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Published on: February 12, 2017
Feasibility and Clinical Value of CT-guided (125)I Brachytherapy for Bilateral Lung Recurrences from Colorectal
Guobao Wang1, Fujun Zhang1, Bin Yang1
1From the Departments of Endoscopy (G.W.), Interventional Radiology (F.Z., S.P., Z.Z., T.Z., M.L., F.G.), Sun Yat-sen University Cancer Center and State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou 510060, PR China; Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Road West, Guangzhou 510120, PR China (B.Y.); and Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (J.X.).
Purpose:
To prospectively evaluate the feasibility and clinical value of computed tomography (CT)-guided iodine 125 ((125)I) brachytherapy to treat bilateral lung recurrences from colorectal carcinoma.
Materials And Methods:
This study was approved by Sun Yat-sen University Cancer Center Institutional Review Board and all patients provided informed written consent. Seventy-two patients with bilateral lung recurrences from colorectal carcinoma were enrolled and randomly divided into two groups. Thirty-three were percutaneously treated with CT-guided (125)I brachytherapy (group A) and the other 39 were only given symptomatic and supportive treatments (group B). Follow-up contrast agent-enhanced CT scans were reviewed and efficacy of treatment was evaluated. (125)I brachytherapy was considered a success if it achieved the computerized treatment planning system criteria 1 month after procedure. Analyses included Kaplan-Meier, Mantel-Cox log-rank test, and Cox proportional hazards regression.
Results:
In group A, 37 (125)I brachytherapy procedures were performed in 33 patients with 126 lung metastatic lesions and the success rate was 87.9% (29 of 33 patients). The local control rate of 3, 6, 12, 24, and 36 months was 75.8%, 51.5%, 33.3%, 24.2%, and 9.1%, respectively. A small amount of pulmonary hematoma occurred in five patients, and six patients presented with pneumothorax with pulmonary compression of 30%-40%. No massive bleeding or radiation pneumonitis occurred. The mean overall survival (OS) of group A was significantly longer than that of group B, and (125)I brachytherapy was an independent factor that affected the OS (group A, 18.8 months; group B, 8.6 months; hazard ratio, 0.391 [95% confidence interval: 0.196, 0.779]; P = .008).
Conclusion:
CT-guided (125)I brachytherapy is feasible and safe for the treatment of bilateral lung recurrences from colorectal carcinoma.
