Page 13 - ARNM-1-1

Advances in Radiotherapy
& Nuclear Medicine Seed implantation head-and-neck carcinoma

and 5-year OS rates were 63.6%, 44.6%, 29.9%, and 21.7%, The disadvantages of CT-guidance for I-125 RSI-BT
respectively, with a median OS of 20.0 months. The study are as follows: (i) the long process to train a skilled
reported skin and mucosal toxicities as the major adverse interventional doctor; (ii) the needles’ distribution
events, with the major being lower grade (Grade 2). These that cannot be followed as designed in the pre-plan
adverse events were generally well tolerated by the patients. with free-hand performance due to organ movement,
CT guidance for RSI-BT was an optimal salvage treatment changes and distortions in tumor shape, bleeding, and
not only for advanced parotid gland carcinoma but also interference with the OAR such as blood vessels and
for rHNC, which showed a promising prognosis and lower boney anatomy; (iii) the non-satisfactory quality control
toxicity. However, the quality assurance in the target dose of RSI-BT according to post-plan dose evaluation; (iv) the
pattern was still suboptimal, which cannot realize the pre- different locations where the operation and CT scan take
plan designed requirements, resulting in various outcomes. place; (v) the increase in patient’s radiation exposure due
The other studies about RSI-BT under CT guidance are to multiple CT scans; and (vi) the long operation time,
shown in Table 1 [14,16,31,32] . averaging 2 – 3 h.

Table 1. Reported local control and overall survival of seed implantation for head-and-neck cancer
Study No. of Primary tumor Median Average Median Local control Overall Toxicity
125
patients dose, Gy no. of I activity, rate (%) survival rate
(range) seeds used mCi (%)
(range) (range)
Ji et al. [14] 101 Nasopharyngeal (28) 117 43 (8 – 121) 0.67 5-year: 26.6% 5-year: 15.5% 7.9%
Oral/oropharyngeal (22) (44 – 246) (0.22 – 0.83) Grade 3
Laryngeal/hypopharyngeal (22) 2.0%
Nasal/paranasal sinus (17) Grade 4
Primary cervical neoplasm (9)
Orbital/periorbital (3)
Jiang et al. [16] 113 Nasopharyngeal carcinoma (31) 120 - 0.65 1-year: 57.4% 1-year: 63.6% Skin 22.9%
Oral carcinoma (27) (110 – 160) (0.22 – 0.83) 2-year: 41.8% 2-year: 44.6% Mucosal
Hypopharyngeal carcinoma (16) 3-year: 29.3% 3-year: 29.9% 15.1%
Laryngeal carcinoma (15) 5-year: 15.2% 5-year: 21.7%
Nasal/pararnasal sinuses
carcinoma (10)
Lymph-node metastasis of
unknown (7)
Skin carcinoma (3)
salivary carcinoma (2)
Oropharyngeal carcinoma (1)
Thyroid cancer (1)
Jiang et al. [13] 64 Nasopharyngeal (12) 130 20 (3 – 89) 0.7 1-year: 75.2% 1-year: 57.4% 2 cases
Laryngeal (12) (90 – 160) (0.35 – 0.8) 3-year: 73.0% 3-year: 31.0% of Grade
Buccal cavity (12) 5-year: 69.1% 5-year: 26.6% 4 skin
Thymic (5) reaction;
Oropharyngeal (5) 17% Grade
Hypopharyngeal (5) 1 – 2 skin
Other (13) reaction
Zhu et al. [31] 19 Larynx (6) 131 29 (3 – 78) 0.67 1-year: 73.3% 1-year: 53.0% 1 case skin
STS (3) (90 – 160) (0.4 – 0.8) 2-year: 27.5% 2-year: 18.2% reaction
Hypopharynx (2) 3-year: 27.5% 3-year: 18.2%
Thyroid (2) (Median duration (Median
Nasal cavities (2) of local control: duration of
Other (4) 24 months) overall survive:
13 months)
Jiang et al. [32] 14 Sinus Paranasal (5) 157.5 48 (21 – 158) 0.65 1-year: 52% 1-year: 65% 1 case
Nasopharyngeal (3) (90 – 218) (0.4 – 0.8) 3-year: 39% 3-year: 39% mucosal
Laryngeal (2) 5-year: 39% 5-year: 39% reaction
Other (4) (Median duration (Median
of local control: duration of
18 months) overall survive:
20 months)

Volume 1 Issue 1 (2023) 5 https://doi.org/10.36922/arnm.0907