Preliminary application of 3D-printed coplanar template for iodine-125 seed implantation therapy in patients with advanced pancreatic cancer

• DOI: 10.3748/wjg.v24.i46.5280
• Publication Date: 2018-12-13T02:33:01Z
• Authors: Wei Huang; Jian Lu; Ke-Min Chen; Zhi-Yuan Wu; Qing-Bin Wang; Jing-Jing Liu; Ju Gong; Zhi-Jin Chen; Xiao-Yi Ding; Zhong-Min Wang
• Keywords: Aged, 80 and over; Male; Radiotherapy Planning, Computer-Assisted; Brachytherapy; Radiotherapy Dosage; Middle Aged; 3. Good health; Iodine Radioisotopes; Pancreatic Neoplasms; 03 medical and health sciences; Mesenteric Veins; Treatment Outcome; 0302 clinical medicine; Retrospective Study; Needles; Printing, Three-Dimensional; Humans; Female; Tomography, X-Ray Computed; Pancreas; Aged; Retrospective Studies

To evaluate a 3D-printed coplanar template for iodine-125 seed implantation therapy in patients with pancreatic cancer.A retrospective analysis of our database was performed, and a total of 25 patients with pancreatic cancer who underwent iodine-125 seed implantation between January 2014 and November 2017 were analyzed. Of these, 12 implantations were assisted by a 3D-printed coplanar template (group A), and 13 implantations performed freehand were selected as a control group (group B). A 3D coplanar template was designed and printed according to a preoperative CT scan and treatment planning system. The iodine-125 seeds were then implanted using the template as a guide. Dosimetric verification was performed after implantation. Pre- and postoperative D90, V100, and V150 were calculated. The success rate of iodine-125 seed implantation, dosimetric parameters, and complications were analyzed and compared between the two groups.Iodine-125 seed implantation was successfully performed in both groups. In group A, the median pre- and postoperative D90 values were 155.32 ± 8.05 Gy and 154.82 ± 16.43 Gy, respectively; the difference between these values was minimal and not statistically significant (P > 0.05). Postoperative V100 and V150 were 91.05% ± 4.06% and 64.54% ± 13.40%, respectively, which met the treatment requirement. A better dosimetric parameter was observed in group A than in group B, and the difference was statistically significant (V100: 91.05% ± 4.06% vs 72.91% ± 13.78%, P < 0.05). No major procedure-related complications were observed in either group. For group A, mild hemorrhage was observed in 1 patient with a peritoneal local hematoma due to mesenteric vein damage from the iodine-125 seed implantation needle. The hematoma resolved spontaneously without treatment. Postoperative blood amylase levels remained within the normal range for all patients.A 3D-printed coplanar template appears to be a safe and effective iodine-125 seed implantation guidance tool to improve implantation accuracy and optimize dosimetric distribution.