Accuracy of 3D printing template-assisted CT-guided radioactive iodine-125 seed implantation for peripheral locally recurrent rectal cancer: A retrospective study

Abstract

Objective: This study aimed to investigate the accuracy of needle insertion and dosimetric parameters in three-dimensional printing template (3D-PT)-assisted computed tomography (CT)-guided radioactive iodine-125 (¹²⁵I) seed implantation (RISI) for the treatment of peripheral locally recurrent rectal cancer (pLRRC).

Materials and methods: A total of 37 patients with pLRRC who underwent 3D-assisted CT-guided RISI treatment at Peking University Third Hospital between January 2016 and November 2019 were included in this study. All patients underwent preoperative assessment, CT simulation positioning, preoperative plan design, 3D template printing, 3D template reduction, needle and seed implantation, postoperative dosimetry evaluation, post-operative care, and regular follow-up. The preoperative and postoperative needle position, angle, and tip distance were compared. The dosimetric parameters, including D90 (the dose to 90% of the target volume), D100, V100 (the volume receives 100% of the prescribed dose), V150, V200, conformal index (CI), external index (EI), and homogeneity index (HI), were compared among preoperative plan, intraoperative plan, and postoperative plan. The perioperative complications were assessed.

Results: The total number of needles was 595. The depths of needle insertion in preoperative and intraoperative plans were 109.87 ± 1.33mm and 108.46 ± 1.26 mm, respectively, with no significant difference (p > 0.05). The angles of needle insertion in preoperative and intraoperative plans were (93.55 ± 2.05)° and (92.04 ± 1.99)°, respectively, with no significant difference (p > 0.05). The average deviation of the needle insertion distance was 1.99 ± 0.08 mm. There were no differences in preoperative, intraoperative, and postoperative parameters, including D90, D100, V100, V150, V200, CI, EI, and HI. All patients were closely followed up during the perioperative period (from seven days before surgery to seven days after surgery). No patients experienced severe perioperative complications. A total of eight patients (21.6%) experienced grade 1–2 complications. Among all patients, six individuals (16.2%) experienced pain, one patient (2.7%) had a fever, and one patient (2.7%) suffered from a hemorrhage. All patients recovered after conservative treatment.

Conclusion: The needle insertion in 3D-PT-assisted CT-guided RISI showed good accuracy for treating pLRRC.

Keywords

3D printing template / accuracy / CT guidance / needle insertion / recurrent rectal cancer

References

[1] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7-30.

[2] Roh MS, Colangelo LH, O’Connell MJ, et al. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol. 2009;27(31):5124-5130.

[3] Sauer R, Liersch T, Merkel S, et al. Preoperative versus post-operative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012;30(16):1926-1933.

[4] Gérard JP, Conroy T, Bonnetain F, et al. Preoperative radio-therapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers: results of FFCD 9203. J Clin Oncol. 2006;24(28):4620-4625.

[5] Sebag-Montefiore D, Stephens RJ, Steele R, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet. 2009;373(9666):811-820.

[6] Braendengen M, Tveit KM, Berglund A, et al. Randomized phase III study comparing preoperative radiotherapy with chemoradiotherapy in nonresectable rectal cancer. J Clin Oncol. 2008;26(22):3687-3694.

[7] Camilleri-Brennan J, Steele RJC. The impact of recurrent rectal cancer on quality of life. Eur J Surg Oncol. 2001;27(4):349-353.

[8] Guren MG, Undseth C, Rekstad BL, et al. Reirradiation of locally recurrent rectal cancer: a systematic review. Radiother Oncol. 2014;113(2):151-157.

[9] Klose J, Tarantino I, Schmidt T, et al. Impact of anatomic location on locally recurrent rectal cancer: superior outcome for intraluminal tumour recurrence. J Gastrointest Surg. 2015;19(6):1123-1131.

[10] Mohiuddin M, Marks G, Marks J. Long-term results of reirradiation for patients with recurrent rectal carcinoma. Cancer. 2002;95(5):1144-1150.

[11] Moore HG, Shoup M, Riedel E, et al. Colorectal cancer pelvic recurrences: determinants of resectability. Dis Colon Rectum. 2004;47(10):1599-1606.

[12] Du P, Burke JP, Khoury W, et al. Factors associated with the location of local rectal cancer recurrence and predictors of survival. Int J Colorectal Dis. 2016;31(4):825-832.

[13] Blasko JC, Ragde H, Grimm PD. Transperineal ultrasound-guided implantation of the prostate: morbidity and complications. Scand J Urol Nephrol Suppl. 1991;137:113-118.

[14] Goes RN, Beart RW, Simons AJ, Gunderson LL, Grado G, Streeter O. Use of brachytherapy in management of locally recurrent rectal cancer. Dis Colon Rectum. 1997;40(10):1177-1179.

[15] Martínez-Monge R, Nag S, Martin EW. ¹²⁵Iodine brachytherapy for colorectal adenocarcinoma recurrent in the pelvis and paraortics. Int J Radiat Oncol Biol Phys. 1998;42(3):545-550.

[16] Cao Q, Wang H, Meng N, et al. CT-guidance interstitial ¹²⁵Iodine seed brachytherapy as a salvage therapy for recurrent spinal primary tumors. Radiat Oncol. 2014;9:301.

[17] Jiang P, Liu C, Wang J, Yang R, Jiang Y, Tian S. Computed tomography (CT)-guided interstitial permanent implantation of ¹²⁵I seeds for refractory chest wall metastasis or recurrence. Technol Cancer Res Treat. 2015;14(1):11-18.

[18] Ji Z, Jiang Y, Tian S, et al. The effectiveness and prognostic factors of CT-guided radioactive I-125 seed implantation for the treatment of recurrent head and neck cancer after external beam radiation therapy. Int J Radiat Oncol Biol Phys. 2019;103(3):638-645.

[19] Wang JJ, Yuan HS, Li JN, Jiang WJ, Jiang YL, Tian SQ. Interstitial permanent implantation of ¹²⁵I seeds as salvage therapy for re-recurrent rectal carcinoma. Int J Colorectal Dis. 2009;24(4):391-399.

[20] Wang JJ, Yuan HS, Li JN, Jiang YL, Tian SQ, Yang RJ. CT-guided radioactive seed implantation for recurrent rectal carcinoma after multiple therapy. Med Oncol. 2010;27(2):421-429.

[21] Wang J, Chai S, Wang R, et al. Expert consensus on computed tomography-assisted three-dimensional-printed coplanar template guidance for interstitial permanent radioactive ¹²⁵I seed implantation therapy. J Cancer Res Ther. 2019;15(7):1430-1434.

[22] Wang J, Zhang F, Guo J, et al. Expert consensus workshop report: guideline for three-dimensional printing template-assisted computed tomography-guided ¹²⁵I seeds interstitial implantation brachytherapy. J Cancer Res Ther. 2017;13(4):607-612.

[23] Ji Z, Sun H, Jiang Y, et al. Comparative study for CT-guided ¹²⁵I seed implantation assisted by 3D printing coplanar and noncoplanar template in peripheral lung cancer. J Contemp Brachytherapy. 2019;11(2):169-173.

[24] Ji Z, Jiang Y, Guo F, et al. Dosimetry verification of radioactive seed implantation for malignant tumors assisted by 3D printing individual templates and CT guidance. Appl Radiat Isot. 2017;124:68-74.

[25] Wang H, Wang L, Jiang Y, et al Long-term outcomes and prognostic analysis of computed tomography-guided radioactive ¹²⁵I seed implantation for locally recurrent rectal cancer after external beam radiotherapy or surgery. Front Oncol. 2020;10:540096.

[26] Benson III AB, Venook AP, Al-Hawary MM, et al. NCCN clinical practice guidelines in oncology: rectal cancer (Version 2.2020). 2020. Accessed March 3, 2020. Available at the website of NCCN.org.

[27] Wang H, Peng R, Li X, et al. The dosimetry evaluation of 3D printing non-coplanar template-assisted CT-guided ¹²⁵I seed stereotactic ablation brachytherapy for pelvic recurrent rectal cancer after external beam radiotherapy. J Radiat Res. 2021;62(3):473-482.

[28] Wang L, Wang H, Jiang Y, et al. The efficacy and dosimetry analysis of CT-guided ¹²⁵I seed implantation assisted with 3D-printing non-co-planar template in locally recurrent rectal cancer. Radiat Oncol. 2020;15(1):179.

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