J Gynecol Oncol.  2021 Mar;32(2):e15. 10.3802/jgo.2021.32.e15.

Safety and efficacy of 3D-printed templates assisted CT-guided radioactive iodine-125 seed implantation for the treatment of recurrent cervical carcinoma after external beam radiotherapy

• Liu Y
• Jiang P
• Zhang H
• Wang J

• KMID: 2526352
• DOI: http://doi.org/10.3802/jgo.2021.32.e15

Abstract

Objective
To investigate the safety and efficacy of 3-dimensional (3D) printing noncoplanar templates (PNCT) assisted computer tomography (CT) guided radioactive¹²⁵I seed implantation (RISI) for the treatment of recurrent cervical carcinoma (RCC) after external beam radiotherapy (EBRT).
Methods
A total of 103 patients with inoperable post-EBRT RCC were included in this retrospective study. A total of 111 lesions received RISI. Eight lesions were at the pelvic center, 75 lesions were at the pelvic lateral, and 28 lesions were extra-pelvic metastasis. The median prescription dose was 120 Gy. The primary end points were adverse events and local control (LC), and the secondary end points were overall survival (OS) and progression-free survival.
Results
Grade 2 adverse events of acute nausea, diarrhea, and pollakiuria occurred in 1, 2, and 1 patient, respectively. One patient suffered from grade 3 acute proctitis. Late toxicity was observed in 2 patients with rectovaginal fistula. No grade 5 toxicity occurred. The 3-year LC and OS rates were 75.1% and 20.8%, respectively. The median OS was 17 months. The multivariate analysis showed that the minimum dose received by the “hottest” 90% of the gross tumor volume (D 90 ) ≥130 Gy, squamous cell carcinoma, hemoglobin ≥80 g/L and good short-term efficacy (complete response or partial response) were independent predictors of LC and OS (all p<0.05).
Conclusions
3D-PNCT assisted CT-guided RISI is a safe, effective, and minimally invasive modality for RCC. The hemoglobin level, pathological type, dose distribution and short-term efficacy are considered as independent factors for clinical outcomes.

Keyword

Interstitial Radiotherapy; Image-Guided Radiation Therapy; Radiation Dosimetry; Brachytherapy; Uterine Cervical Neoplasms; Neoplasm Recurrence; Locoregional