| (ONE)Study of effect of CT electromagnetic navigation system forguiding 125 I radioactive seeds implantation in spinal metastatic tumorsObjective: Through the control study of 125 I seed implantation spinal metastatic tumors guided by CT electromagnetic navigation system and traditional CT, we aim to compare the difference of puncture time and radiation doses between the two imaging guiding methods, and to evaluate the efficiency of these two methods.Methods: A total of 45 cases of spinal metastatic tumors with spinal compression were collected, including 22 men and 23 women aged 52–76 years(mean age: 62 years). Twenty cases were treated by CT electromagnetic navigation system guided 125 I seed implantation. Twenty-five cases were treated by traditional CT guided 125 I seed implantation as control group. Record data about time of puncture, times of puncture needle adjustment, CT scan times and CT radiation doses(dose length product).Results: Puncture needle insertion succeeded in both groups. Mean puncture needle adjustment was 0.3±0.1277 for CT electromagnetic navigation system group( navigation group for short) and 2.08±0.1143 or traditional CT group(CT group for short). Mean puncture time was(234.7±11.71)s for navigation group and(421.5±10.51)s or CT group. Mean scan times was 2.300±1.277 for navigation group and 4.080±0.1143 for CT group. Mean dose length product was(176.4±11.19)m Gycm for navigation group and(299.9±8.402)Gycm for CT group. According to the statistical analysis, the differences between two groups were statistically significant in puncture needle adjustment, puncture time, scan times and mean dose length product(P<0.0001), each was less in navigation group than in CT group. Navigation image aiming accuracy was less than 5mm in 18 cases, 5-10 mm in 2 cases, no case was more than 10 mm. There was no severe complication occur in both groups such as massive hemorrhage and injure of spinal cord.Conclusions: CT electromagnetic navigation system guided puncture needle insertion can reduce puncture needle adjustment, puncture time, scan times and radiation doses than guided by traditional CT. Both of these two guiding methods showed good safety. ABSTRACT(TWO)Clinical efficacy of CT electromagnetic navigationsystem-guided 125 I radioactive seeds implantation therapy in spinalmetastatic tumors with spinal compressionObjective: The purpose of this study was to examine the safety and clinical efficacy of CT electromagnetic navigation system-guided radioactive 125 I radioactive seed implantation treatment in spinal metastatic tumors with spinal compression.Methods: A total of 20 cases of spinal metastatic tumors were collected, including twelve men and eight women aged 48–75 years(mean age: 65 years). All the patients suffered severe pain, 12 of them accompanied with nerve function impairment. We used treatment planning system(TPS) to construct three-dimensional images of the spinal metastatic tumors and to determine what number and dose rate distribution to use for the 125 I seeds. The matched peripheral dose of the 125 I seed implantation was 90–130 Gy. Twenty-four spinal metastatic tumors were treated by CT electromagnetic navigation system-guided radioactive 125 I seed implantation. A median of 19(range: 4–43) 125 I seeds were implanted. Numerical rating scale was used to evaluate pain relief. ASIA criteria was used to evaluate nerve funtion. WHO efficacy evaluation criteria was used to evaluate the efficacy for treating spinal metastatic tumors.Results: Twenty cases were followed for a median of 15.3 months(range: 7–32 months). The rate of pain relief was 95%. The median survival time for all of the patients was 16 months(95 confidence interval:13-27 months). The cumulative 6- and 12-month survival rates were 100% and 78.81%, respectively.The median control time for all of the patients was 12.5 months(95% confidence interval:8-15.5 months). The 3-, 6-, and 12-month cumulative local control rates were 100%, 95%, and 60%, respectively. The neural functional recovery rate was 50%(6/12) three months after 125 I seeds implantation. The cord doses were ≤30Gy, and the doses for the other OARs, such as the intestine and liver, were <25Gy. No major complications were observed. No 125 I seeds were lost or migrated to other tissues or organs.Conclusions: CT electromagnetic navigation system-guided radioactive 125 I seed implantation is a safe, effective, and minimally invasive method for the treatment of patients with spinal metastatic tumors with spinal compression. It is a possible alternative therapy for the treatment of spinal metastases. |
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