title: CT-guided permanent 125I seed interstitial brachytherapy for recurrent retroperitoneal lymph node metastases after external beam radiotherapy.
abstract: OBJECTIVE
  To evaluate the feasibility, efficacy, and safety of permanent (125)I seed interstitial brachytherapy reirradiation in patients with retroperitoneal lymph node recurrence under CT guidance.
  
  
  METHODS
  Seventeen patients with 19 retroperitoneal lymph node recurrence after external beam radiotherapy underwent CT-guided (125)I seed implant brachytherapy from October 2007 to August 2014. Treatment for all patients was preplanned using a three-dimensional radiation therapy planning system 3-5 days before brachytherapy; dosimetry verification was performed immediately after brachytherapy.
  
  
  RESULTS
  The actuarial D90 (dose delivered to 90% of the target volume) was 100-198 Gy (median, 126.5 Gy). In 9 patients, pain intensity decreased to mild pain 1-3 weeks after brachytherapy. Pain-free survival ranged 2-15 months (median, 5 months; 95% confidence interval [CI]: 0.1, 9.9). The overall response rate was 19 of 19 (100%). The median local control time was 15 months (95% CI: 2.3, 27.7). The 6-, 12-, and 24-month local control rate was 88.0%, 63.2%, and 42.1%, respectively. Twelve patients (70.6%) developed distant metastases and died. Two patients (11.8%) are alive with distant metastases but no evidence of local recurrence. Three patients (17.6%) are alive with no evidence of local recurrence. Median overall survival was 10 months (95% CI: 5.7, 14.3); the 1- and 2-year survival rates were 38.1% and 15.3%, respectively. No major complications related to the procedure occurred during or after brachytherapy.
  
  
  CONCLUSIONS
  Reirradiation with CT-guided permanent (125)I seed interstitial brachytherapy is feasible, safe, and effective as pain relief or salvage treatment for patients with recurrent retroperitoneal lymph nodes.
authors.affiliation: Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China.
authors.forename: Lihong
authors.initials: L
authors.lastname: Yao
authors.affiliation: Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China.
authors.forename: Yuliang
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China.
authors.forename: Ping
authors.initials: P
authors.lastname: Jiang
authors.affiliation: Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China.
authors.forename: Na
authors.initials: N
authors.lastname: Meng
authors.affiliation: Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China.
authors.forename: Ang
authors.initials: A
authors.lastname: Qu
authors.affiliation: Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China.
authors.forename: Suqing
authors.initials: S
authors.lastname: Tian
authors.affiliation: Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China.
authors.forename: Haitao
authors.initials: H
authors.lastname: Sun
authors.affiliation: Department of Radiology, Peking University Third Hospital, Beijing, P. R. China.
authors.forename: Chen
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China. Electronic address: junjiewang_edu@sina.cn.
authors.forename: Junjie
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Oncology, Tengzhou Central People's Hospital, Tengzhou, Shangdong, P. R. China. Electronic address: kaixianzhang@aliyun.com.
authors.forename: Kaixian
authors.initials: K
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008207:Lymphatic Metastasis / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000532:radiotherapy*; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D015642:Radiology, Interventional; D011879:Radiotherapy Dosage; D012187:Retroperitoneal Space; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes
keywords: (125)I seed; Interstitial brachytherapy; Re-irradiation; Recurrence; Retroperitoneal lymph node