This article is a commentary on:
A Retrospective Study on Using a Novel Single Needle Cone Puncture Approach for the Iodine-125 Seed Brachytherapy in Treating Patients With Thoracic Malignancy
Lijuan Zhang1
Chenfei Jia
Fenxian Zhang
Enli Chen- 1Department of Oncology, Hebei General Hospital, Shijiazhuang, China
- 2Department of Oncology, Cangzhou Central Hospital, Cangzhou, China
- 3School of Life Science, Shanxi Agricultural University, Jinzhong, China
- 4Hebei Seed Diagnosis and Treatment Center, Hebei General Hospital, Shijiazhuang, China
By Li F, Wang L, Zhang Y, Feng W, Ju T, Liu Z, Wang Z and Du X (2021). Front. Oncol. 11:640131. doi: 10.3389/fonc.2021.640131
125I seed brachytherapy is increasingly used for various types of advanced cancers, and the therapeutic effects are well recognized (1). However, for the treatment of mediastinal tumors, it is difficult to achieve accurate seed distribution and dose distribution. In a recent retrospective study, Li et al. (2) developed a single needle cone puncture method for 125 I seed (SNCP-125I) brachytherapy for the treatment of thoracic malignancy. The study is especially of great significance in the treatment of patients with lung hilar and mediastinal tumors, which offers an extremely effective therapeutic approach. However, there are still some issues that we expect to discuss with the authors.
First of all, because the only needle used in this technique was repeatedly punctured through tumor lesion, the tumor cells carried by the needle will inevitably be brought to the needle path, which may increase the risk of tumor needle path metastasis. Ryd et al. showed that 103 ~ 104 tumor cells could be implanted in each needle path after the puncture of solid tumors (3). Wang et al. conducted a cytological examination on the tissue smears on the surface of the needle core and needle sheath used in 125I seed implantation, and the results showed that the positive rate of tissue smears on the surface of the needle sheath was 5.2% (13/250), and the positive rate of the needle core was 2.8% (7/250). In addition, they showed that the longer the distance of the implanted needle through normal tissue, the more tumor cells will remain in the needle path (4). Therefore, this technique may increase the risk of needle path metastasis.
Secondly, SNCP-125I not only is difficult to operate but also has high technical requirements and a long learning curve, which prevents its broad application in the clinical practice. In recent years, the technology of three-dimensional (3D) printing template-guided 125I seed implantation has developed rapidly, which can achieve a more accurate distribution of the seed and dose while greatly reducing operation difficulty (5, 6). Ji et al. (7) treated 22 patients with a thoracic malignant tumor with a 3D printing coplanar coordinate template (3D-PCCT) -assisted CT-guided 125I seed implantation. There were 2 patients whose tumor was located in the mediastinum. All operations were successfully performed, and the distribution of the seed and dose was consistent with the preoperative plan. These results indicate that 3D-PCCT-assisted 125I seed implantation is safe and effective in the treatment of mediastinal tumors. Lv et al. (8) applied coplanar template (CPT)-assisted 125I seed implantation to treat 32 patients with advanced lung cancer with mediastinal lymph node metastasis in the 4R group. The results showed that all patients successfully completed seed implantation, and the postoperative dose distribution and dose of organs at risk were consistent with the preoperative plan. In addition, the effective rate was 84.37% 6 months after the operation, and no lung radiation injury, large vessel injury, bleeding, and other serious complications were found during the follow-up. It is suggested that template-assisted CT-guided 125I seed implantation for mediastinal lymph node metastasis can better achieve the preoperative plan and avoid important blood vessel and organ damage, which is an accurate, effective, and safe treatment method. Therefore, the SNCP-125I technique should be preferred when there are few puncture paths, and the template guidance method should be preferred in other cases.
In conclusion, the SNCP-125I technique may increase the risk of needle path metastasis due to repeated tumor lesion puncture. If SNCP-125I is to be administered, it is necessary to improve the puncture level of the operator, optimize the preoperative treatment plan, and take corresponding preventive measures during the operation, as well as active anti-tumor treatment and regular follow-ups after the operation. At last, template-assisted 125I seed implantation should be preferred in some cases.
Author Contributions
LZ, CJ, FZ, and EC wrote the letter. All authors contributed to the article and approved the submitted version.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s Note
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Acknowledgments
The authors would like to thank the participating members. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
References
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Keywords: radioactive iodine-125 brachytherapy, single needle cone puncture, thoracic malignancy, life-threatening symptom, survival
Citation: Zhang L, Jia C, Zhang F and Chen E (2022) Commentary: A Retrospective Study on Using a Novel Single Needle Cone Puncture Approach for the Iodine-125 Seed Brachytherapy in Treating Patients With Thoracic Malignancy. Front. Oncol. 12:921080. doi: 10.3389/fonc.2022.921080
Received: 15 April 2022; Accepted: 23 May 2022;
Published: 14 June 2022.
Edited by:
Xiaodong Wu, The University of Iowa, United StatesReviewed by:
Zhe Ji, Peking University Third Hospital, ChinaCopyright © 2022 Zhang, Jia, Zhang and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Enli Chen, 18332161518@163.com