| Objective: To evaluate the feasibility, safety, and efficacy of CT-guided permanent iodine-125 seed implantation for lung and mediastinal tumor. Methods: 54 cases of lung and mediastinal tumor were underwent CT-guided interstitial 125I seeds implantation with low-released 5-fu, in which there are 43 cases of lung tumor and 16 cases of mediastinal tumor.In 43 cases of lung tumors, male 31, femal 12. Age from 56-82 years, mean 67 years old .16 cases have the related symptoms and 11 cases once had other treatments. The sites are central 10 cases and peripheral 29 cases. Primary bronchogenic carcinoma 39 cases(small cell lung cancer 7 cases, squamous carcinoma 15, adenocarcinoma 11 and large cell carcinoma 6 cases), recurrent lung adenocarcinoma 2, metastasis 2 . TNM stages: Ⅱ BIO, Ⅲ A 15, Ⅲ B 11, Ⅳ 3 。In 16 cases of mediastinal tumors, male 11, femal 5. Age froml7-65 years, mean 67 years old .9 cases have the related symptoms and 1 case once had other treatments. The sites are anterior mediastinum 5 cases, middle 10 and posterior one case. Miligement thymoma 3 cases, lymphoma 5 cases, undefferential tumor 2 cases and metastasis 8cases.Appliance and equipments: (1) CT scanning appliance: Four-spiral CT (Philips, Mx8000) (2)Puncture guiding system: laser navigating system (Philips, pinpoint) (3) The treatment planning system for permanent iodine-125 seed implantation (HGGR-3000 type,) (4) Implanted instrument: 18G implanted needle and turntable pistol(provided by HOKAI Company), IM6711-125I seeds. (5) Slowly released chemical medicine: 5-FU pyrimidine.All patients were performed under multi-spiral CT (Philips, Mx8000) with laser navigating system (pinpoint) according to TPS, using the way of percutanous puncture to put the seeds and chemical medicine into the tumors and related area of lymph drainage respectively. For mediastinal tumor, the first step was to make artificial pneumothorax then to do the percutanous puncture and implant seeds.Using CT to follow up and observe the changes of tumor sizes and clinical symptom.Evaluation of improvement of clinical symptom : ? Complete remmision (CR) :The symptom of respiratory system was completely vanished after treatment. ? partial remmision ( PR): The symptom of respiratory system was obviously alleviative ,and there were no effect on patients'sleep basically.Patients could live a normal life. (3) Minimal remmision (MR) : The symptom of respiratory system was alleviative, but there were have bad effect on patients'sleep. ? no remmision ( NR ) : The symptom of respiratory system wasn't alleviative or aggravated to the same degree beforer alleviation and even became more serious.Evaluation of tumor's size : CD Complete remmision (CR): We only could observe the high-density radioactive seeds in CT imaging. (2) partial remmision (PR): The volume of tumor reduced^ 25% in CT imaging.?Minimal remmision (MR): The volume of tumor reduced< 25% in CT imaging or reduced =^25% but then increased. @no remmision (NR): The volume of tumor had no change or increased or reduced firstly but then incrensed to the same size or more than before treatment.Evaluation of controlling lymph node metastasis: ? Complete remmision ( CR): There were no new lymph node metastasis in the neighbourhood after treatment, ?partial remmision ( PR): There were new lymph node metastasis in the neighbourhood after treatment but the number<3 and the maximum diameter<10 mm. ?Minimal remmision (MR) : There were new lymph node metastasis in the neighbourhood after treatment but the number < 5 and the maximum diameter < 15mm. Those lymph node didn't mix together.? no remmision (NR) :There were extensive lymph node metastasis and those lymph node mixed together.The group of effective treatment included CR and PR, the group of failing to respond to treatment included MR and NR.Evaluation of curative effect: We applied statistical software (SPSS 10.0 for windows)to analyse the conditions of tumor's size ,clinical symptom and lymph node metastasis before and after treatment,and carry out matched t-test. P<0.05 had statistical differences, P<0.01 had extremely statistical differences.Results There were 10 cases central lung cancer in the 43 lung tumorsj cases had atelectasis, but 1 month after treatment,we found the patients recover from atelectasis,and the feel of short of breath disappeared. 4 cases had pneumothorax in the process of implantation(2 cases had pneumoderma), we did nothing for 3 cases , and for the fourth case we only exhausted the air in the next day. 9 cases had phlegm with blood in the three days after implantation,without special treatment.We checked patients' routine blood test and functional liver test before implantation and after implantation( one week, two weeks, four weeks,eight weeks). 2 cases' liver function had minor abnormality before implantation, after implantation there were no change.41 cases'liver function were normal. 43 cases' routine blood test didn't change.In the 12 months follow- up, 7cases had metastasis in different organs,5 cases lost connection in the follow-up between 6-12 months.The number of adjusting the needle's orientation in the lesion was from 1 to 9 times(mean 4.46) .The time of puncture was 56-135 min(mean 116).The size of tumor was 3-56mm(mean 3.75cm).The number of seeds was 3-56(mean27.35).The activity of seeds was 0.61.0 mci,The absorption dosimetry of tissue was 555 11760 cGy away 5mm from the seed(mean 5395.75 cGy).6 cases had twice implantation , interval time was 2-4 months. 1 case had thrice implantation.There were no complication such as seeds migration, radioactive pneumonia in all patients Improvement of symptom : 16 cases had symptom of respiratory system such as sense of suppression in the chest, feel of short of breath, dry cough, hoarseness. 1 case died of myocardial infarction.The clinical effective rate respectively was 81.25% ( 13/16) in first month, 87.5% (14/16) in third month, 75% in the sixth month, 66.67% (10/15) in twelfth month.Tumor size : The effective rate respectively was 93.02% (40/43) in first month, 97.67% (42/43))in third month, 81.39% ( 35/43 ) in the sixth month, 73.68 % ( 28/3 8 ) in twelfth month( 5 cases lost connection in the 6-12 follow-up).There were extremely statistical differences in the 1-6 month folloe-up, statistical differences in the 12 month folloe-up. We implanted the slowly released chemical medicine( 5-FU pyrimidine seed)to the area of lymph drainage in order to prevent and control lymph metastasis. The effective rate respectively was 100% (28/28) in first month, 100% (28/28)) in third month, 85.71% in the sixth month, 77.77 (21/27) in twelfth month.1 case died of brain stroke.16cases of mediastinal tumor:The size of tumor was 23-61mm(mean 43mm).The number of seeds was ll-38(meanl8.5).The activity of seeds was 0.60.8 mci, The absorption dosimetry of tissue was 2033.65 7060.14 cGy away 5mm from the seed(mean 3756.75 cGy).13 cases use artificial pneumothorax, he number of adjusting the needle'sorientation in the lesion was from 1 to 6 times(mean 3.86) .The time of puncture was 75-160 min(mean 139).There were no complication such as seeds migration, radioactive pneumonia in all patients.The effective rate respectively was 93.75% ( 15/16) in first month, 100% (16/16) in third month, 81.25% (13/16) in the sixth month, 75 % (12/16) in twelfth monthConclusion CT guided percutaneous permanent iodine-125 seed implantation has a very effective result in controlling the seeded tumors, especially for the patient who can not accept the radiotheraphy and chemical theraphy .this method was a safe, reliable and effective curative method for chest tomor.
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