Clinical Study On The Effect Of ¹²⁵I Seeds Implantation In The Treatment Of Refractory Head And Neck Tumors

OBJECTIVE:To investigate the side effect and safety of the treatment in refractory head and neck tumors with radioactive ¹²⁵I seeds interstitial implantation.METHODS:Between October 2016 to June 2019,24 patients of refractory head and neck tumors received radioactive ¹²⁵I seeds implantation in Affiliated Zhongshan hospital of Dalian University,and included in the study.Among them,there were 8patients with recurrence,10 patients with metastatic lymph nodes and 6 patients with primary disease.There were 12 male patients and 12 female patients,aged 47?95 years,median 78 years old.All patients had clearly pathological diagnosis.Routine examination and CT scan positioning were performed in one week before the operation,and the images were uploaded to a treatment planning system?TPS?.All patients carried out preoperative planning design and individual guide plate production.The prescription dose of GTV was 100?160Gy,median 138Gy,and the seeds activity were0.4?0.8m Ci?median 0.6m Ci?.CT-guided radioactive ¹²⁵I seed implantation was performed,with 3-77 seeds implanted?median 32?.All patients carried out postoperative dose assessment and symptomatic treatment such as infection prevention and hemostasis were performed at the same time.Imaging examination and telephone follow-up were reviewed every 3 months for 3 years after seeds implantation.Follow-up to December 2019,observed the clinical efficacy,local control time,and local control rate.Side effects in the skin,mucosa membranes,peripheral nerve injury and pain relief were evaluated.RESULTS:All patients were operated successfully.The actual postoperative GTV D₉₀was 94?175Gy,GTV D₁₀₀was 48?134Gy,GTV V₉₀ was 86.6%?100%,GTV V₁₀₀was70.1%?100%.All patients were followed-up for 6?37 months?median 12.5months?.The local control time was 6?37 months?median 12 months?.According to RECIST v1.1 standard,CR was shown in 10 cases,PR in 7 cases,SD in 2 cases and PD in 5 cases.The local control rate was 100%at 6 months,83.3%at 12 months and 79.2%at 24 months.Five patients had grade one skin reaction.Two patients experienced grade two skin reactions,two experienced grade two mucosal reactions.No peripheral nerve injury was observed.And there were no adverse reactions at grade three or above.Only one patient had two seeds fall off after the operation,and the rest did not see any seeds displacement or fall off.Twelve patients had cancerous pain before operation.The NRS score was 6.08±1.16 before operation,3.67±1.07 at 1 month after operation,2.33±0.98at 3 months after operation,1.91±0.99 at 6 months after operation,and 2.12±1.45 at12 months after operation?P<0.05?.7 patients were treated with oral opioid analgesics before operation,and 6 patients had significant pain relief after operation.One patient suffered from aggravated pain due to tumor progression at 7 months after operation.As of December 2019,9 patients died,of which 4 were due to local uncontrolled tumors,2were due to pulmonary infections,and 3 were due to distant metastases,but the local lesions treated with seed implantation were well controlled.CONCLUSIONS:Radioactive ¹²⁵I seed implantation is a safe,accurate,minimally invasive,effective and reliable treatment method for refractory head and neck tumors with good local control effect,small adverse reactions and effective relief of cancer pain.