Year : 2017 | Volume
: 13 | Issue : 4 | Page : 605--606
Expert consensus workshop report: Guideline for three-dimensional-printing template-assisted computed tomography-guided 125I seeds interstitial implantation brachytherapy
Shiro Saito1, Xin Ye2,
1 Department of Urology, National Hospital Organization Tokyo Medical Center, Meguro, Japan
2 Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, Shandong Province, 250021
|How to cite this article:|
Saito S, Ye X. Expert consensus workshop report: Guideline for three-dimensional-printing template-assisted computed tomography-guided 125I seeds interstitial implantation brachytherapy.J Can Res Ther 2017;13:605-606
|How to cite this URL:|
Saito S, Ye X. Expert consensus workshop report: Guideline for three-dimensional-printing template-assisted computed tomography-guided 125I seeds interstitial implantation brachytherapy. J Can Res Ther [serial online] 2017 [cited 2018 Mar 22 ];13:605-606
Available from: http://www.cancerjournal.net/text.asp?2017/13/4/605/214478
Permanent seed implantation brachytherapy (BT) is an established technique for the treatment of prostate cancer or breast cancer. Recently, multiple manuscripts revealed that iodine-125 or palladium-103 BT achieves better cancer control in prostate cancer compared to dose-escalated intensity-modulated radiation therapy. The reason why BT has better cancer control ability is that biochemically effective dose of iodine seeds in treating prostate cancer is much higher than X-ray. High-risk prostate cancer with high Gleason score usually shows unexpected high recurrence rate even it is treated in earlier stage. Many articles revealed that BT has highest cancer control ability compared to other treatment modalities such as radical prostatectomy or external beam radiation therapy. BT is expected to be a powerful weapon to treat highly malignant cancer.
BT is commonly performed for the treatments of prostate cancer, breast cancer, and cervical cancer in many countries. However, this technique is commonly used for treating pancreas cancer, lung cancer, head and neck cancer, and oral cancer in China. The Department of Radiation Oncology in Peking University Third Hospital first established BT standard procedure in China in 2002 and popularized their technology throughout the country in the past 15 years. Although BT is mostly used for initial and curative treatment in western countries, the majority of its use in China is for palliative treatment for recurrent cancer.
With long-term experience of BT in China, clinical investigations revealed outstanding outcomes for both effectiveness and safety. Initially, the technique of seed implantation to the organs existing far deep from body surface, such as pancreas or lung, is usually based on computed tomography (CT) guidance with freehand needle insertion. At the time of dosimetric planning of BT, seeds may be planned to place at various locations in the tumor for obtaining ideal dose distribution. Not like prostate or mammary gland, tumor in the pancreas or lung exists in deep part of the body, so that accurate needle insertion may be difficult even it is guided by CT image. Intestine or other organs that need to avoid needle passage may exist at the route of needle insertion. As for these reasons, BT for pancreas or lung cancer needs needle insertion from multiple directions with large number of needles. Using normal template that guides needles to parallel direction, it may be difficult to achieve good tumor control because for the limitation of seed placement to ideal position. Recently, a Chinese expert group of BT investigated a new concept of template for the guidance of needle insertion in treating pancreas or lung cancer. To obtain ideal seed placement in the tumor, multidirectional needle insertion is necessary and the pattern may be different in each individual. What is important to achieve ideal dose distribution in BT is to manage tailor-made treatment plan. The Chinese BT group tried to treat patients with template designed for each individual by three-dimensional (3D) printer. Based on CT image, ideal seed placement is planned to obtain ideal dosimetry before moving into template construction. After the final decision of seed placement, accurate direction of needles that will not be obstructed by intestine or other organs is also planned. Finally, the plan will be transferred to 3D printer to construct tailor-made template. This technology is quite unique and may create new part of BT for treating the tumor existing deep in the body. Chinese BT group that creates this technology will move into Phase III trial to prove the improvement of dosimetry and cranial outcomes. We all expect for the outcomes from this new concept using modern technology.
Currently, the dose distribution and standardization of technique are main restriction factors for brachytherapy. 3D printing template-assisted CT-guided 125I seeds interstitial implantation may provide the optimum way to address these problems. This technique will be a critical landmark in the development of brachytherapy, leading the minimally invasive treatment of tumor to a new era.