Effectiveness and safety of a robot-assisted 3D personalized template in  125 I seed brachytherapy of thoracoabdominal tumors

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Abstract

Purpose

This research aims to evaluate the effectiveness and safety of a robot-assisted 3D personalized template in ¹²⁵I seed brachytherapy of thoracoabdominal tumors.

Material and methods

Forty-three patients with different tumors were involved in this research between 2013 and 2015. They were all eligible to ¹²⁵I seed implantation based on robot-assisted 3D personalized template. Meanwhile, 51 patients with similar tumors, which were treated with a conventional coplanar template, were involved for comparison. Follow-up was carried out after the surgery to evaluate the therapeutic efficacy, including overall survival (OS) of the patient and local control (LC) of the tumor. Complications were also summarized to evaluate the safety. Besides, statistical analysis was achieved to investigate possible factors associated with the result.

Results

In the robot-assisted 3D personalized template-guided brachytherapy, the median target volume treated by the prescription dose (V ₁₀₀) was 95.3% (range, 92.4-109.8), and the median dose administered to 90% of the target volume (D ₉₀) was 126.1 Gy (range, 114.2-132.0), improved 5% and 8% compared with the conventional template-guided brachytherapy, respectively. The median OS was 30 months (95% CI: 19.4-40.6) and the rates of 2-year OS and LC were 58.1% and 86.0%, respectively. The median OS was prolonged 10 months and the 2-year OS and LC were improved 18.9% and 23.3% compared with the conventional template-guided brachytherapy, respectively.

Conclusions

Through analysis of the selected patients with thoracoabdominal tumors, the robot-assisted 3D personalized template in ¹²⁵I seed brachytherapy was a more effective and safer method. It can achieve a more favorable OS and LC.

Related collections

Most cited references 26

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Impact of Radiotherapy on Complications and Patient-Reported Outcomes After Breast Reconstruction

Reshma Jagsi, Adeyiza O. Momoh, Ji Qi … (2018)

Background Patients considering postmastectomy radiation and reconstruction require information regarding expected outcomes to make preference-concordant decisions. Methods A prospective multicenter cohort study of women diagnosed with breast cancer at 11 centers between 2012 and 2015 compared complications and patient-reported outcomes of 622 irradiated and 1625 unirradiated patients who received reconstruction. Patient characteristics and outcomes between irradiated and unirradiated patients were analyzed using t tests for continuous variables and chi-square tests for categorical variables. Multivariable mixed-effects regression modelsassessed the impact of reconstruction type and radiotherapy on outcomes after adjusting for relevant covariates. All statistical tests were two-sided. Results Autologous reconstruction was more commonly received by irradiated patients (37.9% vs 25.0%, P < .001). Immediate reconstruction was less common in irradiated patients (83.0% vs 95.7%, P < .001). At least one breast complication had occurred by two years in 38.9% of irradiated patients with implant reconstruction, 25.6% of irradiated patients with autologous reconstruction, 21.8% of unirradiated patients with implant reconstruction, and 28.3% of unirradiated patients with autologous reconstruction. Multivariable analysis showed bilateral treatment and higher body mass index to be predictive of developing a complication, with a statistically significant interaction between radiotherapy receipt and reconstruction type. Among irradiated patients, autologous reconstruction was associated with a lower risk of complications than implant-based reconstruction at two years (odds ratio [OR] = 0.47, 95% confidence interval [CI] = 0.27 to 0.82, P = .007); no between-procedure difference was found in unirradiated patients. The interaction was also statistically significant for satisfaction with breasts at two years ( P = .002), with larger adjusted difference in satisfaction between autologous vs implant approaches (63.5, 95% CI = 55.9 to 71.1, vs 47.7, 95% CI = 40.2 to 55.2, respectively) in irradiated patients than between autologous vs implant approaches (67.6, 95% CI = 60.3 to 74.9, vs 60.5, 95% CI = 53.6 to 67.4) in unirradiated patients. Conclusions Autologous reconstruction appears to yield superior patient-reported satisfaction and lower risk of complications than implant-based approaches among patients receiving postmastectomy radiotherapy.

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C Earle, Leland E Lim, Patrick Chien (2002)

To analyze prognostic factors influencing pancreatic cancer survival following curative resection, using prospectively collected, population-based data. Several studies have analyzed the determinants of long-term survival in postresection pancreatic cancer patients, but the majority of these have been single-institutional chart reviews yielding inconsistent results. This retrospective cohort study examined 396 Medicare-eligible patients over age 65 who were diagnosed with nonmetastatic pancreatic adenocarcinoma and who underwent surgical resection with curative intent while residing in one of the 11 Survival, Epidemiology, and End Results (SEER) registries between January 1991 and December 1996. Linked Medicare data provided information on treatment and comorbidity, while linked census tract data supplied sociodemographic characteristics. Median survival for the overall study population was 17.6 months, with 1- and 3-year survival rates of 60.1% and 34.3%, respectively. Survival appears to be gradually improving over time, concomitant with a rise in the proportion of patients undergoing surgery in teaching centers. Prognostic variables significantly diminishing survival on univariate analysis included African American race, treatment not in a teaching hospital, lack of adjuvant chemoradiation therapy, as well as histopathologic factors that included tumor size larger than 2 cm in diameter, moderate to poor histologic grade, and positive lymph node metastases. Higher socioeconomic status was associated both with an increased likelihood of receiving adjuvant therapy and improved overall survival. Multivariate analyses indicated the strongest predictors of survival were adjuvant combined chemoradiotherapy, small tumors (<2 cm in diameter), negative lymph nodes, well-differentiated histology, undergoing surgery in a teaching hospital, and high socioeconomic status. Although biologic characteristics remain important predictors of survival for patients with resected pancreatic cancer, the most powerful determinant is postoperative adjuvant chemoradiation therapy. An interesting finding that warrants further investigation is the effect of socioeconomic status on both the likelihood of receiving adjuvant treatment and subsequent survival, indicating a possible relationship between the quality of care delivered and outcomes.

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Clinical efficacy of CT-guided iodine-125 seed implantation therapy in patients with advanced pancreatic cancer.

Chen Kemin, Huang Gang, Liu Yu … (2010)

To examine the clinical efficacy of CT-guided radioactive iodine-125 (125I) seeds implantation treatment in patients with unresectable pancreatic cancer. Thirty-one patients with inoperable pancreatic cancer were enrolled in this study. The 125I seeds were implanted into pancreatic tumor under CT guidance. In addition, 10 patients received routine gemcitabine and 5-fluorouracil chemotherapy 1 week after brachytherapy. Median diameter of the tumor was 5.8 cm. Follow-up period was 2 to 25 months. Symptoms of refractory pain were significantly resolved post-interventionally (P < 0.05), and Karnofsky physical score increased dramatically (P < 0.05). Tumor response which was demonstrated on repeated CT film 2 months post-treatment revealed complete response (CR) in 3 cases, partial response (PR) in 16 cases, stable disease (SD) in 9 cases, and progressive disease (PD) in 3 cases. Overall responding rate (CR+PR) was 61.3%. Median survival time for all patients was 10.31 months. Two seeds of radioactive 125I migrated to the liver in 2 patients. There were no serious complications detected during the follow-up period. This study suggests that CT-guided brachytherapy using 125I seeds implantation appears to be safe, effective, uncomplicated, and could produce adequate pain relief for treating unresectable pancreatic cancer.

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Author and article information

Journal

Journal ID (nlm-ta): J Contemp Brachytherapy

Journal ID (iso-abbrev): J Contemp Brachytherapy

Journal ID (publisher-id): JCB

Title: Journal of Contemporary Brachytherapy

Publisher: Termedia Publishing House

ISSN (Print): 1689-832X

ISSN (Electronic): 2081-2841

Publication date (Electronic): 31 August 2018

Publication date (Print): August 2018

Volume: 10

Issue: 4

Pages: 368-379

Affiliations

[1 ]School of Mechanical Engineering, Tianjin University, Tianjin

[2 ]Department of Oncology, the Second Hospital of Tianjin Medical University, Tianjin, China

Author notes

Address for correspondence: Prof. Shan Jiang, MD, School of Mechanical Engineering, 92 Weijin Road, Nankai District, 300350 Tianjin, China, School of Mechanical Engineering, Tianjin University, Tianjin, China. phone: + 86-22-85356612. ✉ e-mail: shanjmri@ 123456tju.edu.cn

Article

Publisher ID: 33592

DOI: 10.5114/jcb.2018.77957

PMC ID: 6142644

PubMed ID: 30237820

SO-VID: 8d7820a0-a551-4be8-a398-d77fd7d7e1ec

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.