Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China.
Department of Radiation Oncology, The First People's Hospital of Kerqin District, No. 328 Kerqin Street, Tongliao, 028000, China.
Radiat Oncol. 2023 Jan 26;18(1):18. doi: 10.1186/s13014-022-02196-y.
BACKGROUND/OBJECTIVE: This multicenter study aimed to explore the efficacy and toxicity of radioactive Iodine-125 seed implantation for lymph node recurrence in patients with esophageal cancer after external radiotherapy.
Clinical data of eligible patients from 5 centers in China were retrospectively reviewed. A total of 126 patients between January 2016 and March 2019 were included. The median interval between previous radiotherapy and radioactive Iodine-125 seed implantation was calculated. The target volume was 2.1-128.1 cm (median, 22.2 cm) and the median postoperative D90 is 120.6 Gy (range, 101.7-192). Short-term efficacy of tumor response, the long-term efficacy of local progression-free survival (LRFS) and overall survival (OS), and treatment-related toxicity were reported.
For tumor response, 37 (29.4%), 51 (40.5%), 14 (11.1%), and 24 (19.0%) patients achieved complete response, partial response, stable disease and progressive disease, respectively. The 1-, 2- and 3-year LPFS and OS rates were 48.8%, 23.0% and 15.9%, and 80.2%, 38.8%, and 24.5%, respectively. Multivariate analysis identified Karnofsky performance status (P = 0.041) and tumor response (P = 0.049) as independent prognostic factors for LPFS; initial tumor stage (P = 0.034), lesion volume (P = 0.017), and tumor response (P = 0.004) as independent prognostic factors for OS. In total, 77 (61.1%) patients suffered from skin reactions and the incidence of grade 3-5 skin toxicity was 5.6% (7/126).
Radioactive Iodine-125 seed implantation seems efficient with acceptable toxicity for the treatment of lymph node recurrence secondary to esophageal cancer. A head-to-head study is needed to further evaluate the survival benefit.
背景/目的：本多中心研究旨在探讨放射性碘 125 种子植入治疗食管癌患者外放疗后淋巴结复发的疗效和毒性。
回顾性分析中国 5 个中心符合条件的患者的临床资料。共纳入 2016 年 1 月至 2019 年 3 月的 126 例患者。计算上次放疗与放射性碘 125 种子植入之间的中位间隔时间。靶体积为 2.1-128.1cm（中位数为 22.2cm），术后 D90 中位数为 120.6Gy（范围为 101.7-192）。报告了肿瘤反应的短期疗效、局部无进展生存期（LRFS）和总生存期（OS）的长期疗效以及与治疗相关的毒性。
在肿瘤反应方面，分别有 37（29.4%）、51（40.5%）、14（11.1%）和 24（19.0%）例患者完全缓解、部分缓解、疾病稳定和疾病进展。1、2 和 3 年的 LRFS 和 OS 率分别为 48.8%、23.0%和 15.9%，80.2%、38.8%和 24.5%。多因素分析发现 Karnofsky 表现状态（P=0.041）和肿瘤反应（P=0.049）是 LRFS 的独立预后因素；初始肿瘤分期（P=0.034）、病变体积（P=0.017）和肿瘤反应（P=0.004）是 OS 的独立预后因素。共有 77 例（61.1%）患者出现皮肤反应，3-5 级皮肤毒性发生率为 5.6%（7/126）。
放射性碘 125 种子植入术治疗食管癌淋巴结复发疗效显著，毒性可接受。需要进行头对头研究进一步评估生存获益。
