Efficacy Of Ultrasound-Guided Implantation Of Iodine-125 Seed In Treating Recurrent Or Metastatic Abdominopelvic Tumors

Objective:To investigate the clinical efficacy of ultrasound-guided implantation of iodine-125 seed in the treatment of recurrent or metastatic abdominopelvic tumors,as well as the safety and feasibility.Methods:Analyzed retrospectively 36 patients with recurrent/metastatic abdominopelvic tumors(60 lesions),excluding intra-organ metastases,who underwent ultrasound-guided 125I radioactive particle implantation at our institution between January 2012and December 2022.The inclusion criteria were as follows:history of primary tumor and recurrent or metastatic malignant tumor in the abdominopelvic cavity confirmed by relevant examinations;implantation of radioactive particles by ultrasound-guided transabdominal wall puncture;intolerance of conventional treatments such as reoperation or radiotherapy;no serious cardiopulmonary function,coagulation dysfunction,etc.,and ability to tolerate general anesthesia.The imaging examinations(ultrasound,CT or MRI)of the patients were followed up regularly,and the size changes of the lesions were recorded to evaluate the local control of the tumor at 2months after particle implantation.Patients with pain in the preoperative lesion area or within the lesion were counted,and the degree of pain was recorded preoperatively and postoperatively to assess pain relief.Patients’serum tumor marker levels were followed up regularly,and monitoring indicators such as CEA,CA125 and CA19-9were mainly incorporated according to the pathological type of primary tumor,and changes in tumor marker levels before and after implantation were recorded.Routine postoperative follow-up was performed to record patient survival and surgical complications,such as fever,bloating,diarrhea,bleeding,abscess,and infection,to determine whether the procedure was safe and feasible.Results:(1)Clinical data:Among the 36 patients with recurrent/metastatic abdominopelvic tumors(60 lesions)included,13 were male and 23 were female,with an age range of 30-79 years and an average age of 58.3±12.5 years.Pathological types of primary tumors of the 36 patients were 23 cases of gastrointestinal tumors(2 cases of gastric cancer,1 case of smooth muscle sarcoma of small intestine,10 cases of colon cancer,and 10 cases of rectal cancer),5 cases of gynecological tumors(2 cases of ovarian cancer,2 cases of cervical cancer,and 1 case of endometrial cancer),4 cases of pancreatic cancer,and 4 cases of urological tumors(3 cases of bladder cancer and 1 case of adrenal cancer).The locations of the 60 lesions were 42 in the abdomen and 18 in the pelvis,with a median maximum preoperative lesion diameter of 4.0(2.4,7.0)cm.(2)Local control of tumor:The maximum diameter of lesion cross-section (short-axis diameter for pathological lymph nodes)before and two months after implantation were compared,and the control of 60 lesions was as follows:CR 3,PR11,SD 39,PD 7.The local control rate of tumor(CR+PR+SD)was 88.3%.The median maximum tumor diameter was 4.0(2.4,7.0)preoperatively and 3.3(2.0,6.3)2months postoperatively,and there was a statistical difference between the two groups when comparing the maximum tumor diameter preoperatively and 2 months postoperatively(Z=-4.192,P<0.001).(3)Pain relief:Among the 36 patients,there were 31 cases with preoperative pain,of which 12,16 and 3 cases had mild,moderate and severe pain,respectively.There were only 3 cases with unrelieved postoperative pain,and the difference between preoperative and postoperative pain was statistically significant(X~2=43.690,P<0.001).There were 19 cases of complete pain relief,8 cases of partial pain relief,1 case of mild pain relief and 3 cases of no pain relief after two months,and the effective rate was 90.3%.(4)Changes in tumor marker levels:Among the 32 patients included,23 patients had preoperative tumor markers higher than normal,of which 5 decreased to normal,12 decreased but not normal,and 6 increased after surgery,with a decrease rate of 73.9%.9 patients had no abnormal preoperative and postoperative tumor markers.(5)Survival time:The median survival time of 36 patients with recurrent/metastatic abdominopelvic tumors was 15 months.The cumulative survival rates at 6 months,1 year,and 2 years after implantation were77.8%,57.6%,and 24.3%,respectively.(6)Complications:Among the 36 patients,6patients developed complications:4 patients developed fever and temperature less than 39℃ 1-2 days after implantation and 2 patients developed bloating/diarrhea 2-3days after implantation,for a complication rate of 16.7%.After symptomatic treatment,the temperature of patients with fever dropped to normal after 1 day,and patients with bloating/diarrhea were completely relieved after 2 days.No serious complications such as bleeding,abscess,infection,intestinal fistula,or intestinal perforation were observed.Conclusion:(1)Ultrasound-guided implantation of iodine-125 seed is effective in treating recurrent or metastatic abdominopelvic tumors,which can effectively control the local progression of tumors and relieve pain,thus improving the survival quality of patients with advanced tumors.(2)Ultrasound-guided implantation of iodine-125 seed is minimally invasive,and has few complications,which is a safe and feasible treatment modality.