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Dosimetry study of three-dimensional print template for 125I implantation therapy.
Chen, E, Zhang, Y, Zhang, H, Jia, C, Liang, Y, Wang, J
Radiation oncology (London, England). 2021;(1):115
Abstract
BACKGROUND 125I seed implantation has been found to show good therapeutic effects on tumors. Recent studies showed that three-dimensional (3D) print template-assisted 125I seed implantation can optimize radiation dose distribution. This study aimed to compare the dose distribution differences in 125I seed implantation among 3D print noncoplanar template- (3DPNCT), 3D print coplanar template- (3DPCT) assisted implantation and traditional free-hand implantation. METHODS We systematically searched the PubMed, EMbase, Cochrane Library, Wan Fang Med Online, China National Knowledge Infrastructure (CNKI) from the earliest to November 2020 without time or language restrictions. And the references of primary literature were also searched. The outcome measures were dosimetry and operation time. This meta-analysis was carried out using Stata 12.0. RESULTS A total of 16 original articles were selected for inclusion. The differences of D90, D100, V90, and V100 values pre- and post-implantation with traditional free-hand implantation showed statistically significant (p < 0.05). The differences of D90, D100, V100, V150, V200, and D2cc of organs at risk (OAR) values pre- and post-implantation with 3D print template showed no statistically significant (p > 0.05). Compared with traditional free-hand implantation without any templates, 3D print template could improve postoperative D90 (Standard mean difference, SMD = 0.67, 95% confidence interval (CI) = 0.35 to 0.98, p < 0.001), D100 (SMD = 0.82, 95%CI = 0.40 to 1.23, p < 0.001), V90 (SMD = 1.48, 95%CI = 0.95 to 2.00, p < 0.001), V100 (SMD = 1.41, 95%CI = 0.96 to 1.86, p < 0.001), and reduce operation time (SMD = - 0.93, 95%CI = - 1.34 to - 0.51, p < 0.001). In three studies, both 3DPNCT and 3DPCT plans were designed for all patients. The prescribed dose and seed activity were same. Pooled analysis of D90, D100, V100, D2cc of OAR, number of seeds and number of needles showed no significant differences between 3DPNCT and 3DPCT groups (p > 0.05). However, in 3DPNCT group, V150 and V200 were increased (SMD = 0.35, 0.49; 95%CI = 0.04 to 0.67, 0.02 to 0.96; p = 0.028, 0.043); the number of through bone needles was reduced (SMD = - 1.03, 95%CI = - 1.43 to - 0.64, p < 0.001). CONCLUSIONS Compared with traditional free-hand implantation, 3D print template-assisted 125I seeds implantation can optimize dose distribution and reduce the implantation time at the same time. Compared with 3D print coplanar template, 3D print noncoplanar template can increase the volume of high dose within tumor target and is more safer in the respect of puncture route.
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2.
Radioiodine remnant ablation in papillary thyroid microcarcinoma: a meta-analysis.
Yang, T, Zheng, SY, Jiao, J, Zou, Q, Zhang, Y
Nuclear medicine communications. 2019;(7):711-719
Abstract
BACKGROUND The incidence of papillary thyroid microcarcinoma (PTMC) has been increasing sharply, the current statement about whether PTMC patients should undergo radioactive iodine (RAI) remnant ablation is still controversial, mainly because it is uncertain whether RAI treatment can reduce the recurrence rate. OBJECTIVE To evaluate the effectiveness of RAI remnant ablation for thyroid cancer-related outcomes of PTMC patients. METHODS We comprehensively searched PubMed, Cochrane Library, Scopus and Science Direct for studies that compared the effectiveness after total-thyroidectomy or near total-thyroidectomy, with or without RAI remnant ablation treatment. Random and fixed-effects meta-analytical models were used where indicated, and between-study heterogeneity was assessed. RESULTS Twenty-two studies, which included 8724 patients, met our search criteria and were assessed. For PTMC patients treated by total thyroidectomy or near-total thyroidectomy, the locoregional recurrence rates were 1.92 and 7.36% [risk ratio (RR)=0.45; 95% confidence interval (CI)=0.18-1.11; P=0.08] for patients with or without RAI treatment respectively, the distant metastasis rates were 1.39 and 2.46% (RR=0.64; 95% CI=0.28-1.48; P=0.30), and the thyroid cancer-related mortality rates were 0.98 and 1.76% (RR=0.68; 95% CI=0.22-2.09; P=0.50). CONCLUSION For PTMC patients who have already treated by total thyroidectomy or near-total thyroidectomy, incremental RAI remnant ablation may significantly improve thyroid cancer-related outcomes.
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Is papillary thyroid microcarcinoma an indolent tumor?: A retrospective study on 280 cases treated with radioiodine.
Gao, X, Zhang, X, Zhang, Y, Hua, W, Maimaiti, Y, Gao, Z
Medicine. 2016;(40):e5067
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Abstract
The increasing detection of papillary thyroid microcarcinoma (PTMC) has created management dilemmas. To clarify the clinical significance of postsurgery stimulated thyroglobulin (ps-Tg) in PTMC who undergo thyroidectomy and radioactive iodine (RAI), we retrospectively reviewed the 358 PTMC patients who were treated with RAI and followed up in our hospital. Those with an excessive anti-Tg antibody, ultrasound-detected residual were excluded, thereby resulting in the inclusion of 280 cases. Their clinical and histopathological information and clinical outcomes were collected and summarized. Tumor stages were classified according to the tumor, node, metastasis (TNM) staging system and the consensus of the European Thyroid Association (ETA) risk stratification system, respectively. Kaplan-Meier curves were constructed to compare the disease-free survival (DFS) rates of different risk-staging systems. By the end of follow-up, none of the patients died of the disease or relapsed. The 8-year DFS rate was 76.9%. Kaplan-Meier curves showed different DFS rates in TNM stages I versus IV, III versus IV, very low risk versus high risk, low risk versus high risk, respectively (P < 0.05), while they were not significantly different in stage I versus stage III, very low risk versus low risk (P > 0.05). Finally, 40 (14.3%) cases got a persistent disease. Five variables (male sex, nonconcurrent benign pathology, initial tumor size >5 mm, lymph node metastasis, and ps-Tg ≥ 10 μg/L) were associated with disease persistence by univariate regression analysis. Ps-Tg ≥ 10 μg/L was the only independent prognostic variable that predicted disease persistence by multivariate regression analysis (odds ratio: 36.057, P = 0.000). Therefore, PTMC with a small size of ≤1 cm does not always act as an indolent tumor. In conclusion, ps-Tg ≥ 10 μg/L is associated with increased odds of disease persistence. ETA risk stratification is more effective in predicting disease persistence than the TNM classification system.
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Low-dose radioiodine ablation in differentiated thyroid cancer with macroscopic extrathyroidal extension and low level of preablative-stimulated thyroglobulin.
Zhang, Y, Liang, J, Yang, X, Yang, K, Lin, Y
Nuclear medicine communications. 2015;(6):553-9
Abstract
OBJECTIVE High-dose radioactive iodine (RAI) is recommended for patients with nonmetastatic differentiated thyroid cancer with macroscopic extrathyroidal extension (MAEE). It is unclear whether these patients can be treated with low-dose RAI when preablative-stimulated thyroglobulin (ps-Tg) is low. This randomized study aims to evaluate the clinical outcome and ablative efficacy of low-dose radioiodine in patients with MAEE but with low ps-Tg level. MATERIALS AND METHODS Differentiated thyroid cancer patients with complete thyroidal resection, MAEE, any N stage, ps-Tg less than or equal to 5 ng/ml when thyroglobulin antibodies are less than or equal to 46 IU/ml, and no evidence of distant metastasis were included in the study. Patients were randomly allocated to receive low-dose (1110 MBq) or high-dose RAI (3700 MBq). Follow-up was generally performed 6 months after ablation. Successful ablation was identified as (i) stimulated thyroglobulin 1.0 ng/ml or less when thyroglobulin antibodies 46 IU/ml or less; (ii) negative Dx-WBS; and (iii) negative neck ultrasonography. Clinical recurrence was defined as the reappearance of disease confirmed by cytology or pathology. RESULTS A total of 102 patients were analyzed: 51 in the low-dose group and 51 in the high-dose group. There was no significant difference in clinicopathological characters between the two groups. No patient had clinical recurrences during the mean 6.8 months of follow-up. Ablation was successful in 43 of 51 (84.3%) patients in the low-dose group and in 44 of 51 (86.27%) patients in the high-dose group, and thus no significant difference was noted (P=0.7798). CONCLUSION Ablation with low-dose RAI has been proven to be noninferior to high-dose RAI in nonmetastatic patients with MAEE when ps-Tg level is less than 5 ng/ml.
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Status and prospects of percutaneous vertebroplasty combined with ¹²⁵I seed implantation for the treatment of spinal metastases.
Xie, L, Chen, Y, Zhang, Y, Yang, Z, Zhang, Z, Shen, L, Yuan, Z, Ren, M
World journal of surgical oncology. 2015;:119
Abstract
Metastatic spinal tumours are the most common type of bone metastasis. Various methods have been used to treat metastatic spinal lesions, including radiotherapy, chemotherapy, isotope therapy, bisphosphonate therapy, analgesics, and surgery. Conservative treatments such as radiotherapy and chemotherapy are not appropriate and usually are ineffective in patients with vertebral fractures and/or spinal instability. Minimally invasive surgical treatments using non-vascular interventional technology, such as percutaneous vertebroplasty (PVP), have been successfully performed in the clinical setting. PVP is a non-invasive procedure that creates small wounds and is usually associated with only minor complications. In the present study, we will review the clinical status and prospects for the use PVP combined with (125)I seed implantation (PVPI) to treat spinal metastases. The scientific evidence for this treatment, including safety, efficacy, and outcome measures, as well as comparisons with other therapies, was analysed in detail. PVPI effectively alleviates pain in metastatic spinal tumour patients, and the use of interstitial (125)I seed implants can enhance the clinical outcomes. In conclusion, PVPI is a safe, reliable, effective, and minimally invasive treatment. The techniques of PVP and (125)I seed implantation complement each other and strengthen the treatment's effect, presenting a new alternative treatment for spinal metastases with potentially wide application.
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Randomized trial of [131I] metuximab in treatment of hepatocellular carcinoma after percutaneous radiofrequency ablation.
Bian, H, Zheng, JS, Nan, G, Li, R, Chen, C, Hu, CX, Zhang, Y, Sun, B, Wang, XL, Cui, SC, et al
Journal of the National Cancer Institute. 2014;(9)
Abstract
To assess the efficacy of combining radioimmunoconjugate [(131)I] metuximab with radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) treatment compared with RFA alone, a single-center randomized controlled trial was conducted on 127 patients with Barcelona Clinic Liver Cancer staging system (BCLC) classifications of 0-B stage. Patients received either RFA followed by [(131)I] metuximab (n = 62) or RFA alone (n = 65). The primary outcome was overall tumor recurrence. Statistical tests were two-sided. The one- and two-year recurrence rates in the combination group were 31.8% and 58.5%, whereas those in the RFA group were 56.3% and 70.9%, respectively. The median time to overall tumor recurrence was 17 months in the combination group and 10 months in the RFA group (P = .03). The RFA-[(131)I] metuximab treatment showed a greater antirecurrence benefit than RFA in the metuximab target (ie, CD147)-positive subpopulation (P = .007). [(131)I] metuximab may yield prevention of tumor recurrence after RFA.
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Radical treatment of stage IV pancreatic cancer by the combination of cryosurgery and iodine-125 seed implantation.
Chen, JB, Li, JL, He, LH, Liu, WQ, Yao, F, Zeng, JY, Zhang, Y, Xu, KQ, Niu, LZ, Zuo, JS, et al
World journal of gastroenterology. 2012;(47):7056-62
Abstract
AIM: To investigate the therapeutic effect of radical treatment and palliative treatment in stage IV pancreatic cancer patients. METHODS 81 patients were enrolled in the study. Radical treatment was performed on 51 patients, while 30 patients were put under palliative treatment. The procedural safety and interval survival for stage IV pancreatic cancer (IS-IV) was assessed by almost 2.5 years of follow-ups. The IS-IV of patients under the two kinds of treatment, and the effects of treatment timing and frequency on IS-IV, were compared. RESULTS The IS-IV of patients who received radical treatment was significantly longer than those who received palliative treatment (P < 0.001). The IS-IV of patients who received delayed radical or palliative treatment was longer than those who received accordingly timely treatment (P = 0.0034 and 0.0415, respectively). Multiple treatments can play an important role in improving the IS-IV of patients who received radical treatment (P = 0.0389), but not for those who received palliative treatment (P = 0.99). CONCLUSION The effect of radical treatment was significantly more obvious than that of palliative treatment, and multiple radical treatments may contribute more to patients than a single radical treatment.
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Feasibility of adenovirus-mediated hNIS gene transfer and 131I radioiodine therapy as a definitive treatment for localized prostate cancer.
Barton, KN, Stricker, H, Elshaikh, MA, Pegg, J, Cheng, J, Zhang, Y, Karvelis, KC, Lu, M, Movsas, B, Freytag, SO
Molecular therapy : the journal of the American Society of Gene Therapy. 2011;(7):1353-9
Abstract
We have developed a replication-competent adenovirus (Ad5-yCD/mutTK(SR39)rep-hNIS) armed with two suicide genes and the human sodium iodide symporter (hNIS) gene. In this context, hNIS can be used as a reporter gene in conjunction with nuclear imaging and as a potentially therapeutic gene when combined with (131)I radioiodine therapy. Here, we quantified the volume and magnitude of hNIS gene expression in the human prostate following injection of a high Ad5-yCD/mutTK(SR39)rep-hNIS dose using a standardized injection algorithm, and estimated the radiation dose that would be delivered to the prostate had men been administered (131)I with curative intent. Six men with clinically localized prostate cancer received an intraprostatic injection of Ad5-yCD/mutTK(SR39)rep-hNIS under transrectal ultrasound guidance. All men received 2 × 0.5 ml deposits (5 × 10(11) vp/deposit) in each of the four base and midgland sextants and 2 × 0.25 ml deposits (2.5 × 10(11) vp/deposit) in each of the two apex sextants for a total of 12 deposits (5 × 10(12) vp) in 5 ml. On multiple days after the adenovirus injection, men were administered sodium pertechnetate (Na(99m)TcO(4)) and hNIS gene expression in the prostate was quantified by single photon emission computed tomography (SPECT). hNIS gene expression was detected in the prostate of six of six (100%) men. On average, 45% (range 18-83%) of the prostate volume was covered with gene expression. Had men been administered 200 mCi (131)I, we estimate that the mean absorbed dose to the prostate would be 7.2 ± 4.8 Gy (range 2.1-13.3 Gy), well below that needed to sterilize the prostate. We discuss the obstacles that must be overcome before adenovirus-mediated hNIS gene transfer and (131)I radioiodine therapy can be used as a definitive treatment for localized prostate cancer.