Clinical Application Of ¹²⁵Ⅰ Seed Implantation To Locally Advanced And Advanced Non-small Cell Lung Cancer

¹²⁵I seed implatation has been extensively applied in malignant tumor treatment in recent years as a branchytherapy method and one of the comprehensive therapy technique.Researchers among the world have applied ¹²⁵I seed implatation to early lung cancer as postoperation adjuvant branchytherapy,as radical radiotherapy,as palliative care for advanced lung cancer and metastasis tumor from lung cancer,and the clinical effects of seed implatationwere positive.American consults had come through American Brachytherapy Society consensus guidelines for thoracic brachytherapy for lung cancer in 2015 and established the position of seed implantation.Otherwise,it was absent on large-scale,multi-center,randomized controlled trail on seed implantation,there was no consensus on right application time, and no right implanting methods for different treatment aims.Seed implatation was only a technique and have not developed to a subject.This study firstly confirm the treatment aim,then implant the radioactive seed and observe the clinical effect of lung cancer treated by ¹²⁵I seed implatation.Part ICT Guided ¹²⁵I Seed Implantation for residual lesion of locally advanced lung squamous cell cancer after chemoradiotherapyObjective The residual lesions of stage III lung squamous cell cancerafter chemoradiotherapy were performed ¹²⁵I seed implantation,then to observe the effects and safety of ¹²⁵I Seed Implantation for residual lesion of locally advanced lung squamous cell cancer after chemoradiotherapy.Method 120 stage IIIlocally advanced lung squamous cell cancer patients with residual lesions after chemoradiotherapy were divided into two groups,60 patients were in observed group and 60 in controlled group,the controlled group took traditional Chinese herb medicine and symptomatic supportive treatment,the observed group either took traditional Chinese herb medicine,symptomatic supportive treatmentandreceived ¹²⁵I seed implantation.The local clinical effect of observed group was observed;the progression free suivival（PFS）, overall suivival（OS） and life quality, the complication of the operation were observed too.Result Complete Response（CR） was observed 4 months after implantation in 21 patients among observed group, with Partial Response（PR） in 29 patients, Stable Disease（SD） in 7 patients and Progression Disease（PD） in 3 patients. There were 17 patients of 21 CR patients whose diameter of lesions were smaller than 3cm,4 patients diameter of lesions were lager than 3cm,there was（χ2=10.825,p=0.013）.Local reaction was related to PFS and OS（p<0.01）,the PFS and OS of patient who reached CR was longer than PR and SD,the PD patients was the shortest;the middle PFS of observed group and controlled group was 8.0 months and 7.0 months respectively,HR 1.518, 95%CI 1.024-2.250（p=0.038）.The middle OS of observed group and controlled group was 19.0 months and 17.0 months respectively,HR 1.288,95%CI 0.865-1.917（p=0.213）;The improvement rate of cough 4 months after implantation was 63.3% and 38.3%, the no change rate 26.7% and 40.0%,the deterioration rate was 10.0% and 21.7% in observed group and controlled group respectively,there was statistical difference between the two groups（ χ2=7.867,p=0.020）.The improvement rate of dyspnea walked 4 months after implantation was 40.0% and 20.0%, the no change rate 50.0% and 61.7%,the deterioration rate was 10.0% and 18.3% in observed group and controlled group respectively,there was statistical difference between the two groups（χ2=6.202,p=0.045）.The improvement rate of cough of patients whose local reaction were CR and PR was higher than that were SD and PD（χ2=21.786,P=0.001） in observed group;The improvement rate of dyspnea walked of patients whose local reaction were CR was higher than that were PD, SD and PD（χ2=20.775,P=0.002）.There were 11 patients suffered pneumothorax,5 patients suffered hemoptysis,3 patients suffered seed translocation.Conclusion Seed implantation can improve the PFS of locally advanced non-small cell lung cancer,ameliorate cough and dysnpea walked of patients;Patients who got better locally controlled tend to get longer PFS and ameliorate cough and dysnpea walked more probably;seed implantation failed to prolong the OS.PART IICT Guided ¹²⁵I Seed Implantation Combined With Regional Positive Lymph Node Conformal Radiation Therapy in Peripheral Non-Small Cell Lung Cancer preexisting with Interstitial Lung DiseasesObjective To observe the clinical effects and radiation pneumonia（RP） in peripheral non-small cell lung cancer preexisting with interstitial lung diseases（ILD）who received CT guided ¹²⁵I seed implantation combined with regional positive lymph node conformal radiation therapy,and to assess the safety, feasibility and clinical effects of the treating methods.Method The trail included 12 consecutive patients suffered from stage IIIA-IIIB non-smallcell lung cancer and whose pretreatment computed tomography images were evaluated for the presence of ILD.The patients received 3 dimensional conformal radiation therapy（3D-CRT） aimed at positive metastasis lymph nodes, combined with ¹²⁵I seed implantationto the primary lesions in lung.The physical parameters such as V20、MLD、the irradiated ratio of ILD zonewere compared by TPS between the study method and 3D-CRT alone.The incidence of RP, PFS,OS were observed.Result 1 of 12 patients terminated radiotherapy at 50 Gy because of RP, the other 11 patients finished treatment according to TPS. The V20、MLD and the irradiated ratio of ILD zone of the study method was lower than 3D-CRT alone under TPS(p<0.01.RP was observed in 4 patients,Grade 1 was in 2 patients,Grade 2 was in 1 patient and Grade 3 was in 1 patient, and no patients were died from RP.There was no RP occurred in patients whose irradiated ratio of ILD zone was zero.The irradiated ratio of ILD zone of RP patients was higherthan in non-RP patients（p<0.01）,the V20、MLD of RP patients was higher than non-RP patients too,but there was no statistical difference.The disease control rate（complete response 、 partialresponse and stability） for the primary lesions and positive lymph nodes were 100% and 91.7%, respectively. The 6-month and 1-year PFS rates were 91.7% and 25%, respectively, with a median PFS of 10 months.The 1-year and 2-year overall survival（OS） rates were 83.3% and 37%, respectively, with a median OS of 23 months.Conclusion CT guided ¹²⁵I seed implantation combined with regional positive lymph node conformal radiation therapy could reduce V20、MLD、the irradiated ratio of ILD zone compared toconformal radiation therapy only;to lower the irradiated ratio of ILD zone could reduce the occurring possibility of RP;CT guided ¹²⁵I seed implantation in combination with regional positive lymph node conformal radiation therapy were safe and effective.PART IIIClinical effects of ¹²⁵I seed implantation for pulmonary atelectasis of stage IV non-small cell lung cancerObjective To observe the lung re-expansion of patients suffered from pulmonary atelectasis of stage IV non-small cell lung cancer after ¹²⁵I seed implantation,and observe whether the symptom was improved.Method46 stage IVnon-small cell lung cancer patients coexisting with pulmonary atelectasis（non total lung） were been enrolled in this study,and were divided into two groups,23 patients were in observed group and 23 in controlled group.The controlled group received platinum based chemotherapy,the observed group either received platinum based chemotherapy and ¹²⁵I seed implantation.To observed lung re-expansion of patients and improvement of cough and dysnpea.Result There were 15 male,8 female patients in obseved group,mean age 65.3 ± 12.3 years,15 squamous cell carcinoma and 8 adenocarcinoma;There were 14 male,9 female patients in obseved group,mean age 66.5 ± 8.2 years,15 squamous cell carcinoma and 8 adenocarcinoma;there were no statistical difference between the two group in gender,age and pathology（p>0.05）.The number of improvement of cough was 16/23 in observed group,9/23 in controlled group 4 months after seed implantation,there was statistical difference between the groups（χ2=4.293,p=0.038）;The number of improvement of dysnpea walked was 14/23 in observed group,6/23 in controlled group 4 months after seed implantation,there was statistical difference between the groups（χ2=5.662,p=0.017）;the middle cough PFS of observed group and controlled group was 260 ± 11.5 days and 200 ±13.3 daysrespectively,there was statistical difference between the groups（p=0.032）;the middle dysnpea walked PFS of observed group and controlled group was 280 ± 11.4 days and 200 ± 21.5 daysrespectively,there was statistical difference between the groups（p=0.048）.The rate of lung re-expansion73.9%（17/23） in observed group and 34.8%（8/23） in controlled group,there was statistical difference between the groups（ χ2=7.097,p=0.008）.Conclusion¹²⁵I seed implantation could improve the rate of lung re-expansion of stage IV non-small cell lung cancer patients combined with pulmonary atelectasis;¹²⁵I seed implantation could improve the symptom of cough and dysnpea ofpatients and prolong the PFS of cough and dysnpea...