CT-guided radioactive <sup>125</sup>I seeds brachytherapy for lung oligometastases from colorectal cancer: initial results

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Abstract

Objectives

To evaluate the safety and effectiveness of computed tomography (CT)-guided radioactive ¹²⁵I seeds brachytherapy (RISB) for lung oligometastases (LO) from colorectal cancer (CRC).

Methods

Data for 144 LOs from 70 CRC patients who underwent CT-guided RISB were retrospectively analyzed. The primary endpoints were progression-free survival (PFS) and overall survival (OS), and the secondary endpoints were technical success, local control rate (LCR), and complications. Kaplan–Meier method was used for survival analysis. Cox model was used to identify the independent predictors of poor prognosis.

Results

The RISB procedures were successfully performed in all patients, and the success rate was 100%. The median follow-up was 27.8 months. The median PFS was 10.0 months (95% CI: 8.9–11.1) and the 1- and 2-year PFS rates were 32.9% and 5.9%, respectively. On multivariate analysis, serum carcinoembryonic antigen (CEA) ≤ 15 ng/ml ( P = 0.048), middle-high differentiated pathological classification ( P = 0.015), primary TNM stages I-III ( P = 0.001), LO number ≤ 2 ( P < 0.001) and cumulative gross tumor volume (GTV) ≤ 40 cm ³ ( P < 0.001) showed superior PFS. The median OS was 30.8 months (95% CI: 27.1–34.4) and the 1-, 2-, and 3-year OS rates were 95.7%, 67.4%, and 42.5%, respectively. On multivariate analysis, serum CEA ≤ 15 ng/ml ( P = 0.004), middle-high differentiated pathological classification ( P < 0.001), primary TNM stages I-III ( P < 0.001), LO number ≤ 2 ( P < 0.001), cumulative GTV ≤ 40 cm ³ ( P < 0.001) and system treatments combined with chemotherapy and target therapy ( P < 0.001) showed superior OS. The LCR for 3, 6, and 12 months was 97.9%, 91.0%, and 83.6%, respectively. There were 4 cases of pneumothorax at 5.7% that required drainage.

Conclusions

RISB for LO from CRC is safe and effective, and serum CEA, TNM stage, LO number, cumulative GTV, and system treatments should be emphasized for long OS.

Key points

• CT-guided RISB is a new treatment for lung oligometastases from CRC.

• RISB can be an alternative therapy for patients who are unsuitable for surgery, ablation, or SBRT.

• Serum CEA, TNM stage, LO number, cumulative GTV, and system treatments are prognostic factors.

• RISB is a safe method with a curative effect.

Related collections

Most cited references 31

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This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE), endorsed by the European Society for Radiotherapy and Oncology (ESTRO), the European Society of Digestive Endoscopy (ESDO), and the European Society for Clinical Nutrition and Metabolism (ESPEN). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations for malignant disease 1 ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliative treatment of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass (strong recommendation, high quality evidence). 2 For patients with longer life expectancy, ESGE recommends brachytherapy as a valid alternative or in addition to stenting in esophageal cancer patients with malignant dysphagia. Brachytherapy may provide a survival advantage and possibly a better quality of life compared to SEMS placement alone. (Strong recommendation, high quality evidence.) 3 ESGE recommends esophageal SEMS placement as the preferred treatment for sealing malignant tracheoesophageal or bronchoesophageal fistula (strong recommendation, low quality evidence). 4 ESGE does not recommend the use of concurrent external radiotherapy and esophageal stent treatment. SEMS placement is also not recommended as a bridge to surgery or prior to preoperative chemoradiotherapy. It is associated with a high incidence of adverse events and alternative satisfactory options such as placement of a feeding tube are available. (Strong recommendation, low quality evidence.) Main recommendations for benign disease 1 ESGE recommends against the use of self-expandable stents (SEMSs) as first-line therapy for the management of benign esophageal strictures because of the potential for adverse events, the availability of alternative therapies, and costs (strong recommendation, low quality evidence). 2 ESGE suggests consideration of temporary placement of SEMSs as therapy for refractory benign esophageal strictures (weak recommendation, moderate evidence). Stents should usually be removed at a maximum of 3 months (strong recommendation, weak quality evidence). 3 ESGE suggests that fully covered SEMSs be preferred over partially covered SEMSs for the treatment of refractory benign esophageal strictures, because of their lack of embedment and ease of removability (weak recommendation, low quality evidence). 4 For the removal of partially covered esophageal SEMSs that are embedded, ESGE recommends the stent-in-stent technique (strong recommendation, low quality evidence). 5 ESGE recommends that temporary stent placement can be considered for treating esophageal leaks, fistulas, and perforations. The optimal stenting duration remains unclear and should be individualized. (Strong recommendation, low quality evidence.) 6 ESGE recommends placement of a SEMS for the treatment of esophageal variceal bleeding refractory to medical, endoscopic, and/or radiological therapy, or as initial therapy for patients with massive esophageal variceal bleeding (strong recommendation, moderate quality evidence).

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Author and article information

Contributors

Dechao Jiao: jiaodechao007@126.com

Journal

Journal ID (nlm-ta): BMC Cancer

Journal ID (iso-abbrev): BMC Cancer

Title: BMC Cancer

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2407

Publication date (Electronic): 26 February 2024

Publication date PMC-release: 26 February 2024

Publication date Collection: 2024

Volume: 24

Electronic Location Identifier: 265

Affiliations

Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, ( https://ror.org/056swr059) No. 1 Jianshe East Road, Zhengzhou, 450052 China

Article

Publisher ID: 12013

DOI: 10.1186/s12885-024-12013-2

PMC ID: 10895717

PubMed ID: 38403626

SO-VID: 3f2f1ff0-79a5-49c1-b8e5-2b21108ff66d

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 30 August 2023

Date accepted : 16 February 2024

Funding

Funded by: Major Science and Technology Projects of Henan Province in 2022

Award ID: No:221100310100

Funded by: Henan Province Science and Technology Research Project in 2023

Award ID: No:232102311132

Custom metadata

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: lung oligometastases,colorectal cancer,125i brachytherapy,clinical study

Data availability:

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: lung oligometastases, colorectal cancer, 125i brachytherapy, clinical study