|Year : 2020 | Volume
| Issue : 7 | Page : 1549-1554
Chinese expert consensus workshop report: Guideline for permanent iodine-125 seeds implantation of primary and metastatic lung tumors (2020 edition)
Fujun Zhang1, Junjie Wang2, Jinhe Guo3, Xuequan Huang4, Zhiyu Guan5, Guangyan Lei6, Juan Wang7, Xin Ye8, Xiaogang Zhao9, Jing Wang10, Ruoyu Wang11, Bin Liu12, Qing Zhou13, Mingfang Zhao14, Chuanxin Wang15, Yuliang Li12
1 Imaging and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou, China
2 Department of Radiation Oncology, Cancer Centre, Peking University Third Hospital, Beijing, China
3 Department of Radiology, Southeast University, Zhongda Hospital, Nanjing, China
4 Department of Interventional Medicine, The First Hospital Affiliated to AMU (Southeast Hospital), Tianjin, China
5 Department of Thoracic Surgery, The Second Hospital of Tianjin Medical University, Tianjin, China
6 Department of Thoracic Surgery, Shaanxi Provincial Cancer Hospital, Xi'an, China
7 Department of Oncology, Hebei General Hospital, Shijiazhuang, China
8 Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
9 Department of Thoracic Surgery, The Second Hospital of Shandong University, Jinan, China
10 Department of Respiration, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
11 Department of Oncology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
12 Department of Interventional Medicine, The Second Hospital of Shandong University; Interventional Oncology Institute of Shandong University, Jinan, China
13 Department of Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
14 Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
15 Laboratory Medicine Center, The Second Hospital of Shandong University, Jinan, China
|Date of Submission||03-Aug-2020|
|Date of Decision||25-Aug-2020|
|Date of Acceptance||01-Oct-2020|
|Date of Web Publication||9-Feb-2021|
Laboratory Medicine Center, The Second Hospital of Shandong University, Jinan, CN-250033
Department of Interventional Medicine, The Second Hospital of Shandong University; Interventional Oncology Institute of Shandong University, Jinan, CN-250033
Source of Support: None, Conflict of Interest: None
Surgery remains the first option for curing early stage lung cancer. However, many patients are diagnosed at an advanced stage, and thus miss the chance to undergo surgery. As such patients derive limited benefits from chemotherapy or radiotherapy, alternatives based on local control have emerged, including iodine-125 seed implantation. The Interstitial Brachytherapy Society, Committee of Minimally Invasive Therapy in Oncology, the Chinese Anti-Cancer Association organized a group of multidisciplinary experts to revise the guidelines for this treatment modality. It aims to standardize iodine-125 seed implantation procedures, inclusion criteria, and outcome assessment to prevent and manage procedure-related complications.
Keywords: Guidelines, implantation, iodine-125, lung malignancy
|How to cite this article:|
Zhang F, Wang J, Guo J, Huang X, Guan Z, Lei G, Wang J, Ye X, Zhao X, Wang J, Wang R, Liu B, Zhou Q, Zhao M, Wang C, Li Y. Chinese expert consensus workshop report: Guideline for permanent iodine-125 seeds implantation of primary and metastatic lung tumors (2020 edition). J Can Res Ther 2020;16:1549-54
|How to cite this URL:|
Zhang F, Wang J, Guo J, Huang X, Guan Z, Lei G, Wang J, Ye X, Zhao X, Wang J, Wang R, Liu B, Zhou Q, Zhao M, Wang C, Li Y. Chinese expert consensus workshop report: Guideline for permanent iodine-125 seeds implantation of primary and metastatic lung tumors (2020 edition). J Can Res Ther [serial online] 2020 [cited 2021 May 16];16:1549-54. Available from: https://www.cancerjournal.net/text.asp?2020/16/7/1549/308755
| > Introduction|| |
Globally, lung cancer is the top malignant tumor with approximately 1,855,900 new cases and 1,589,900 deaths in 2012. China's situation is severe. According to the reported estimates in 2015, the annual incidence of lung cancer was 57.26/100,000, and the annual mortality was 45.87/100,000 with the largest absolute number globally. Its pathogenic factors include smoking, air contamination, and heredity. For its early stage, including small cell lung cancer (SCLC) or non-SCLC (NSCLC), surgery is the first option for cure. However, many patients are diagnosed at an advanced stage and have no chance of surgery. These patients will receive limited benefits from chemotherapy or radiotherapy, and many alternatives based on local control have emerged, including permanent iodine-125 seed implantation, thermal ablation, and photodynamics therapy. Studies on iodine-125 seed implantation have been reported treating lung cancer, and many patients benefit from this alternative technique.,,,, Furthermore, iodine-125 seed implantation has also been shown to be effective on metastatic lung cancer.,,,,
In 2014, Comprehensive Interventional Physicians Society of the Shandong Medical Association and Interventional Oncology Society of the Shandong Anti-Cancer Association organized experts on minimally invasive treatment of tumors to discuss standardized processes for CT-guided iodine-125 seed implantation. Therefore, “Shandong Expert Consensus for Permanent Iodine-125 Seeds Implantation of Primary and Metastatic Lung Tumors” was summarized and published in “Shandong Medical Journal” in 2015. In 2018, the Interstitial Brachytherapy Society, Professional Committee of Minimally Invasive Treatment of Cancer of the Chinese Anti-Cancer Association organized multidisciplinary experts to revise the guidelines, and summarized the “Chinese Expert Consensus Workshop Report: Guidelines for permanent iodine-125 seed implantation of primary and metastatic lung tumors,” which was published in “Thoracic Cancer” in 2019.
Both guidelines greatly contributed to developing and standardizing iodine-125 seed implantation of lung tumors. However, many shortcomings have been found in these guidelines and further improvements are needed. Therefore, the Interstitial Brachytherapy Society, Professional Committee of Minimally Invasive Treatment of Cancer of the Chinese Anti-Cancer Association organized a group of multidisciplinary experts to revise these guidelines for permanent iodine-125 seed implantation of primary and metastatic lung tumors.
| > Concept and Principle of Iodine-125 Brachytherapy|| |
As a brachytherapy, radioactive seeds are implanted directly into the lesion, and kill tumor cells by consistently releasing rays. Iodine-125 is the most common permanent implanted seeds with a size of 4.5 mm × 0.8 mm and an envelope of nickel titanium alloy. γ-rays with energy lower than 0.0355 MeV could inhibit cell proliferation and angiogenesis, induce apoptosis, and kill tumor cells.,,
| > Implanting Modalities|| |
Percutaneous iodine-125 seed implantation was usually performed under computed tomography (CT) or ultrasound guidance. For lung tumors, CT is a more preferred technique. Ultrasound could be used for some lesions near or adhere to chest wall. Magnetic resonance imaging (MRI) has shown considerable value in percutaneous biopsy and target localization, and may be one alternative guiding modality of iodine-125 seed implantation for lung tumors.
Image and three dimensional printing non-coplanar template guided
Recently, three dimensional (3D) printing non-coplanar template (PNCT) technology has been widely used in the field of iodine-125 seed implantation for treating malignant tumor, including head and neck tumors, pancreatic cancer, recurrent rectal cancer, spinal tumors, recurrent soft tissue tumor, and lung tumors. However, 3D PNCT guided iodine-125 seed implantation should overcome the influence of rib obstruction and respiratory mobility. There was no solution for promotion.
Electronic fibrobronchoscope: Mainly used for
(1) Early stage of central lung cancer; (2) localized intratracheal tumor, which cannot be treated with surgery or other radical therapy.,
(1) Lung tumor which is adjacent to hilum, large vessels, or heart, and could not be treated with radical resection and (2) unresectable lung tumor.
Endobronchial ultrasound guided
The ultrasonic probe in the front of the lens could clearly show the relationship between blood vessels, lymph nodes, and tumors outside the airway. Under the real-time monitoring of ultrasound images, iodine-125 seed implantation can avoid damage to the surrounding large blood vessels and improve the safety and accuracy of seed implantation.
Such as iodine-125 seed implantation during robot-assisted surgery.,
| > Principles of Iodine-125 Seed Implantation|| |
Multi-disciplinary team and individualized treatment
An effective and reasonable treatment plan should be made after consulting physicians in the Department of Thoracic Surgery, Respiratory, Oncology, Radiation Oncology, and Interventional Medicine.
Delineate target area according to lung window, as well as organs at risk (OARS). Select appropriate prescription dose (PD) and activity of seeds, and make treatment plan with the treatment planning system (TPS).
Implant seed into the tumor under CT guidance, and perform intraoperative dose optimization if necessary.
Bilateral lesions should be treated separately each time.
Evaluate dose of target tumor with dose–volume histogram (DVH) and isodose profile after the procedure.
Observe complications including hemorrhage, radiation pneumonitis during follow-up after the procedure.
| > Indications and Contraindications|| |
- Primary lung cancer: (1) not candidates for surgery due to low cardiopulmonary reserve or old age;, (2) refused to accept surgery; (3) recurrent and unresectable tumor;, (4)residual or progressed tumor after surgery, radiotherapy, or chemotherapy; (5) to get tumor-free boundary with thermal ablation or surgery; (6) Karnofsky performance status (KPS) >60, and predicted life span >6 months;(7) the diameter of the largest tumor <7 cm
- Metastatic lung cancer: (1) unilateral lesions with the number ≤3 and the diameter ≤5 cm; (2) Bilateral lesions should be treated separately with the number ≤3 and the diameter ≤5 cm.
(1) cachexia with multi-functional failure; (2) intractable infection or radiation inflammation around the lesion;(3) skin infection or ulceration around the puncture site;(4) severe coagulation disorders or anemia; (5) ipsilateral massive malignant pleural effusion; (6) KPS score <60; (7) predicted life span ≤6 months.
| > Preoperative Preparation and Examination|| |
Evaluation of patients
Whether the patient is appropriate for iodine-125 seed implantation should be determined after MDT consultation by checking the history, physical, and imaging examinations [Figure 1]. Enhanced CT of chest with the slice thickness of 5 mm 1 week before the procedure is necessary to detect the size, location, and distance to other organs, vessels, and trachea of the tumor. For the cases requiring 3D PNCT, delineate anchor points on the skin. Necessary imaging examinations should be performed to detect metastasis and determine the TNM stage, including Positron Emission Tomography – Computed Tomography (PET-CT).
Percutaneous or fiberbronchoscopic biopsy is necessary before iodine-125 seed implantation.
Treatment planning system
After importing the data of chest enhanced CT into TPS, delineate clinical target volume (CTV) according to images on the lung window (with width of 1000 HU, level of −650 HU and slice thickness of 5 mm). The recommended activity of seed is 0.6–0.8 mci, and the PD is 120–160 Gy. Planning target volume (PTV) should cover CTV and one more 1 cm beyond the margin. OARS around the tumor should also be delineated. Order iodine-125 seeds according to TPS plan. Design 3D-PNCT if necessary. MRI or PET-CT is recommended to delineate target volume when atelectasis exists. Dose–volume histogram is used to evaluate plan dose plan.
Include blood count, urine, stool, blood coagulation, liver and kidney function, blood glucose level, tumor markers, electrocardiogram (ECG), echocardiography, and lung function test.
Drugs and electrocardiogram monitoring
Anesthesia, analgesia, antitussive, hemostasis, vasodilator, and antihypertensive drugs and monitoring devices should be prepared before the procedure.
Patients or their mandatary should sign informed consent, be fasted for 4 h before local anesthesia or 6 h before intravenous general anesthesia. Oral antitussive is necessary before the procedure.
| > Operation Processes|| |
Body position and anesthesia
Select appropriate body position according to tumor location and performance status of the patient. Vacuum cushions were used to fix patients. Local or intravenous general anesthesia is selected according to the practice of local hospital. Disinfect the operation field with strict implementation of aseptic manual. Planar template should be fixed to the frame, while 3D PNCT should be fixed according to TPS plan and anchor points on skin.
Iodine-125 seed implantation
Take CT guidance as an example. CT with a slice thickness of 0.5 cm was performed before the procedure to identify the tumor location and mark operation field. Select appropriate intercostal space as puncture plane, and determine the puncture site, angle, and depth. Auxiliary technologies, such as bone drilling or artificial pneumothorax, could be used for cases where bone acts as a barrier for puncture. Insert the puncture needles into the tumor under CT guidance, and implant iodine-125 seeds according to TPS plan. The distance among puncture needles is usually 1–1.5 cm. The puncture of needles could be accomplished at once or on fractionation procedure. After all needle tips reach the distal edge of the tumor, retrace the needle with equal distance or according to TPS plan, and implant iodine-125 seeds. CT scan was recommended to be repeated during the procedure to ensure that the seeds were implanted as the TPS plan. Revise the implantation plan if necessary. After implantation, re-scan the entire lung, and check the distribution and number of iodine-125 seeds in every plane. If there is cold area, implant some more seeds to match the dose requirement of TPS plan. Check if there are complications including pneumothorax or hemorrhage, and treat it if necessary, such as percutaneous drainage. Import data of CT scan after the procedure into TPS, and verify if the dose meets the dose requirement of preoperative plan.
Monitoring during the procedure
Heart rate, blood pressure, and blood oxygen saturation are carefully monitored. Consciousness, breathing, and symptoms of patients, including pain, cough, or hemoptysis are closely observed. Treat it if necessary.
Patients should be escorted back to the ward by doctors. ECG monitoring and oxygen inhalation are necessary until the patient's condition is stable. X-ray examination or chest CT should be repeated 24 h after the procedure, checking if there is pneumothorax, hemothorax, or seed migration.
| > Adverse Reactions and Complications|| |
Adverse reactions and complications after seed implantation should be evaluated according to Common Terminology Criteria for Adverse Events, and radioactivity response evaluation criteria Radiation Therapy Oncology Group (RTOG)/EORTC1987 from the U. S. RTOG.
- Pneumothorax: No medical treatment is recommended for slight pneumothorax, especially when there is no symptom. If the compression ratio of the affected lung exceeds 30% and patients suffer from suffocating or dyspnea, thoracic drainage is recommended
- Hemorrhage: (1) Lung hemorrhage: For patients with bloody sputum or hemoptysis, medicine (such as pituitrin, reptilase, aminomethylbenzoic acid, or ethamsylate) should be used. Bronchial artery embolization is recommended if necessary. (2) Hemothorax: The reasons include damage of intercostal artery, internal thoracic artery, or vessels inside the lung, which cause bleeding into the thoracic cavity. If the amount is more than 500 ml, blood transfusion and fluid resuscitation are recommended. Arteriography and embolization are necessary if the above treatments do not work. Surgery is recommended if necessary, especially when the blood pressure and heart rate are unstable
- Pleural reaction: Relatively rare. Main symptoms include nagging cough, dizzy, sweatiness, pale face, palpitation, hypotension, chest constriction, and conscious disturbance. The operation should be suspended immediately. Lay the patient on the bed, keep warm, and monitor the heart rate, blood pressure, and consciousness. After rest or psychological counseling, some patients may recover soon. For patients with hypoglycemia or unstable vital signs, oxygen inhalation and glucose administration are recommended. Adrenaline should be administered to avoid shock if necessary
- Infection: Relatively rare. Main symptoms include fever, leukocytosis. Antibiotics administration is recommended, and strict sterile manipulation can avoid infection
- Puncture tract metastasis: Relatively rare. Surgery or repeated iodine-125 seed implantation may work. Chemotherapeutics (such as 5-fluorouracil or tegafur) injection through puncture needles would reduce the incidence
- Seed migration: Iodine-125 seeds may migrate to distal bronchia or thoracic cavity. It should be carefully screened
- Local radiation pneumonitis and radiation pulmonary fibrosis: Rare. It may occur in patients who received repeated iodine-125 seed implantation
- Other rare complications: Such as pulmonary embolism, aeroembolism and nerve damage. The treatment depends.
| > Follow-up and Effect Evaluation|| |
Enhanced CT of chest is recommended at 1, 3, 6, 9, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months. It should be repeated once a year for 5 years. PEC-CT or MRI would be applied if necessary.
Effect evaluation of local lesion
It is according to Response Evaluation Criteria in Solid Tumor Version 1.1. Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes (whether a target or nontarget) must have reduction in short axis to <10 mm. Partial Response (PR): At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. Progressive Disease (PD): At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm.(Note: the appearance of one or more new lesions is also considered progression). Stable Disease: Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.
Clinical effect evaluation
Based on the local effect evaluation, the state of survival should be recorded in 1, 2, 3, and 5 years. Meanwhile, pay attention to Karnofsky Performance Status (KPS), pain relief rate, and drug administration of the patient.
| > Iodine-125 Seed Implantation With Other Therapies|| |
Many combined treatments have been used in treating lung tumors, including iodine-125 seed implantation with surgery, chemotherapy, bronchial artery chemoembolization, radiotherapy, and targeted drugs. Iodine-125 seed implantation with chemotherapy could significantly prolong the disease progression free survival (PFS) and enhance the disease control rate (DCR) with no increased side effects. For patients with advanced lung cancer after first-line radiotherapy and chemotherapy, iodine-125 seed implantation with bronchial artery chemoembolization has achieved satisfactory responses, which can prolong PFS of patients. Iodine-125 seed implantation with radiotherapy could also enhance PFS and DCR. Tyrosine-kinase inhibitor (TKI) is one of the main methods for treating advanced NSCLC with epidermal growth factor receptor mutations. Despite the initial response, most patients ultimately develop acquired resistance to TKIs after 1-1.5 years. Iodine-125 seed implantation with TKIs has shown efficacy for treating patients with oligoprogressive disease associated with long PFS and overall survival.
| > Radiation Protection after The Procedure|| |
Radiation protection after iodine-125 seed implantation should follow the expert consensus from Chinese Anti-Cancer Association. Contact within 50 cm is prohibited in at least 2 months after the procedure, and the patients should wear a lead pad for at least 4 months.,,
| > Technology Access|| |
Technology access should follow the management practice from the Chinese Medical Doctor Association and Chinese Anti-Cancer Association.
Financial support and sponsorship
National Natural Science Foundation of China (11971269), Key Research & Development Plan of Shandong Province (2019GSF108105), National Science Fund for Distinguished Young Scholars of China (61625102), National Key R&D Program of China (2016YFC1303800), Science and Technology Project of Jinan Health Committee (2020-3-65).
Conflicts of interest
There are no conflicts of interest.
| > References|| |
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin 2015;65:87-108.
Zheng RS, Sun KX, Zhang SW, Zeng HM, Zou XN, Chen R, et al
. Report of cancer epidemiology in China, 2015. Zhonghua Zhong Liu Za Zhi 2019;41:19-28.
Kanwal M, Ding XJ, Cao Y. Familial risk for lung cancer. Oncol Lett 2017;13:535-42.
Sco WJ, Howington J, Feigenberg S, Movsas B, Pisters K, American College of Chest Physicians. Treatment of non-small cell lung cancer stage I and stage II. ACCP evidence-based clinical practice guidelines. Chest 2007;132:234S-42S.
Zhang FJ, Li CX, Wu PH, Wu YX, Jiao DC, Liu J, et al
. CT guided radioactive 125I seed implantation in treating localized advanced pulmonary carcinoma. Zhonghua Yi Xue Za Zhi 2007;87:3272-5.
Li YL, Wang YZ, Zhang FJ. CT guided percutaneous 125I seed implantation for central lung cancer in old patients and Short-Term Efficacy Evaluation. Zhonghua Zhongliu Fangzhi Zazhi 2007;14:1818-20.
Jiao DC, Zhang FJ, Lu LG, Wu YX, Li CX, Duan GF. CT guided radioactive 125I seed implantation in treating lung malignant tumors. J Intervent Radiol 2008;17:190-3.
Yu X, Li J, Zhong X, He J. Combination of Iodine-125 brachytherapy and chemotherapy for locally recurrent stage III non-small cell lung cancer after concurrent chemoradiotherapy. BMC Cancer 2015;15:656.
Jiang G, Li Z, Ding A, Zhou F, Jiao W, Tang D, et al
. Computed tomography-guided iodine-125 interstitial implantation as an alternative treatment option for lung cancer. Indian J Cancer 2015;51 Suppl 2:e9-12.
Huang Q, Chen J, Chen Q, Lai Q, Cai S, Luo K, et al
. Computed tomographic-guided iodine-125 interstitial implants for malignant thoracic tumors. Eur J Radiol 2013;82:2061-6.
Zhang FJ, Wu PH, Gu YK, Zhao M, Zhang L, Tang ZB, et al
. CT guided radioactive seed 125I implantation in treating lung metastasis. Chin J Radiol 2004;38:906-9.
Zhang L, Fan WJ, Huang ZL, Wu PH, Huang JH, Zhang FJ, et al
. Minimally invasive therapy for primary hepatocellular carcinoma with lung metastasis. Chin J Biomed Engin 2009;3:224-8.
Zhou K, Wu PH, Zhang FJ, Huang JH, Fan WJ, Zhang L, et al
. Percutaneous iodine-125 seeds implantation for lung metastasis from gastrointestinal tract. J Interv Radiol 2006;15:235-7.
Wang JJ, Zhuang YZ. Iodine-125 seed implantation for malignant tumors. Chin J Minim Inva Surg 2001;3:187-91.
Comprehensive Interventional Physicians Society of Shandong Medical Association, Interventional Oncology Society of Shandong Anti-Cancer Association. Shandong expert consensus of iodine-125 seeds implantation for lung malignancies. Shandong Med J 2016;56:1-3.
Zhang F, Wang J, Guo J, Li Y, Huang X, Guan Z, et al
. Chinese expert consensus workshop report: Guideline for permanent iodine-125 seed implantation of primary and metastatic lung tumors. Thorac Cancer 2019;10:388-94.
Wang JJ, Zhang FJ. Treatment Standard of Radioactive Seed Implantation for Tumor. Bejing: People's Medical Publishing House Co. Ltd.; 2016.
Narra VR, Howell RW, Harapanhalli RS, Sastry KS, Rao DV. Radiotoxicity of some iodine-123, iodine-125 and iodine-131-labeled compounds in mouse testes: Implications for radiopharmaceutical design. J Nucl Med 1992;33:2196-201.
Xiang GL, Zhu XH, Lin CZ, Wang LJ, Sun Y, Cao YW, et al
. 125I seed irradiation induces apoptosis and inhibits angiogenesis by decreasing HIF-1α and VEGF expression in lung carcinoma xenografts. Oncol Rep 2017;37:3075-83.
Parashar B, Patel P, Singh P, Monni S, Trichter S, Sabbas A, et al
. Management of single malignant lung nodules in elderly patients (70 years or older) who are not candidates for lobectomy. Am J Clin Oncol 2012;35:480-5.
Yang F. Ultrasound guided 125I seed implantation for advanced lung cancer. Chin J Practical Med 2015;42:23-4.
Liu M, Huang J, Xu Y, He X, Li L, Lü Y, et al
. MR-guided percutaneous biopsy of solitary pulmonary lesions using a 1.0-T open high-field MRI scanner with respiratory gating. Eur Radiol 2017;27:1459-66.
Xing G, Chai SD, Guo DA, Lian ZC. The value of MRI in orientation of the masses in central bronchial carcinoma accompanied with atelectasis during treatment with interstitial implantation of 125I seed. J Prac Radiol 2011;27:1021-4.
Wang JJ, Zhang FJ, Guo JH, Chai SD, Zheng GJ, Zhang KX, et al
. Expert consensus workshop report: Guideline for three-dimensional printing template-assisted computed tomography-guided 125 I seeds interstitial implantation brachytherapy. J Cancer Res Ther 2017;13:607-12.
Ji Z, Jiang Y, Guo F, Peng R, Sun H, Fan J, et al
. Safety and efficacy of CT-guided radioactive iodine-125 seed implantation assisted by a 3D printing template for the treatment of thoracic malignancies. J Cancer Res Clin Oncol 2020;146:229-36.
Lu M, Pu D, Zhang W, Liao J, Zhang T, Yang G, et al
. Trans-bronchoscopy with implantation of 125I radioactive seeds in patients with pulmonary atelectasis induced by lung cancer. Oncol Lett 2015;10:216-22.
Du Rand IA, Barber PV, Goldring J, Lewis RA, Mandal S, Munavvar M, et al
. Summary of the British Thoracic Society guidelines for advanced diagnostic and therapeutic flexible bronchoscopy in adults. Thorax 2011;66:1014-5.
Jiang AG, Lu HY, Ding ZQ. Implantation of 125 I radioactive seeds via c-TBNA combined with chemotherapy in an advanced non-small-cell lung carcinoma patient. BMC Pulm Med 2019;19:205.
Lee W, Daly BD, DiPetrillo TA, Morelli DM, Neuschatz AC, Morr J, et al
. Limited resection for non-small cell lung cancer: Observed local control with implantation of I-125 brachytherapy seeds. Ann Thorac Surg 2003;75:237-42.
Stewart AJ, Mutyala S, Holloway CL, Colson YL, Devlin PM. Intraoperative seed placement for thoracic malignancy-A review of technique, indications, and published literature. Brachytherapy 2009;8:63-9.
Xu T, Peng WD, Gu X, Yu WJ. Endobronchial ultrasound-guided iodine-125 radioactive seed implantation as a novel therapy for mediastinal tumors. Cancer Biother Radiopharm 2019;34:547-50.
Ma GW, Pytel M, Trejos AL, Hornblower V, Smallwood J, Patel R, et al
. Robot-assisted thoracoscopic brachytherapy for lung cancer: Comparison of the ZEUS robot, VATS, and manual seed implantation. Comput Aided Surg 2007;12:270-7.
Lin AW, Trejos AL, Mohan S, Bassan H, Kashigar A, Patel RV, et al
. Electromagnetic navigation improves minimally invasive robot-assisted lung brachytherapy. Comput Aided Surg 2008;13:114-23.
Yan WL, Lv JS, Guan ZY, Wang LY, Yang JK, Liang JX. Impact of target area selection in 125 Iodine seed brachytherapy on locoregional recurrence in patients with non-small cell lung cancer. Thorac Cancer 2017;8:147-52.
Skowronek J. Brachytherapy in the treatment of lung cancer-a valuable solution. J Contemp Brachytherapy 2015;7:297-311.
Li J, Yu M, Xiao Y, Yang L, Zhang J, Ray E, et al
. Computed tomography fluoroscopy-guided percutaneous 125 I seed implantation for safe, effective and real-time monitoring radiotherapy of inoperable stage T1-3N0M0 non-small-cell lung cancer. Mol Clin Oncol 2013;1:1019-24.
Song J, Fan X, Zhao Z, Chen M, Chen W, Wu F, et al
. 125 I brachytherapy of locally advanced non-small-cell lung cancer after one cycle of first-line chemotherapy: A comparison with best supportive care. Onco Targets Ther 2017;10:1345-52.
Niu L, Zhou L, Xu K, Mu F. Combination of cryosurgery and Iodine-125 seeds brachytherapy for lung cancer. J Thorac Dis 2012;4:504-7.
Parashar B, Patel P, Monni S, Singh P, Sood N, Trichter S, et al
. Limited resection followed by intraoperative seed implantation is comparable to stereotactic body radiotherapy for solitary lung cancer. Cancer 2010;116:5047-53.
Zhan P, Zhu QQ, Miu YY, Liu YF, Wang XX, Zhou ZJ, et al
. Comparison between endobronchial ultrasound-guided transbronchial biopsy and CT-guided transthoracic lung biopsy for the diagnosis of peripheral lung cancer: A systematic review and meta-analysis. Transl Lung Cancer Res 2017;6:23-34.
Li J, Zhang L, Xu W, Wang T, Zhou L, Xie Q, et al
. Computed tomography-guided implantation of 125 I seeds brachytherapy for recurrent multiple pulmonary oligometastases: Initial experience and results. J Contemp Brachytherapy 2017;9:132-8.
Wang JJ, Yuan HS, Wang H, Liu JP, Jiang WJ, Tian SQ, et al
. CT-guided interstitial implantation of 125I seed for lung cancer. Chin J Min Inv Surg 2008;2:119-21.
Huo XD, Chai SD, Zheng GJ, Yang JK, Liang JX, Wei W. Function of PET-CT in 125I seeds permanent braehytherapy treatment for lung cancer. J Chin Clin Med Imaging 2011;22:616-8.
Chinese Medical Association, Radiation Oncology Society. Expert consensus on work flow and quality control of CT-guided 125I seed permanent interstitial brachytherapy assisted by 3D-printing non-coplanar templates. Chin J Radiat Oncol 2017;26:495-500.
Huo B, Wang L, Wang HT, Huo XD, Cao Q, Wang LL, et al
. Feasibility of radioactive seed implantation in the treatment of lung cancer assisted by template combined with rib drilling technique. J Shandong Univ (Health Sciences) 2017;55:26-31.
Ni RH, Zhang ZM, Yang ZZ, Ma JG, Hu N, Hu W, et al
. Artificial pneumothorax in CT-guided radioactive iodine-125 seed implantation in the treatment of mediastinal tumors. Eur Rev Med Pharmacol Sci 2014;18:3034-7.
Wei W, Shen XH, Sun H, Lu WL, Chai SD, Yang JK. The short-term therapeutic effects of radioactive 125I seeds implantation for treatment of non-small-cell lung cancer. Chin J Int Med 2012;51:978-81.
Yang RJ, Yang RX, Wang JJ. Dose verification of treatment planning system. Chin J Radiol Med Prot 2011;4:493-5.
Kluetz PG, Chingos DT, Basch EM, Mitchell SA. Patient-reported outcomes in cancer clinical trials: measuring symptomatic adverse events with the national cancer institute's patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE). Am Soc Clin Oncol Educ Book 2016;35:67-73.
Nishino M, Jackman DM, Hatabu H, Yeap BY, Cioffredi LA, Yap JT, et al
. New response evaluation criteria in solid tumors (RECIST) guidelines for advanced non-small cell lung cancer: Comparison with original RECIST and impact on assessment of tumor response to targeted therapy. AJR Am J Roentgenol 2010;195:221-8.
Chen C, Wang W, Yu Z, Tian S, Li Y, Wang Y. Combination of computed tomography-guided iodine-125 brachytherapy and bronchial arterial chemoembolization for locally advanced stage III non-small cell lung cancer after failure of concurrent chemoradiotherapy. Lung Cancer 2020;146:290-6.
Li W, Dan G, Jiang J, Zheng Y, Zheng X, Deng D. Repeated iodine-125 seed implantations combined with external beam radiotherapy for the treatment of locally recurrent or metastatic stage III/IV non-small cell lung cancer: A retrospective study. Radiat Oncol 2016;11:119.
Interstitial Brachytherapy Society, Professional Committee of Minimally Invasive Treatment of Cancer of the Chinese Anti-Cancer Association. Expert consensus for radiation protection management of radioactive iodine-125 seed implantation ward. Chin Med J-Peking 2017;97:1455-6.
Sui AX, Li JM, Tang FL, Zhang HT, Ren JN, Pang LB, et al
. Radiation safety and protection of close contacts from radiator after implantation of radioactive 125I seeds. Chin J Radiol Med Prot 2012;32:626-8.
Lu J. Radiation protection of 125I seed implantation. J Chin Oncol 2004;10:363-4.
Zhuo SQ, Chen L, Zhang FJ, Zhao M, Zhang L, Liu J, et al
. Radiation dose monitoring around the patient after 125I seed implantation. Cancer 2007;26:666-8.
Radioactive Seed Implantation Expert Committee of Chinese Medical Doctor Association; Interstitial Brachytherapy Society, Professional Committee of Minimally Invasive Treatment of Cancer of the Chinese Anti-Cancer Association. Management practice of radioactive seed implantation. Chin Med J Peking 2017;97:1450-1.