Published online Dec 14, 2018. doi: 10.3748/wjg.v24.i46.5280
Peer-review started: September 6, 2018
First decision: October 4, 2018
Revised: October 27, 2018
Accepted: November 9, 2018
Article in press: November 9, 2018
Published online: December 14, 2018
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.
Core tip: 3D-printed templates have been used as a new iodine-125 seed implantation guidance tool to improve implantation accuracy and radiotherapy dosimetry in superficial organs. However, few studies have sufficient information on template application in profound organs, especially the pancreas. Our retrospective study evaluates the effectiveness and safety of a 3D-printed coplanar template for iodine-125 seed implantation therapy in patients with pancreatic cancer. The template was designed and printed according to a preoperative computed tomography scan. Under 3D-printed template guidance, the postoperative dosimetric parameter was better than that obtained with traditional free-hand implantation.