Computed tomography-magnetic resonance imaging fusion-guided iodine-125 seed implantation for single malignant brain tumor: Feasibility and safety
Shi-Feng Liu1, Jian Lu2, Hong Wang3, Yan Han4, De-Feng Wang5, Li-Li Yang1, Zi-Xiang Li1, Xiao-Kun Hu1
1 Center for Interventional Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
2 Department of Radiology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China
3 Department of Dermatology, Qingdao No. 6 People's Hospital, Qingdao, Shandong, China
4 Department of Science and Education, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
5 Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
Center for Interventional Medicine, The Affiliated Hospital of Qingdao University, 1677 Wutaishan Road, Qingdao 266000, Shandong
Source of Support: None, Conflict of Interest: None
Background: To investigate the feasibility and safety of computed tomography-magnetic resonance imaging (CT-MRI) fusion-guided iodine-125 seed implantation for a single malignant brain tumor.
Methods: From November 2015 to October 2016, 12 patients with a single malignant brain tumor were treated with permanent iodine-125 seeds implantation. CT-MRI fusion images were used to make the preoperative treatment plan, intraoperative dose optimization, postoperative verification, and tumor response follow-up. The dosimetry parameters of CT-MRI image fusion plans were compared between preprocedures and postprocedures, including plan target volume, V100 (the percentage of the target volume covered by the prescription dose [PD]), D90 (the dose that covers 90% of the target volume), and V200 (the percentage volume of the brain tumor receiving 200% of the PD). Adverse events were graded by the Common Terminology Criteria for Adverse Events. Clinical and radiological follow-ups were performed at a 3-month interval.
Results: All the interstitial implantations were completed successfully under the guidance of CT-MRI image fusion. The dosimetry parameters of CT-MRI image fusion postplans did not differ significantly from those of preplans (P > 0.05). No higher than Grade 2 adverse events were observed during the follow-up. Tumor control was achieved in 10 of 12 patients (83.33%). The median overall survival time was 15.05 ± 3.35 months (95% confidence interval 12.99–17.26).
Conclusions: CT-MRI image fusion is feasible for the design, optimization, and verification of treatment planning. CT-MRI fusion-based brachytherapy may improve dosimetry of brain tumor while sparing the normal structures, potentially impacting disease control, treatment-related toxicity, and long-term survival.