Iodine-125and5-fu Seed Implantation For The Treatment Of Head And Neck Cancer By CT-guided

Background and PurposeHead and neck cancer is the sixth most common malignancies, whichaccounts much for disfigurement of oral and maxillofacial region. In recent years,the annual incidence has reached15.22/1000,000in our country. Despite greatdiversity in individual morbidity, this cancer has five distinct characteristics for allpatients, including high invasion, high relapse rate, high mortality, high disabilityrate and high expense. Though better curative effect may be achieved in somepatients with early cancer through pure surgery or external beam radiotherapy,2/3of patients have already been with advanced carcinoma before they are diagnosed.As the advanced carcinoma has invaded important tissues surrounding it withlymphatic metastasis, excision and conventional external beam radiotherapybecome harder to be performed. Furthermore,30%-40%patients who haveundergone thorough therapy will suffer local recurrence and distant metastasis.Recurrence and metastasis have become the greatest threats for patient’s survival.For patients who are diagnosed with advanced head and neck cancer orsuffering from recurrence and metastasis, the efficacy of conventional treatmentsuch as salvage excision, re-radiotherapy is not promising. In addition, even though some decent progress has been made in the comprehensive treatmentfeaturing radiotherapy and chemotherapy, the limitations and side effects ofconventional radiotherapy and intravenous chemotherapy remain unchanged. Asthe development of modern medicine, the reserve of organ function and enhanceof life quality have become particularly important for patients in tumor treatmentevaluation, along with pursuing prolonged life expectancy. It is still an issue worthconsideration to explore a more effective treatment, which can minimize the harmcaused by the therapy itself with patients being well treated.In this study, we draw on the experience of brachytherapy and interstitialchemotherapy, minimally invasive paracentesis was adopted to conductIodine-125and5-Fu seeds implantation by CT-guided for some patients with headand neck cancer. Further, data of clinical characteristic was concluded andanalyzed for evaluating clinical value of the new minimally invasive therapy inthe treatment of head and neck malignancy.Materials and MethodsA retrospective study was performed. Based on the different treatment,patients were divided into group A and group B. In group A, Iodine-125and5-Fuseeds were implanted simultaneously by CT-guided. In group B, only Iodine-125seeds were used. After the treatment, all patients were followed up to analyze thechanges of clinical data. Local efficacy, degree of pain relief, Karnofskyfunctional status and side effect were included. The survival curves were alsorequired to draw. All data we collected were analyzed by using SPSS17.0.According to the different data types, median or interquartile range was used todescribe and T test or chi square was used to compare.ResultsA total of32patients with head and neck cancer were enrolled in this study.Group A consisted of15patients (recurrent tumor9cases and metastasis tumor6 cases), and group B consisted of17patients (primary tumor3cases, recurrenttumor9cases and metastasis tumor5cases). Based on the preoperative planning,the operations were successfully performed in all patients.Refer to the RECIST Version1.1standard, after1,2and6months, the localeffective rate was60%,80%,80%and the local control rate was100%,100%,86.7%, respectively in group A. At the same time, the local effective rate was23.5%,64.7%,70.6%and the local control rate was100%,94.1%,70.6%,respectively in group B. One month after treatment, the effective rate in group Awas significantly higher than B, the difference was statistically significant(P=0.036).According to the VAS score standard, the pain control rate was81.8%ingroup A and88.2%in group B. There was no statistically significant differencebetween the groups (P=0.836).The evaluation of KPS was recorded as follows:2months after treatment, theproportion of patients above80points increased to80%in group A and88.2%ingroup B. Statistically significant difference could be found in the two groups (P＜0.05)．According to CTCAE (v4.02:2009/9/5), no patients had toxicity gradingachieved grade3or more. There are no significant differences in some importantbiochemical markers in pre-operation and post-operation. Significant changes inliver and kidney functions were not found.Group A patient’s median survival time was18months (range5-30month),the accumulative survival rate in1,2years was73.3%,33.3%. Group B patient’smedian survival time was15months (range5-32month), the accumulativesurvival rate in1,2years was64.7%,23.5%. The two groups had no statisticallysignificant difference in survival curve.ConclusionCT-guided iodine-125seed implantation or combined with5-Fu seedimplantation for head and neck cancer was feasible and safety.5-Fu seed can significantly enhance the effect without additional complications. This therapy canquickly control the growing of tumor and relieve pain. Besides, it can improve thelife quality of the patient and may prolong the survival time. But there is still alack of large randomized control study, further discussion would be done.