Clinical Efficacy Of CT-guided ¹²⁵I Seed Brachytherapy In The Treatment Of Liver Cancer

Background:Liver cancer is one of the malignant tumors that threat the health and life of people.According to cancer statistics in China at 2015,among the most commonly diagnosed cancers among men,liver cancer is accounted for the forth.The most leading causes of cancer death among both men and women,liver cancer is accounted for the third.There are some methods to treat liver cancer,such as surgery,radiotherapy,chemotherapy,molecular targeted therapy and interventional therapy.Surgical treatment including liver resection and liver transplantation.Interventional therapy including transcatheter arterial chemoembolization?TACE?,radiofrequency ablation,microwave ablation,chemical ablation,freezing and 125F radioactive seed implantation,etc.Surgery is the first choice for the treatment of liver cancer,but most patients are diagnosed in advanced stage,or the tumor location does not meet the surgical indications.Some patients can not tolerate surgery due to age or poor cardiopulmonary function,and even other patients refused surgery.TACE has been widely used in clinical,but when the tumor is larger,ha more collateral circulation,the clinical effect of TACE is not so satisfactory.The 5-year survival rate of patients with advanced hepatic malignancy was 6%-26%.Radiotherapy has an obvious local tumor control effect,but it does great harm to the human body normal tissues.Computed tomography?CT?-guided ¹²⁵I seed brachytherapy in the treatment of hepatic malignancy have been used in clinical,and it has shown significant efficacy especially in prostate cancer,thyroid cancer,breast cancer.¹²⁵I seed implantation treatment has the advantages of strong controllability of radiation dose,high dose in tumor targe,small damage to the surrounding normal tissues.Purpose:The aim of this study was to evaluate the efficacy and complications of CT-guided permanent ¹²⁵I seed interstitial brachytherapy in the treatment of liver cancer.Methods:We retrospectively reviewed the clinical data of 41 patients with liver cancer who underwent CT guided ¹²⁵I seed brachytherapy during September 2014 to September 2016 in Department of Health Oncology,Shandong Provincial Hospital Affiliated to Shandong University.A abdominal enhanced CT scan or liver enhanced MRI scan was performed to verify the location and size of the tumor and its relation with surrounding organs.A treatment plan was made for each patienthe using a computerized treatment planning system?TPS?based on CT or MRI images.The median matched peripheral dose?MPD?was 120 Gy.With CT guidance,¹²⁵I seeds were placed into the tumor.All procedures were performed with local anesthesia.After operation,CT scan was performed to verify the position and intensity of ¹²⁵I seeds.CT scan was performed 1 month,3,6,9 and 12 months after operation to evaluate the local control rate of tumor and complications.Results:Altogether 58 liver lesions were included in this study.24 cases of male,17 cases of female,age from 32 to 73 years old,the average is 55.8 years.The median longest diameter was 3.05 cm?0.9-6.9cm?.The number of ¹²⁵I seeds was 3-143.The activity was 1.85 × 107—2.96 X 107Bq?0.5mCi-0.8mCi?.One month after operation,8 liver lesions gained complete remission?CR?,24 partial remission?PR?,12 stable disease?SD?and 14 progression of disease?PD?.The local tumor control rate 1 month,3,6,9 and 12 months after operation was 75.9%,60.9%,46.7%,33.3%and 20.0%,respectively.During the follow-up of 1-20 months?median 6 months?,27 patients survived and 14 died.The rate of pain relief was 94.1%?16/17?.Minor complications were bleeding[41%?10/41?],nsusea/vomiting[2.4%?3/41?],fever[4.9%?2/41?],pneumothorax[4.9%?2/41?]and seed displacement[4.9%?2/41?].Conclusion:CT-guided ¹²⁵I seed brachytherapy is a safe and effective treatment for liver cancer with few complications.