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. 2020 Apr 6;20(1):25.
doi: 10.1186/s40644-020-00299-x.

Clinical efficacy and prognostic factors of CT-guided 125I brachytherapy for the palliative treatment of retroperitoneal metastatic lymph nodes

Huzheng Yan  1   2   3 , Ma Luo  1   2   3 , Lifei Wang  4 , Zhenkang Qiu  1   2   3 , Zhiqiang Mo  5 , Zhanwang Xiang  6 , Yanling Zhang  1   2   3 , Guanyu Chen  1   2   3 , Zhihui Zhong  1   2   3 , Xiuchen Wang  1   2   3 , Fei Gao  7   8   9 , Fujun Zhang  10   11   12
Affiliations

Clinical efficacy and prognostic factors of CT-guided 125I brachytherapy for the palliative treatment of retroperitoneal metastatic lymph nodes

Huzheng Yan et al. Cancer Imaging. .

Abstract

Background: Due to the unique anatomical location of retroperitoneal metastatic lymph nodes, current treatment options are limited. This study was designed to explore the clinical efficacy and prognostic factors of CT-guided 125I brachytherapy for the treatment of retroperitoneal metastatic lymph nodes.

Methods: We retrospectively evaluated 92 patients received 125I brachytherapy for retroperitoneal metastatic lymph nodes. A layered Cox proportional hazards model was established to filter out the independent factors affecting local tumor progression-free survival (LTPFS).

Results: The median LTPFS was 8 months. Metastatic lymph node with uniform density (p-0.009), clear boundaries (p-0.011), regular morphology (P < 0.001), and < 3 organs at risk of metastasis (p-0.020) were associated with better LTPFS. Necrotic lymph nodes (p < 0.001), fusion (p-0.003), and invasion of vessels visible on images (p < 0.001) were associated with poor LTPFS. Puncture path through abdominal wall or paravertebral approach were also associated with better LTPFS than a hepatic approach (P < 0.05). A maximum diameter ≤ 3 cm (P-0.031) or 3-5 cm (P-0.018) were also associated with significantly better LTPFS than a maximum diameter ≥ 5 cm. The Cox proportional hazards model suggested that lymph nodes invaded the large vessels visible on images, maximum diameter and puncture path were independent risk factors for LTPFS.

Conclusion: CT-guided 125I brachytherapy is an optional palliative treatment modality for retroperitoneal metastatic lymph nodes, which can provide high local control without severe complications. Better preoperative planning, intraoperative implementation, better choice of puncture path, and selection of appropriate tumor size are important factors that can improve the clinical efficacy of 125I brachytherapy for retroperitoneal metastatic lymph nodes.

Keywords: 125I brachytherapy; 125I seed; Retroperitoneal metastatic lymph nodes.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a Preoperative TPS, red lines represent the tumor’s contour. b Preoperative dose volume histograms (DVH), target = tumor. The prescribed dose (PD) was 120 Gy. A total of 90% of the tumor target (D90 = 127.5 Gy) received 127.5 Gy, and 92.5% of the tumor target received 100% of the prescribed dose (V100 = 92.5%). c postoperative practical distribution of seeds. d Postoperative DVH, D90 = 117.0 Gy, V100 = 90.0%. The postoperative dose distribution coincided roughly with preoperative distribution
Fig. 2
Fig. 2
a-f represents variables, a. Uniform density; b. Necrosis; c. Regular morphology; d. Fusion; e. Clear boundary; f. OAR, The organs at risk
Fig. 3
Fig. 3
a. Maximum diameter; b. Invasion of vessels visible on image; c. Puncture path
Fig. 4
Fig. 4
A 34-year-old male patient with retroperitoneal metastatic lymph nodes from primary hepato cellular carcinoma. a. Preoperative enhanced CT showed metastatic lymph nodes (arrow) with size of 42mm * 21mm, adjacent to the left renal vein, inferior vena cava, and abdominal aorta. b. Intraoperative CT scan. c, d. 4months after 125I brachytherapy, the lesion had disappeared.
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