Probe Into ¹²⁵I Seeds Implantation Of Hepatic Cancer And Study On Implantation Metastasis In Needle Tract Post Operation

Objective: Radioactive seeds implantation was considered as a perfect treatment to localised prostate cancer, and was attempted to treat other malignant tumors. Treatment of hepatic cancer was a severe matter; however, the cognition change of radiosensitivity of liver gave us a hand. Radiotherapy became more important gradually. Hence, radioactive seeds implantation, as a kind of brachytherapy, was attempted to treat hepatic cancer. During implantation, tumor was punctured repeatedly and the consideration of para-therapeutic implantation metastasis occurred. The first aim of these studies was to probe into curative effect and complications of treating primary and metastatic hepatic cancer using radioactive seeds implantation. And the other aim was to investigate para-therapeutic implantation metastasis in needle tract post operation.Methods: This study was divided into two parts. (1) ¹²⁵I seeds implantation of hepatic cancer: 12 cases of pathologically confirmed primary or metastatic hepatic cancer were implanted radioactive seeds in the way of pre-operation plan designed by treatment planning system according to prescription dose, target volume, and radioactive seeds activity respectively. The ultrasound or CT guided implantation methods was percutaneous puncture or intra-operation implantation through a little incision. The distance of each 2 puncture needles was 1 cm, while distance of each 2 radioactive seeds in the same needle tract was 0.5cm⁰.8cm. The arrangement of all seeds was conform the principal of rarefaction in center and close in periphery. Absolute diet, anti-inflammation, homeostasis and nutritional support were executed post operation. Performance status, peripheral white blood cell (PWBC), glutamate-pyruvate transaminase (GPT), glutamic-oxaloacetic transaminase (GOT), alkaline phosphatase (ALP), tumor size, complications such as fever, hemorrhage, digestive tract reaction were recorded pro- and post-operation. (2) Implantation metastasis in needle tract: 16 cases of malignant tumor patients underwent radioactive seeds implantations. All of them were implanted radioactive seeds in the way of pre-operation plan designed by treatment planning system according to prescription dose, target volume, and radioactive seeds activity respectively. These ultrasound or CT guided implantation methods were percutaneous puncture or intra-operation implantation through a little incision. Superficial tissue of 250 seeding needle cores and 250 stylophores employed in neoplasm radioactive seeds implantation was smeared on slides to search for tumor cells. The distance that the needles traversed in normal tissue was noted. All patients received chemotherapy or endocrine therapy after operations in a sooner time. Tumor cells, doubtful tumor cells and medium to severe atypical cells were considered to be positive cells. The puncture areas from epidermis to tumors were detected by the ultrasound or CT at 10th, 30th, 60th, 180th post operations.Results: (1) ¹²⁵I seeds implantation of hepatic cancer: The length of follow-up was 2 months to 12 months. Comparing images of different time, none was complete remission, and 3 partial remission, 6 stable disease, 3 progressive disease. All patients'performance status including mental status, appetite, and sleep had no obviously change in the first 3 days post operation, while the performance status improved greatly from 7th day after operation. Indices mentioned were compared pre-operation and 1-week post operation: PWBC was significantly different (P<0.05), GPT not significantly different (P>0.05), GOT significantly different (P<0.05), ALP significantly different (P>0.05). Comparisons between pre-operation and 1-month post operation were shown as follow: PWBC was not significantly different (P>0.05), GPT not significantly different (P>0.05), GOT significantly different (P<0.05), ALP significantly different (P<0.05). Local tolerant pain occurred in the first 24 hours and lasted 2 or 3 days. 10 cases (83.3%) developed fever, 2 cases digestive tract reaction of class III^IV, 10 cases (83.3%) digestive tract reaction of class 0^II, 2 cases (16.67%) hepatic encephalopathy and dead, 1 case (8.33%) hemorrhage of puncture points, 1 case (8.33%) ablation of radioactive seeds. No implantation metastasis neoplasm was seen by imaging examination during follow-up. (2) Implantation metastasis in needle tract: The positive cells frequency of needle stylophores was 5.2% (13/250), and the frequency of cores was 2.8% (7/250). These two groups had no significant difference (P>0.05). the positive cells frequency of needles those traversed distance less than 3 cm in normal tissue was 6.19%(13/210), while the frequency of needles traversing distance equal to or more than 3 cm was 2.41% (7/290). The difference between the two groups with different traversing distances was significant (P<0.05). The superficial tissue of these needles included positive cells, mucus, red blood cells, inflammatory cells and necrosis tissue. More tissue could be seen on needle core. From 10th to 180th day post operation, no needle tract metastatic tumor could be seen in CT or sonographic image. During the course of follow-up, 1 patient died in 30-day, 1 in 60-day, and 3 in 180-day after operation.Conclusions: (1) ¹²⁵I seeds implantation can be used as a palliative or supplementary treatment to primary and metastatic hepatic caner and patients refusing to chemotherapy and radiotherapy. Complications shouldn't be ignored, and some measures must be taken to prevent or handle them. It might evoke some complications such as fever, digestive tract reaction, hemorrhage of puncture point, even death. Some measures must be taken to prevent or handle these complications. (2) Tumor cells could ablate into the needle tract during radioactive seeds implantation. Some preventive measures, such as optimization of pre-operation and intra-operation treatment plan, chemotherapy or endocrine therapy after operation, may be beneficial to avoid the implantation metastasis of neoplasm in needle tracts.