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Advances in Radiotherapy
& Nuclear Medicine 3D-PT-assisted CT-guided I RSI
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Table 2. Characteristics of radioactive seed implantation in each area for recurrent head and neck cancer
Site Cranial base Maxillary sinus region Parapharyngeal The floor of the mouth region Neck lymph node
space region region
Patient Lateral decubitus Lateral decubitus position Lateral decubitus Supine position Lateral decubitus
positioning position position position
Anesthesia Deep vein compound Deep vein compound anesthesia/ Local anesthesia Lingual nerve block combined Local anesthesia
method anesthesia local infiltration anesthesia technique with local infiltration anesthesia technique
technique
Template type 3D-PNCT 3D-PNCT 3D-PNCT 3D-PNCT 3D-PNCT/3D-PCT
Abbreviations: 3D-PCT: Three-dimensional-printing co-planar template; 3D-PNCT: Three-dimensional-printing non-co-planar template.

distribution of needles is essential for dose accuracy. In operative values, with no statistically significant differences
contrast, traditional puncture techniques can be influenced (P > 0.05), suggesting that this method offers good accuracy.
by the technical skills and experience of the operators. In Specifically, the differences in post-operative parameters
addition, Qiu et al. conducted a retrospective analysis on were as follows: post-operative lesion volume (5.57%),
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the accuracy of 3D-PT-assisted 125 I RSI for recurrent or D90 (0.34%), V100 (0.33%), V150 (−1.20%), V200 (21%),
metastatic HNCs. The findings indicated that the average minimum peripheral dose (2.8%), CI (−14.2%), EI (4.71%),
depth of the needle insertion during the procedure was and HI (-10.4%). Ji et al. conducted a comparison of
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6.23 ± 0.24 cm compared to 6.21 ± 0.24 cm preoperatively, the dose distribution between the post-operative and
with an average angle of 83.14 ± 3.64 degrees versus pre-operative plans for radioactive particle implantation
83.09 ± 3.66 degrees when comparing pre-operative assisted by 3D-PT, demonstrating that using a 3D-printed
and intraoperative measurements. Furthermore, Huang guiding template significantly improved the accuracy
et al. conducted a study comparing the distance and of radioactive particle implantation. Importantly, there
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angle deviations of the needle tip during pre-operative were no statistically significant differences in dosimetric
and intraoperative implantation of 125 I radioactive seeds parameters (D90, minimum peripheral dose, V150, and
guided by individualized 3D-PTs. The patients were V200) between the post-operative and pre-operative
divided into four groups based on the puncture site: the plans. Furthermore, Qiu et al. assessed the precision
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parotid and masseter region group, the maxillary and of personalized 3D-PT-assisted 125 I RSI for recurrent or
paranasal region group, the submandibular region, and the metastatic HNC. The study revealed that the post-operative
upper neck region group. The researchers found that the dosimetric parameters were effectively aligned with the
distance deviation in the submandibular posterior region planned dosimetry, showing no significant deviations.
group was significantly smaller than those in other regions, Similarly, Liang et al. conducted a dosimetric study
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particularly in the parotid and maxillary areas. investigating the use of 3D-PT-assisted 125 I radioactive
The precision of 3D-PT-assisted CT-guided I RSI has particle implantation in patients with cervical lymph node
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been demonstrated in multiple studies, with post-operative metastases. The results showed no statistically significant
dose measurements fully aligning with the pre-operative differences between the pre-operative and post-operative
plans as outlined in the requirements. 39-42 Hongtao et measurements of D90, V90, V100, and V150.
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al. applied I seeds in treating malignant tumors using The clinical studies of RSI for HNC were typically
individualized 3D-PTs, finding that the dose parameters retrospective, focusing on recurrent HNC cases
for particle implantation guided by these templates were (Tables 3 and 4). 22,24,25,38,40,43-46 Compared to CT-guided
nearly identical before and after planning. Liang et al. RSI, the 3D-PT-assisted I RSI for HNC has been shown
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reported that the use of 3D templates significantly reduced to reduce the dosimetric differences between pre- and
patient radiation exposure and alleviated the anxiety and post-planning and lowered the difficulty of puncture.
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pressure experienced by both operators and patients, with Moreover, incorporating individual template guidance can
an average CT scan frequency of only 5.7 times. In addition, reduce the time required for implantation and minimize
Sun et al. conducted a comparison of dosimetric data for 38
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pre-operative planning and post-operative verification damage to normal tissues.
of 125 I particle implantation assisted by a 3D-PT under Jiang et al. conducted a retrospective study involving
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CT guidance for mobile tumors in the thoracic cavity. 14 cases of CT-guided I RSI for the treatment of recurrent
The results indicated that the post-operative dosimetric HNCs. The median follow-up period was 13 months,
parameters showed minimal changes compared to the pre- with a median local control duration of 18 months (95%
Volume 2 Issue 4 (2024) 8 doi: 10.36922/arnm.4212