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Interstitial 125I seeds implantation to treat spinal metastatic and primary paraspinal malignancies

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Abstract

Spinal cord metastatic malignances and locally invasive paraspinal carcinomas were severe pain and disabling complications. The treatment modality was unclear. We retrospectively evaluated the safety and efficacy of 125I seed implantation for spinal metastatic and paraspinal malignancies in our center. A total of 19 patients and 22 procedures were included in this study. Eight patients received a seed implant in an operation, and 11 patients were implanted percutaneousely under CT-guidance. The number of 125I seeds implanted ranged from 6 to 100, with a median of 26. The specific activity of 125I seeds ranged from 0.45 to 0.80 mCi per seed, with a median of 0.5 mCi. The minimal peripheral doses of 125I seed implantation were 90–140 Gy, with median of 120 Gy. Follow-up ranged from 3 to 69 months with a median of 22 months. All patients tolerated seed implantation well. The 1, 2, 3, and 5 year local control rates were 63%, 47%, 31%, and 3%, respectively, with a median of 22 months (3–61 months). The 1, 2, 3, and 5 year survival rates were 74%, 56%, 43%, and 43%, respectively, with a median of 33 months. Ten patients (52.6%) developed distant metastases. Two (10.5%) patients showed recurrence at 13 and 39 months. Seven (36.8%) patients were still alive, 84% (16/19) of patients had either normal or improved ambulation following seed implant. No myelopathies were encountered. Our study suggests a promising local therapy for a selected population of patients with spinal cord metastatic or paraspinal carcinoma.

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Abbreviations

LDR:

Low-dose rate

HDR:

High-dose rate

SLD:

Sublethal damage

MPD:

Minimal peripheral dose

TPS:

Treatment planning system

EBRT:

External beam radiotherapy

GTV:

Gross tumor volume

PTV:

Planning tumor volume

HVL:

Half-value layer

RTOG:

Radiation therapy oncology group

CR:

Complete respone

PR:

Partial response

SD:

Stable disease

PD:

Progressive disease

S:

Surgery

RT:

Radiotherapy

CTx:

Chemotherapy

LR:

Local recurrence

NED:

No evidence of disease

M:

Months

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Acknowledgments

The authors would like to thank Dr. Weijuan Jiang and Hailin Yao for their contributions and suggestions, and also Yong Zhao for his critical review and suggestions.

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Authors and Affiliations

  1. Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, 100191, Beijing, China

    Junjie Wang, Hao Wang, Yuliang Jiang, Suqing Tian & Ruijie Yang

  2. Department of Radiology, Peking University Third Hospital, 100083, Beijing, China

    Huishu Yuan

  3. Department of Surgery, Peking University Third Hospital, 100083, Beijing, China

    Qingjun Ma & Xiaoguang Liu

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  1. Junjie Wang
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  2. Huishu Yuan
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  3. Qingjun Ma
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Correspondence to Junjie Wang.

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Wang, J., Yuan, H., Ma, Q. et al. Interstitial 125I seeds implantation to treat spinal metastatic and primary paraspinal malignancies. Med Oncol 27, 319–326 (2010). https://doi.org/10.1007/s12032-009-9212-1

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  • DOI: https://doi.org/10.1007/s12032-009-9212-1

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