¹²⁵I seed implantation brachytherapy for esophageal squamous cell carcinoma  期刊论文  

AIM: To evaluate the safety and efficacy of intraoperative 125I seed implantation for advanced esophageal squamous cell carcinoma (ESCC). METHODS: Eca-109 cells cultured in vitro were divided into four groups: cells untreated (control group) and those treated with low- (0.2 mCi), medium- (0.4 mCi) and high-dose 125I seeds (0.8 mCi). After 125I seed implantation, the cloning efficiency, apoptotic index and cell cycle of Eca-109 cells were detected. For animal experiment, Eca-109 cells were inoculated subcutaneously in the right femoribus internus of nude mice. ESCC-bearing mice were then divided into five groups: mice untreated (control group), mice undergoing spurious operation (prick into the tumor without implanting seeds), and those treated with low- (0.2 mCi), medium- (0.4 mCi) and high-dose 125I seeds (0.8 mCi). Tumor volume was then evaluated. For clinical trial, 298 patients with phase II to III ESCC were randomized into two groups: patients undergoing both surgery and intraoperative 125I seed implantation and those undergoing surgery alone. Postoperative complications were observed. The shortand long-term efficacy of 125I seed implantation was followed up. RESULTS: The cloning efficiency of cells of the three treatment groups was significantly lower than that of control cells (all P < 0.05). The cell cloning efficiency was also significantly lower in cells treated with high- and medium-dose 125I seeds than in those treated with low-dose 125I seeds (both P < 0.01) though no significant difference was noted between the high- and medium-dose groups (P > 0.05). The apoptotic index (AI) of cells of the three treatment groups was significantly higher than that of control cells (all P < 0.01). The apoptotic index (AI) was also significantly higher in cells treated with highand medium-dose 125I seeds than in those treated with low-dose 125I seeds (both P < 0.01) though no significant difference was noted between the high- and medium-dose groups (P > 0.05). The percentage of G2/M phase cells increased with the enhancement of the 125I seed activity (P < 0.01). The reduced rates of tumor growth in mice treated with 125I seeds were statistically higher than that in control mice. There was no statistical difference in the reduced rate of tumor growth between control mice and mice undergoing spurious operation (P > 0.05) as well as between mice treated with high- and medium-dose 125I seeds. In patients undergoing 125I seed implantation, no displacement or loss of seeds occurred. The local recurrence rate was significantly lower (14.9% vs 38.7%, P < 0.05) and the rate of complete response (CR) plus partial response (PR) was significantly higher (78.8% vs 30.3%, P < 0.05) in patients undergoing intraoperative 125I seed implantation than in those undergoing surgery alone. There were no statistical differences in the incidence of complications and the 1-year survival rate (both P > 0.05) between the two groups of patients. However, the 3-, 5-, and 7-year survival rates were statistically higher in patients undergoing surgery alone than in those undergoing intraoperative 125I seed implantation (64% vs 52%, 42.7% vs 34.5% and 25.1% vs 12.6%, all P < 0.05). CONCLUSION: Intraoperative 125I seed implantation brachytherapy can reduce local recurrence and improve survival in patients with ESCC and therefore represents a safe, effective and simple approach for ESCC.