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

9.2. Better precision and accuracy assistance for operators only requires a 6-month training

All RSI-BT procedures are precise and accurate. First, the program for experienced doctors, including interventional
3D-PNCT can be matched very well to both the patient radiologists, surgeons, and radiation oncologists.
and tumor, and no positional errors can occur due to 10. Perspectives
organ stabilization and no patient movement in the
head-and-neck region due to immobilization. Second, all RSI-BT has mainly been utilized in treating early-stage
needle insertion follows the guide holes (ports) on the prostate carcinoma with ultrasound guidance in Western
template according to the pre-planned designed template Countries. 3D-PT-assisted CT-guided I-125 RSI-BT greatly
base on CT images obtained preoperatively. It should be expands the indications and enriches the aspects of BT.
recognized that all the needles’ position adheres to the Precision and ablative radiation for cancer treatment in
pre-plan, assuring a successful, accurate, and high-quality the future of anti-cancer treatment as conventional surgery
I-125 RSI-BT under CT supervision. If the deviation in a or EBRT show greater toxicity and long-term treatments
needle’s position is observed to be more than 2 mm, a fine and recovery time to normal life. For developing countries,
adjustment can be made intraprocedurally until the real- cancer treatment-related organ side effects and disruption
time plan is exactly confirmed with the pre-plan algorithm. in function makes the cost unreasonable. I-125 RSI-BT
The toxicity incidence has been observed to have decreased is minimally invasive and, most of the time is performed
due to no OARs in the needle’s pathway. under local anesthesia requiring the patient to spend only
1 day to recover to normal life. More and more prospective,
9.3. Ablative doses large-scale randomized clinical trials should be performed
I-125 RSI-BT can deliver very high radiation doses to to evaluate and encourage the development of I-125 RSI-BT
identified targets with 3D-PT-assisted CT guidance. With for appropriate patients. In medical practice, the ultimate
real-time adaptive dose optimization, RSI radiation doses guideline of a therapeutic strategy is based on prospective
[49]
of EQD2 should be more than 120 Gy compared with EBRT, and randomized controlled trials . The I-125 RSI-BT has
and tumor ablation with these higher doses of radiation is produced long-lasting remission and extended patients’
similar to interventional radiofrequency; however, organ survival for many years. Precision ablation with BT has been
function is preserved. EBRT has to penetrate the normal confirmed in hundreds of thousands of patients in China
tissues to reach the targets making the dose-escalation for the past 20 years, which has promoted RSI-BT from an
very difficult to achieve due to the normal tissues’ dose experimental therapy to a routine clinical application. I-125
limitation, and this is why EBRT is just an adjuvant RSI-BT has been increasingly used in various sites for primary
treatment and not a curative modality most of the time. treatment. With the development of multimodality image
fusion, artificial intelligence TPS, robot assistant implantation
9.4. Single operation systems, and stranded seeds, it is a great opportunity for the
The I-125 RSI-BT is performed just once with an I-125 RSI-BT to become soon an independent, minimally
operative time of about 45 min to 1.5 h, usually averaging invasive ablative discipline for cancer treatment or an
about 1 h. This technique is an advanced version of the adjuvant option with surgery or EBRT.
hypofunctional, ablative RT. It should be referred to
as stereotactic body radiotherapy (SABT). SBRT often Acknowledgments
requires 3 – 5 fractionated radiation treatments and 1 week None.
time. Fractionation with high-dose radiation is usually
very few, so RSI-BT is the true ablative RT. Funding

9.5. Cost-effect benefit Special fund of the National Clinical Key Specialty
Construction Program, P. R. China (2021).
The last and greatest advantage of I-125 RSI-BT is its cost-
effectiveness, which is relatively reasonable and more Conflict of interest
suitable for developing countries. All the investments
required for I-125 RSI-BT are not as high as EBRT, The authors declare that they have no conflicts of interest.
not requiring significant space, construction, radiation Author contributions
protection, and machines. CT machines are accessible all
around the world at present, and installation of support Conceptualization: Gordon L. Grado, Junjie Wang
devices such as the stabilization systems and BT-TPS are Writing – original draft: Suqing Tian, Bin Qiu
easy to obtain and utilize. The practice of I-125 RSI-BT has Writing – review & editing: Ping Jiang, Yuliang Jiang,
become relatively simple and convenient because 3D-PT Zhe Ji, Mingwei Huang

Volume 1 Issue 1 (2023) 12 https://doi.org/10.36922/arnm.0907