Endobronchial Ultrasound-Guided Iodine-125 Radioactive Seeds Implantation For Mediastinal Lymph Node Metastases

Objective:To evaluate the feasibility and short-term efficacy of endobronchial ultrasound-guided iodine-125(125 I)radioactive seeds implantation for mediastinal lymph node metastases.Methods:Between March 2013 and March 2015,20 patients(15males,5 females;50-75 years;mean 63.4±7.68years),who had mediastinal lymph node metastases underwent interstitial implantation of 125 I radioactive seeds under EBUS guidance. All the procedures were performed in the respiratory department of the Second Affiliated Hospital of Chongqing Medical University. the pathological diagnoses of all the patients were obtained, including squamous cell lung carcinoma(12cases),lung adenocarcinoma(4cases),small cell lung cancer(2cases),esophagus cancer(1cases),hepatocellular carcinoma(1cases).And among which,5 patients had malignant superior vena cava syndrome(SVCS) caused by mediastinal metastatic malignancies.The short-term efficiency and feasibility are reviewed retrospectively.Results:The procedure was successful in all patients. No majorprocedure-associated death occurred. Intraoperative small hemoptysis occurred in 3 cases(15%),4 received an artificial pneumothorax on CT(20%),5 had low-grade fever(25%),7 experienced slight pulmonary hemorrhage(35%),and they were all alleviated after symptomatic treatments. Follow-up CT was respectively carried out every 2 months in all patients postoperatively. The tumor diameter and physical status of all patients were obtained during follow-up.The response evaluation criteria in solid tumors(RECIST) were used to evaluate the therapeutic effect, the overall response rate(CR+PR) was65.00%(13/20),80.00%(16//20),85.0%(17/20) at 2 month,4 months and 6months’ follow-up respectively. Besides, symptoms of the patients with SVCS were obviously relieved after the operation,symptom relief rate was100% after 6 months.No migration of seeds or restenosis occurred in any patient.Conclusion:The EBUS-guided iodine-125 radioactive seeds implantation is minimally invasive with fewer complications. It has good short-term efficacy for mediastinal metastatic tumor. It can effectively relieve the symptoms of malignant SVCS caused by mediastinal metastatic malignancies. It is feasible, safe and effective for mediastinal lymph node metastases.