relief:Among the 19 patients,12patients had different degrees of perineal and/or perianal,hip and lower abdominal pain before the operation.2 months after surgery,8 cases had complete relief,1 case had partial relief,1 case had mild relief,and 2cases had ineffective pain relief,and the pain relief rate was83.3%（10/12）.（2）Relief of other clinical symptoms:Among the 19patients,9 had different degrees of mucous stools,bloody stools,posterior leurgy and increased frequency of defecation before surgery,2cases were accompanied by vaginal bleeding,and 1 case was accompanied by dysuria.2 days after surgery,other clinical symptoms of11 patients began to be relieved to varying degrees;2 months after surgery,all the above symptoms disappeared completely,and the remission rate was 91.7%（11/12）.3.Serum tumor marker changes:In 16 of the 19 patients,primary tumors were colorectal cancer,the median preoperative CEA was 5.53（1.62,30.23）,and 4.47（1.92,17.46）two months after surgery.The median CEA level 2 months after surgery was lower than that before surgery,but there was no statistical significance between the two groups（p>0.05）.In2 cases,primary tumors were cervical cancer,the median CA125 before surgery was 18.28（13.40,14.02）,and 16.34（9.27,15.24）two months after surgery.The median level of CA125 two months after surgery was lower than that before surgery,but there was no significant difference between the two groups（p>0.05）.In one case,the primary tumor was prostate cancer,and the Alpha-Feto Protein（AFP）level decreased 2 months after surgery,and all were within the normal range.Serum tumor marker levels of primary tumors in 9 of the 19 patients were in the normal range before surgery and 2 months after surgery,CEA levels in 9 patients（all primary tumors were colorectal cancer）were higher than the normal range before surgery,2 months after surgery,CEA levels in 2 of the 9 cases decreased to the normal range,5 cases decreased to different degrees,and 2 cases increased to different degrees,in another case（primary tumor was rectal cancer）,CEA level was in the normal range before surgery and increased2 months after surgery.4.Postoperative survival:The cumulative survival rates of 6 months,2years and 3 years were 100%,88.2%and 64.7%,respectively.The median survival time was 40.0 months.5.Complications:Among the 19 patients,a small amount of tumor bleeding occurred in 1 case,postoperative radiation enteritis occurred in 1case,no special treatment was given to the above two cases and they were self-alleviated.No complications such as massive vaginal fistula,urethral fistula,pelvic bleeding and particle displacement occurred in all patients.Conclusion:1.Ultrasound-guided transrectal/vaginal/perineal puncture radioactive¹²⁵I seed implantation has definite efficacy in the treatment of pelvic sacral malignancies,which can effectively control local tumors,relieve patients’clinical symptoms,and improve patients’quality of life.2.Ultrasound-guided transrectal/vaginal/perineal puncture radioactive¹²⁵I seed implantation in the treatment of pelvic sacral malignancies with few postoperative complications,mild,safe and feasible.