Introduction
The 5-year survival rate for patients with oral
cancer is ~80%, but it decreases to 40–50% in those with regional
or distant metastasis (1). Lip
squamous cell carcinoma constitutes 25–30% of all oral malignancies
and can be effectively managed through various therapeutic
modalities, including surgical resection, external-beam
radiotherapy (EBRT). In locally advanced disease, treatment failure
is characterized by high local recurrence (20–40%) and regional
lymph node metastasis, both of which substantially worsen patient
prognosis (2). Surgical resection
remains the cornerstone of curative treatment for early-stage oral
squamous cell carcinoma, and accumulating evidence supports
multimodal strategies incorporating adjuvant radiotherapy to
optimize oncological outcomes (3–5).
However, extensive resection can lead to disfiguring defects and
functional impairments, including mastication, swallowing and
speech difficulties, whereas radical EBRT frequently entails
serious complications such as osteoradionecrosis (ORN), xerostomia
and intractable mucositis, all of which markedly compromise the
quality of life of patients (6,7).
Conventional therapeutic approaches are often
impractical in elderly patients with multiple chronic
comorbidities. The patient described in this study was diagnosed
with Alzheimer's disease. Consequently, neither surgery nor
definitive EBRT could be performed. The cognitive impairment
limited the patient's ability to cooperate with postoperative
rehabilitation and daily radiotherapy positioning. Furthermore,
general anesthesia was associated with an unacceptably high risk of
severe complications and the patient's family firmly declined any
surgical intervention. The present case highlighted that there is
an urgent unmet clinical need for alternative strategies that
balance effective tumor suppression with preservation of organ
function and quality of life in this high-risk elderly
population.
Radioactive 125I seed implantation has
advanced rapidly in recent years, demonstrating broad applicability
across various solid malignancies, including lung, pancreatic and
liver cancers, as well as bone metastases (8–11).
Accumulating evidence further supports the efficacy of this
approach in head and neck malignancies. Li et al (12) reported the safety and efficacy of
radioactive 125I seed implantation as salvage therapy
for locally recurrent head and neck soft-tissue sarcoma and Zhang
et al (13) demonstrated its
utility in inoperable head and neck cancers, whereas Tian et
al (14) described
ultrasound-guided radioactive 125I seed implantation for
oral squamous cell carcinoma, achieving favorable local control.
These studies provide a key foundation for extending this technique
to the treatment of lip squamous cell carcinoma in medically
complex elderly patients. The present study aimed to report a case
of lip squamous cell carcinoma in an elderly patient who presented
with rapid tumor progression, severe pain and restricted mouth
opening. Biopsy confirmed squamous cell carcinoma. The lesion
showed marked clinical regression after radioactive 125I
seed implantation, leading to prolonged survival.
Case report
Case presentation
An 80-year-old woman presented to the Affiliated
Zhongshan Hospital of Dalian University (Dalian, China) in
September 2018 with a confirmed diagnosis of lip squamous cell
carcinoma. The patient had a longstanding history of Alzheimer's
disease, which had been diagnosed in 2010 and had gradually
progressed to mild-to-moderate cognitive dysfunction. The
Mini-Mental State Examination score was 18 of 30. The patient also
had a 15-year history of hypertension and an 8-year history of type
2 diabetes mellitus, both adequately controlled with oral
medications. The patient's regular regimen included donepezil 5 mg
once daily, amlodipine 5 mg once daily and metformin 500 mg twice
daily. The activities of daily living score was 60, indicating
partial dependence on routine self-care.
Clinical findings
On admission, the patient's height was 155 cm, body
weight 48 kg and body mass index 20.0 kg/m2. The
Nutritional Risk Screening 2002 score (15) was 3, suggesting mild malnutrition
risk. In 2016, a soybean-sized mass had been incidentally noted on
the lower lip. The patient remained asymptomatic and received no
treatment at that time. However, by 2018, the mass had grown
rapidly and become progressively painful, eventually causing
gradual restriction of mouth opening (Fig. 1A). The patient had also developed
food-evoked pain [visual analog scale (16): 6–7/10]. Due to having Alzheimer's
disease, the patient could not complete independent self-rating;
the pain evaluation was conducted with family assistance based on
the patient's verbal description. Additional clinical
manifestations included dysarthria and halitosis. Physical
examination revealed a firm, immobile lower-lip lesion with
ill-defined margins, mucosal ulceration and superficial bleeding.
Palpation of the right neck revealed 5 enlarged lymph nodes, with a
maximum diameter of up to 2 cm, which were firm and poorly
mobile.
Diagnostic assessment
Contrast-enhanced computed tomography (CT) revealed
a soft-tissue mass measuring 4.0 × 7.0 cm involving the
midline-to-right aspect of the lower lip (Fig. 2A). The lesion invaded the vermilion
border and underlying orbicularis oris muscle, with a maximum depth
of invasion of 2.5 cm. A total of 12 enlarged lymph nodes were
identified in levels II–III of the right neck, the largest
measuring 1.7 cm in longitudinal diameter. No radiological evidence
of distant metastasis was detected. Routine laboratory tests,
including complete blood count, hepatic and renal function and
coagulation parameters, were all within normal limits. However, the
serum squamous cell carcinoma antigen level was markedly elevated
at 4.2 ng/ml (normal upper limit <1.5 ng/ml). A preoperative
biopsy of the lip lesion was performed for pathological evaluation.
The specimen, measuring 0.8 × 0.5 × 0.3 cm, showed infiltrative
nests of atypical squamous epithelial cells with keratin pearls and
distinct intercellular bridges, which were consistent with the
manifestations of moderately differentiated squamous cell
carcinoma. Serial sections (4 µm) were prepared from formalin-fixed
and paraffin-embedded tissue specimens. Hematoxylin and eosin
(H&E) staining was automatically performed on a Roche staining
system [Roche Diagnostics (Shanghai) Co., Ltd.] according to the
manufacturer's recommended protocol for routine histomorphological
assessment. All immunohistochemical (IHC) staining procedures were
conducted using the Roche BenchMark ULTRA automated IHC platform
(Roche Diagnostics). Sections were loaded onto the platform, where
endogenous peroxidase activity was automatically blocked by the
system during the IHC procedure. Heat-induced epitope retrieval was
performed using the CC1 retrieval system [cat. no. 950-124; Roche
Diagnostics (Shanghai) Co., Ltd.] in accordance with the
manufacturer's antibody specifications and standard instrument
protocols. After routine washing, sections were incubated with
primary antibodies following the platform's standard operating
procedures. Ready-to-use primary antibodies against pan-cytokeratin
(CK) (cat. no. ZM-0063), CK5/6 (cat. no. ZM-0313), P40 (cat. no.
ZM-0432) and Ki-67 (cat. no. ZM-0166) were obtained from Zhongshan
Golden Bridge Biotechnology Co., Ltd. and applied without further
dilution. Programmed death ligand 1 (PD-L1) expression was
evaluated using the PD-L1 IHC 22C3 pharmDx kit (clone 22C3; cat.
no. SK006; Dako; Agilent Technologies, Inc.). The linker-based
detection components (HQ-linker and HRP-conjugated multimer) and
chromogenic detection reagents were integrated within the OptiView
DAB IHC Detection System [cat. no. 760-700; Roche Diagnostics
(Shanghai) Co., Ltd.]. This ready-to-use kit was designed for the
Ventana BenchMark ULTRA automated staining platform, and all kit
reagents were applied undiluted. Specific antigen signals were
visualized using the DAB chromogen supplied in this kit. Nuclei
were lightly counterstained with hematoxylin. Positive and negative
controls were rigorously included in each staining run. Archived
human tissue specimens with confirmed positive target-protein
expression were used as positive controls. For negative controls,
primary antibodies were replaced with isotype-matched non-immune
IgG at equivalent concentration, with all other experimental
conditions unchanged. All control slides were processed in parallel
with study sections in every staining batch. IHC staining was
positive for CK5/6, CK and P40, with a Ki-67 proliferation index of
40%; P53 and P16 were negative, and PD-L1 expression was
undetectable in tumor cells (Fig.
3). Based on the radiological, serological and
histopathological findings, the patient was diagnosed with
moderately differentiated lip squamous cell carcinoma with right
cervical lymph node metastasis, staged as cT3N2bM0 (stage IVA)
according to the American Joint Committee on Cancer staging system
(17).
Therapeutic intervention
In September 2018, the patient underwent
125I seed brachytherapy for treatment of the primary lip
squamous cell carcinoma. Preoperative CT-guided target delineation
was performed rigorously: The gross tumor volume (GTV) was defined
based on the visible tumor on CT images, and the clinical target
volume was generated by expanding the GTV by 3–5 mm to cover
potential microscopic infiltration. The prescribed dose was 140 Gy.
This was consistent with the head and neck squamous cell carcinoma
brachytherapy guidelines of the American Brachytherapy Society and
the American College of Radiology, which recommend 120–160 Gy, as
well as with our institutional experience (18,19).
Patient positioning was optimized according to tumor location and
preoperative CT localization was performed. Local anesthesia was
administered, and needle trajectories and angles were precisely
adjusted. A total of five needle channels were established in
strict accordance with the preoperative plan (Fig. 2B). Model 6711 sealed 125I
seeds (Shanghai Syncor Medicine Corp., Ltd.) were used, with a
single-seed activity of 0.6 mCi and a physical half-life of 59.4
days. After the needle tips reached the distal tumor margin, the
needles were retracted at equal intervals for seed deposition. A
total of 43 seeds were implanted to deliver the prescribed 140 Gy.
Immediate postprocedural CT confirmed homogeneous seed distribution
without leakage or aggregation (Fig.
2C). For perioperative pain control, the patient received a
single subcutaneous dose of morphine (5 mg) ~30 min preoperatively
and intravenous flurbiprofen axetil (50 mg) during the procedure;
the postoperative visual analogue scale pain score decreased to
2–3/10.
In November 2018, the patient underwent CT-guided
three-dimensional (3D) template-assisted 125I seed
brachytherapy for the metastatic cervical lymph nodes, following
the same target delineation principles. A total of 35
125I seeds (each with an activity of 0.56 mCi) were
implanted to deliver a prescription dose of 140 Gy.
No serious procedure-related complications occurred
during treatment or follow-up. The patient developed only mild
local swelling on the first postoperative day, which resolved
spontaneously within 3 days. No bleeding, surgical site infection,
skin ulceration, ORN or xerostomia was observed during long-term
follow-up.
Follow-up and outcomes
After radioactive 125I seed implantation,
X-ray imaging revealed well-distributed seeds (Fig. 2D). Postoperative dosimetric
parameters were as follows [Dx represents the minimum dose covering
x% of the planning target volume (PTV) and Vx indicates the
percentage of the PTV receiving at least x% of the prescribed
dose]: D90, 141.7 Gy; D100, 37.3 Gy; V90, 99.5%; V100, 98.2%; and
V150, 75.8% (Fig. 4A). These
parameters, particularly the D90 exceeding 140 Gy, suggested
adequate dosimetric coverage for tumor control. The tumor size
substantially decreased at 2 weeks (Fig. 1B). The tumor shrank further at 1
month, with the appearance of necrotic tissue (Fig. 1C). Further shrinkage was evident at
2 months, with only scabbing and a residual tumorous protrusion
(Fig. 1D). CT imaging revealed
marked tumor reduction and 125I seed accumulation
(Fig. 2E).
After radioactive 125I seed implantation
for cervical lymph node metastasis, X-ray imaging revealed
homogeneous seed distribution in metastatic neck lymph nodes
(Fig. 2F). The postoperative target
volumes were as follows: D90, 143.8 Gy; D100, 99.4 Gy; V90, 96.2%;
V100, 94.6%; V150, 74.1% (Fig. 4B).
Comprehensive assessment was performed every 2–3 months and
indicated gradual reduction of the lesion. Both the lip tumor and
the cervical lymph node metastases displayed a marked clinical
regression after 6 months (Fig.
1E). The patient experienced an obvious improvement in mouth
opening, swallowing and chewing functions, and was capable of
normal oral intake. No adverse effects, including xerostomia and
hyposalivation, and ORN, were observed.
At 2 years after the treatment, the lower-lip lesion
had healed completely with cicatricial tissue, leaving a smooth and
flat scar surface (Fig. 1F). The
patient's Karnofsky performance status (20) score was 90. To date (last follow-up:
December 2025), the patient remains alive, with overall survival
exceeding 7 years. The case timeline is summarized in Fig. 5.
Discussion
Managing locally advanced lip squamous cell
carcinoma in elderly patients with multiple comorbidities remains a
formidable clinical challenge. In the present case, an 80-year-old
woman with Alzheimer's disease and stage IVA (cT3N2bM0) lip
squamous cell carcinoma was deemed ineligible for curative surgery
and definitive EBRT following multidisciplinary consensus.
Accordingly, CT-guided 3D template-assisted 125I seed
brachytherapy was implemented, shifting the therapeutic goal from
complete radiologic response to durable long-term tumor control
with maximal preservation of organ function.
Our institution has extensive experience with
CT-guided 3D template-assisted radioactive 125I seed
implantation for refractory solid malignancies (18,19,21,22),
with proven efficacy and safety in lung cancer, liver cancer and
osseous metastases (23–25). This minimally invasive technique has
also yielded promising outcomes in recurrent and metastatic head
and neck malignancies (12–14,26).
Building on this institutional foundation, the entire procedural
workflow was systematically optimized, including preoperative
planning, 3D template fabrication, intraoperative guidance and
postoperative dosimetric verification, with individualized
adjustments based on the anatomy and clinical status of the
patient.
This case yields three pivotal clinical insights.
First, it validates a patient-centric evaluation paradigm for
cognitively impaired elderly patients who cannot perceive or
articulate subtle symptoms. For this vulnerable population,
treatment efficacy should be assessed comprehensively through
sustained tumor control and preservation of physiological
functions, including oral intake, verbal communication and facial
structural integrity. Second, 3D-printed template technology
enables precision dose sculpting comparable to surgery, achieving
highly conformal target coverage while effectively sparing adjacent
key structures. This level of accuracy is difficult to achieve with
conventional EBRT. Third, the patient's unprecedented 7-year
survival challenges the traditional perception of interstitial
brachytherapy as merely palliative, thereby confirming its
potential curative value in carefully selected patients with
unresectable advanced lip squamous cell carcinoma.
Comparison with the existing data contextualizes the
remarkable outcome observed in this case. Tian et al
(14) reported a series of oral
squamous cell carcinomas treated with ultrasound-guided radioactive
125I seed implantation, with a median follow-up of 15
months. Li et al (12)
evaluated image-guided radioactive 125I seed
implantation as salvage therapy in 13 patients with recurrent
soft-tissue sarcomas after prior surgery and radiotherapy,
achieving a local control rate of 69.2% and a median overall
survival of 17 months. Zhang et al (13) reported a median overall survival of
15 months in a larger cohort of 132 patients with inoperable head
and neck cancers. Collectively, these studies confirm that
125I seed brachytherapy can provide substantial tumor
control and survival benefit even in advanced or recurrent disease.
In the present study, the patient's sustained remission beyond 84
months extends the observed survival horizon for this modality.
This outcome suggests that the therapeutic potential of
125I seed brachytherapy may substantially exceed the
median survival benchmarks reported previously in appropriately
selected patients who achieve a favorable response.
This study had several limitations. The patient
could not cooperate with regular CT or magnetic resonance imaging
examinations owing to progressive cognitive deterioration from
advanced Alzheimer's disease, precluding standardized serial
radiological follow-up and objective imaging-based response
assessment. Nonetheless, sustained clinical remission, complete
wound healing, intact oral and facial function, and asymptomatic
survival for 7 years constitute robust patient-centric evidence of
long-term efficacy and safety. Mechanistically, the continuous
low-dose-rate gamma radiation emitted by 125I seeds
induces persistent DNA damage and irreversible tumor cell
apoptosis. Interstitial implantation precisely confines high-dose
radiation to the target lesion while minimizing peripheral exposure
(27,28). For locally invasive head and neck
squamous cell carcinoma with cervical lymph node metastases, the
American Brachytherapy Society (29) and American College of Radiology
(30) brachytherapy guidelines
recommend a prescription dose of 120–160 Gy. In the present study,
140 Gy was chosen as the target prescription dose for two key
reasons. First, the primary lip tumor invaded the underlying
musculature to a maximum depth of 2.5 cm, with multiple metastatic
nodes in levels II–III of the right neck. These features
necessitated a relatively high radiation dose to eradicate
microscopic disease. Second, the present single-center
retrospective data showed that 3D template-guided implantation with
a 140-Gy prescription dose consistently yielded a D90 of ≥140 Gy
for both primary and metastatic lesions. This ensures full clinical
target volume coverage while limiting high-dose radiation to
adjacent normal lip and oral mucosal tissues. In the present case,
the D90 values for the primary tumor and cervical nodes were 141.7
and 143.8 Gy, respectively-both exceeding the prescribed threshold.
These dosimetric results provide strong assurance for achieving
durable local tumor control and sustained clinical remission. A D90
exceeding 140 Gy provides sufficient dosimetric assurance for
radical tumor eradication, and 3D-printed templates ensure
millimeter-scale accuracy in needle placement, thus effectively
eliminating low-dose cold spots and reducing radiation-related
complications (31,32).
In conclusion, CT-guided 3D template-assisted
125I seed brachytherapy represents a highly efficacious,
minimally invasive and function-preserving therapeutic alternative
for patients with locally advanced lip squamous cell carcinoma who
are unsuitable for conventional curative treatment. In the present
case, this individualized approach achieved durable tumor control
while preserving quality of life in an elderly patient with
cognitive impairment. Larger prospective trials are warranted to
refine patient selection criteria, standardize treatment procedures
and optimize dosimetric parameters for broader clinical adoption of
this approach.
Acknowledgements
Not applicable.
Funding
Funding: No funding was received.
Availability of data and materials
The data generated in the present study may be
requested from the corresponding author.
Authors' contributions
GZ, SY and JZ conceived and designed the study. GZ,
SY, XZ, FX, LX and QW collected and analyzed the clinical, imaging
and pathological data. GZ, SY and XZ interpreted the data and
drafted the manuscript. JZ and SL supervised the study. SL
performed radiological image evaluation, sorted imaging data,
participated in dosimetric analysis and organized all figure
preparation. SL and JZ critically revised the manuscript for
important intellectual content. GZ, XZ and SY contributed to
manuscript review, revision and English language polishing. GZ and
JZ confirmed the authenticity of all raw data. All authors have
read and approved the final manuscript.
Ethics approval and consent to
participate
The study protocol was approved by the Ethics
Committee of the Affiliated Zhongshan Hospital of Dalian University
(approval no. 2022111).
Patient consent for publication
Written informed consent was obtained from the
patient's son for publication of this case report and the
accompanying images.
Competing interests
The authors declare that they have no competing
interests.
References
|
1
|
Miranda-Filho A and Bray F: Global
patterns and trends in cancers of the lip, tongue and mouth. Oral
Oncol. 102:1045512020. View Article : Google Scholar : PubMed/NCBI
|
|
2
|
Tan Y, Wang Z, Xu M, Li B, Huang Z, Qin S,
Nice EC, Tang J and Huang C: Oral squamous cell carcinomas: State
of the field and emerging directions. Int J Oral Sci. 15:442023.
View Article : Google Scholar : PubMed/NCBI
|
|
3
|
Yoshida R, Gohara S, Sakata J, Matsuoka Y,
Hirosue A, Kawahara K, Kawaguchi S, Nagao Y, Yamana K, Nagata M, et
al: Onodera's prognostic nutritional index correlates with tumor
immune environment and survival in patients with oral squamous cell
carcinoma undergoing chemoradiotherapy. Transl Oncol.
13:1008502020. View Article : Google Scholar : PubMed/NCBI
|
|
4
|
Gore SM, Crombie AK, Batstone MD and Clark
JR: Concurrent chemoradiotherapy compared with surgery and adjuvant
radiotherapy for oral cavity squamous cell carcinoma. Head Neck.
37:518–523. 2015. View Article : Google Scholar : PubMed/NCBI
|
|
5
|
Eldeeb H, Macmillan C, Elwell C and Hammod
A: The effect of the surgical margins on the outcome of patients
with head and neck squamous cell carcinoma: Single institution
experience. Cancer Biol Med. 9:29–33. 2012.PubMed/NCBI
|
|
6
|
Mojdami ZD, Barbour A, Oveisi M, Sun C,
Fine N, Saha S, Marks C, Elebyary O, Watson E, Tenenbaum H, et al:
The effect of Intensity-modulated radiotherapy to the head and neck
region on the oral innate immune response and oral microbiome: A
prospective cohort study of head and neck tumour patients. Int J
Mol Sci. 23:95942022. View Article : Google Scholar : PubMed/NCBI
|
|
7
|
Watson EE, Hueniken K, Lee J, Huang SH, El
Maghrabi A, Xu W, Moreno AC, Tsai CJ, Hahn E, McPartlin AJ, et al:
Development and standardization of an osteoradionecrosis
classification system in head and neck cancer: Implementation of a
Risk-based model. J Clin Oncol. 42:1922–1933. 2024. View Article : Google Scholar : PubMed/NCBI
|
|
8
|
Li Q, Huang Y, Shen C, Zhou J, Lin P, Lu
Y, He A, Liu X and Luo M: Efficacy and safety of CT-guided 125I
particle implantation for the treatment of elderly lung cancer: A
system evaluation and meta-analysis. BMC Geriatr. 25:6292025.
View Article : Google Scholar : PubMed/NCBI
|
|
9
|
Xia Y, Zhou Q, Jiang X, Tu W, Liu Q, Li L
and Shi Y: Investigation into the efficiency and prognostic
elements of CT-guided 125I particle implantation for
liver cancer. Cancer Imaging. 25:892025. View Article : Google Scholar : PubMed/NCBI
|
|
10
|
Sharma R, Sagoo NS, Haider AS, Sharma N,
Haider M, Sharma IK, Igbinigie M, Aya KL, Aoun SG and Vira S:
Iodine-125 radioactive seed brachytherapy as a treatment for spine
and bone metastases: A systematic review and meta-analysis. Surg
Oncol. 38:1016182021. View Article : Google Scholar : PubMed/NCBI
|
|
11
|
Yao H, ZhuGe Y, Jin S, Chen S, Zhang H,
Zhang D and Chen Z: The efficacy of coaxial percutaneous iodine-125
seed implantation combined with arterial infusion chemotherapy for
advanced pancreatic cancer: A randomized clinical trial. Int J
Radiat Biol. 100:1041–1050. 2024. View Article : Google Scholar : PubMed/NCBI
|
|
12
|
Li J, Wang J, Meng N, Qu A, Yuan H, Liu C,
Ran W and Jiang Y: Image-guided percutaneous (125)I seed
implantation as a salvage treatment for recurrent soft tissue
sarcomas after surgery and radiotherapy. Cancer Biother Radiopharm.
26:113–120. 2011.PubMed/NCBI
|
|
13
|
Zhang Y, Liang Y, Liu Z, Zhang H, Gao Z
and Wang J: Efficacy of radioactive 125I seed implantation in
treating inoperable or refused operation head and neck cancers. J
Cancer Res Ther. 20:642–650. 2024. View Article : Google Scholar : PubMed/NCBI
|
|
14
|
Tian Q, Zhu HH and Li H: Interstitial
brachytherapy of oral squamous cell carcinoma with
ultrasound-guided iodine-125 radioactive seed implantation. Eur Rev
Med Pharmacol Sci. 22:1680–1685. 2018.PubMed/NCBI
|
|
15
|
Kondrup J, Rasmussen HH, Hamberg O and
Stanga Z: Nutritional risk screening (NRS 2002): A new method based
on an analysis of controlled clinical trials. Clin Nutr.
22:321–336. 2003. View Article : Google Scholar : PubMed/NCBI
|
|
16
|
Hjermstad MJ, Fayers PM, Haugen DF,
Caraceni A, Hanks GW, Loge JH, Fainsinger R, Aass N and Kaasa S;
European Palliative Care Research Collaborative (EPCRC), : Studies
comparing numerical rating scales, verbal rating scales, and visual
analogue scales for assessment of pain intensity in adults: A
systematic literature review. J Pain Symptom Manage. 41:1073–1093.
2011. View Article : Google Scholar : PubMed/NCBI
|
|
17
|
Amin MB, Edge SB, Greene FL, Byrd DR,
Brookland RK, Washington MK, Gershenwald JE, ComptonC C, Hess KR,
Sullivan DC, et al: AJCC Cancer Staging Manual. 8th edition.
Springer; New York: 2017
|
|
18
|
Zhao GS, Liu S, Liu H, Lv WC, Yang L, Li
C, Zhou J, Wang RY and Song YC: Evaluation of the efficacy of
CT-guided 3D template-assisted 125I seed implantation in the
treatment of unresectable STS: A multicenter retrospective study.
Sci Rep. 12:37312022. View Article : Google Scholar : PubMed/NCBI
|
|
19
|
Zhao GS, Liu S, Yang L, Li C, Wang RY,
Zhou J and Zhang YW: Evaluation of radioactive (125)I seed
implantation for the treatment of refractory malignant tumours
based on a CT-guided 3D template-assisted technique: Efficacy and
safety. BMC Cancer. 20:7182020. View Article : Google Scholar : PubMed/NCBI
|
|
20
|
Schag CC, Heinrich RL and Ganz PA:
Karnofsky performance status revisited: Reliability, validity, and
guidelines. J Clin Oncol. 2:187–193. 1984. View Article : Google Scholar : PubMed/NCBI
|
|
21
|
Yang L, Li C, Wang Z, Wu J, Zhou J and
Wang R: The clinical efficacy of computed tomography-guided (125)I
particle implantation combined with arterial infusion chemotherapy
in the treatment of pancreatic cancer. J Cancer Res Ther.
17:720–725. 2021. View Article : Google Scholar : PubMed/NCBI
|
|
22
|
Zhao G, Liu S, Liu Y, Li X, Yu G, Zhang Y,
Bian J, Wu J, Zhou J and Gao F: CalliSpheres®
microsphere transarterial chemoembolization combined with 125I
brachytherapy for patients with non-small-cell lung cancer liver
metastases. Front Oncol. 12:8820612022. View Article : Google Scholar : PubMed/NCBI
|
|
23
|
Li L, Tian S, Han X, Tian J and Zhang C:
Computed tomography-guided radioactive iodine-125 seed implantation
for liver malignancies in challenging locations. J Cancer Res Ther.
20:1165–1172. 2024. View Article : Google Scholar : PubMed/NCBI
|
|
24
|
Cao G, Chang X, Wang Z, Liu X, Xu K, Wang
J and Zhang H: Dose and local efficacy analysis of iodine-125 seed
implantation therapy for lung tumors. Front Oncol. 15:15893252025.
View Article : Google Scholar : PubMed/NCBI
|
|
25
|
Zhao GS, Zhou HZ, Wang QS, Zhou XY, Sun
JB, Gao F, Wang RY, Wang Z, Zhou J, Liu S and Zhuang BQ: The
radioactive 3D-printed template-assisted CT-guided 125I seed
implantation for refractory bone metastases: A multicenter
retrospective analysis of efficacy, safety, and immune function
changes. PLoS One. 21:e03478932026. View Article : Google Scholar : PubMed/NCBI
|
|
26
|
Qiu B, Jiang Y, Ji Z, Sun H, Fan J, Li W,
Shao Y, Jiang P and Wang J: The accuracy of individualized
3D-printing template-assisted I(125) radioactive seed implantation
for recurrent/metastatic head and neck cancer. Front Oncol.
11:6649962021. View Article : Google Scholar : PubMed/NCBI
|
|
27
|
Jiang P, Wang J, Ran W, Jiang Y, Tian S
and Sun H: Five-year outcome of ultrasound-guided interstitial
permanent (125)I seeds implantation for local head and neck
recurrent tumors: A single center retrospective study. J Contemp
Brachytherapy. 11:28–34. 2019. View Article : Google Scholar : PubMed/NCBI
|
|
28
|
Qiu L, Wu R, Chen Y, Xiang H, Zhan W,
Zhang Y, Li Q, Liu H, Ding J, Li Y, et al: Dosimetry study of
3D-printed noncoplanar template-assisted CT-guided 125I seed
implantation for the treatment of recurrent and metastatic tumors
in the head and neck. PLoS One. 20:e03302712025. View Article : Google Scholar : PubMed/NCBI
|
|
29
|
Viswanathan AN, Erickson BA, Ibbott GS,
Small W Jr and Eifel PJ: The American College of Radiology and the
American Brachytherapy Society practice parameter for the
performance of low-dose-rate brachytherapy. Brachytherapy.
16:68–74. 2017. View Article : Google Scholar : PubMed/NCBI
|
|
30
|
Nag S, Cano ER, Demanes DJ, Puthawala AA
and Vikram B; American Brachytherapy Society, : The American
Brachytherapy Society recommendations for high-dose-rate
brachytherapy for head-and-neck carcinoma. Int J Radiat Oncol Biol
Phys. 50:1190–1198. 2001. View Article : Google Scholar : PubMed/NCBI
|
|
31
|
Chen E, Zhang Y, Zhang H, Jia C, Liang Y
and Wang J: Dosimetry study of three-dimensional print template for
125I implantation therapy. Radiat Oncol. 16:1152021. View Article : Google Scholar : PubMed/NCBI
|
|
32
|
Jiang Y, Ji Z, Guo F, Peng R, Sun H, Fan
J, Wei S, Li W, Liu K, Lei J and Wang J: Side effects of CT-guided
implantation of (125)I seeds for recurrent malignant tumors of the
head and neck assisted by 3D printing non co-planar template.
Radiat Oncol. 13:182018. View Article : Google Scholar : PubMed/NCBI
|
