125Iodine brachytherapy via a trans-superior vena cava approach in patients with metastases in middle mediastinal lymph nodes: a novel approach.
OBJECTIVE
Certain metastasis-containing middle mediastinal lymph nodes cannot be approached by standard CT-guided brachytherapy. We here describe a novel trans-superior vena cava approach for such nodes. The aim of this prospective study was to assess the safety and clinical value of125iodine (I) brachytherapy via a trans-superior vena cava approach in patients with metastases in middle mediastinal lymph nodes.


METHODS
From February 2008 to October 2011, 32 patients with 43 pathologically confirmed metastasis-containing mediastinal middle lymph nodes underwent CT-guided percutaneous125I brachytherapy via a trans-superior vena cava approach. Their complications and treatment responses were analyzed. Variations in blood pressure, heart rate, hemoglobin concentration and oxyhemoglobin saturation before, during and after the procedure were recorded, as were complications, including hemorrhage, pneumothorax and development of Breuer's reflex. Treatment response was assessed according to the response evaluation criteria for solid tumors Version 1.1.


RESULTS
According to follow-up CT examination after 6 months, 22 patients (68.75%) achieved complete responses and four (12. 5%) partial responses. One patient died of myocardial infarction. Overall response rate was 81.25%, with a local control rate of 87.5%. The median survival was 25.7 months, with progression-free survival of 19.74 ± 0.81 months. The 1-year and 3-year overall survival rates were 53.13% and 28.13%. There were minimal immediate or delayed complications; no complications were severe.


CONCLUSIONS
We consider this novel approach a safe means of treating certain mediastinal middle lymph node metastases.
Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, Shandong Province, China.|Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, China.
Bin
B
Liu
Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, Shandong Province, China.|Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, China.
Yuliang
Y
Li
Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, Shandong Province, China.|Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, China.
Yongzheng
Y
Wang
Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, Shandong Province, China.|Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, China.
Wujie
W
Wang
Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, Shandong Province, China.
Lili
L
Wang
Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, Shandong Province, China.|Ben-Gurion University, Negev, Israel.
Yancu
Y
Hertzanu
Department of Radiation Oncology, Cancer Centre, Peking University Third Hospital, Beijing, China.
Junjie
J
Wang
Department of Medical Imaging & Interventional Radiology, Cancer Center and State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, Guangdong, China.
Fujun
F
Zhang
D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007455:Iodine; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008482:Mediastinum / Q000473:pathology*; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D014683:Vena Cava, Superior / Q000601:surgery*
D007455:Iodine
brachytherapy; mediastinum; superior vena cava