Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2018; 24(46): 5280-5287
Published online Dec 14, 2018. doi: 10.3748/wjg.v24.i46.5280
Preliminary application of 3D-printed coplanar template for iodine-125 seed implantation therapy in patients with advanced pancreatic cancer
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
Wei Huang, Zhi-Yuan Wu, Qing-Bin Wang, Jing-Jing Liu, Xiao-Yi Ding, Zhong-Min Wang, Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Jian Lu, Ju Gong, Zhi-Jin Chen, Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
Ke-Min Chen, Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Author contributions: Wang ZM designed the research and supervised the report; Huang W performed the research and wrote the paper; Chen KM and Ding XY supervised the report; Lu J, Wu ZY, and Wang QB analyzed the data; Liu JJ, Gong J, and Chen ZJ provided clinical advice.
Supported by the National Natural Science Foundation of China, No. 81771949 and No. 81471808; the Project of Medical Key Specialty of Shanghai Municipality, No. ZK2015A22; and the Science and Technology Commission of Shanghai Municipality, No. 18411968600.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent before participating in the study.
Conflict-of-interest statement: None declared.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Zhong-Min Wang, MD, Chief Doctor, Professor, Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Road, Huangpu District, Shanghai 200025, China. james0722@163.com
Telephone: +86-21-64370045-600331 Fax: +86-21-63860461
Received: September 6, 2018
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
Abstract
AIM

To evaluate a 3D-printed coplanar template for iodine-125 seed implantation therapy in patients with pancreatic cancer.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: 3D printing, Brachytherapy, Iodine-125, Pancreatic cancer

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.