CT-guided Radioactive 125I Seed Implantation for Abdominal Incision Metastases of Colorectal Cancer: Safety and Efficacy in 17 Patients

Published:November 03, 2022DOI:



      To retrospectively evaluate the safety and efficacy of computed tomography (CT)-guided iodine-125 (125I) seed implantation for patients with abdominal incision metastases from colorectal cancer.

      Materials and Methods

      Data of patients with abdominal incision metastases of colorectal cancer from November 2010 to October 2020 were retrospectively reviewed. Each incisional metastasis was percutaneously treated with 125I seed implantation under CT guidance. Follow-up contrast-enhanced CT was reviewed, and the outcomes were evaluated in terms of objective response rate, complications, and overall survival.


      A total of 17 patients were enrolled in this study. The median follow-up was 18 months (range, 2.7-22.1 months). At 3, 6, 12, and 18 months after the treatment, objective response rate was 52.9%, 63.6%, 33.3%, and 0%, respectively. A small amount of local hematoma occurred in two patients and resolved spontaneously without any treatment. Two patients experienced a minor displacement of radioactive seeds with no related symptoms. Severe complications, such as massive bleeding and radiation injury, were not observed. No ≥ grade 3 adverse events were identified. By the end of follow-up, 14 patients died of multiple hematogenous metastases. The one-year overall survival rate was 41.6%, and the median overall survival was 8.6 months.


      CT-guided 125I seed implantation brachytherapy is safe and feasible for patients with abdominal incision metastases from colorectal cancer.


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        • Silecchia G
        • Perrotta N
        • Giraudo G
        • et al.
        Abdominal wall recurrences after colorectal resection for cancer: results of the Italian registry of laparoscopic colorectal surgery.
        Dis Colon Rectum. 2002; 45 (1177): 1172-1177
        • Cass AW
        • Million RR
        • Pfaff WW.
        Patterns of recurrence following surgery alone for adenocarcinoma of the colon and rectum.
        Cancer-Am Cancer Soc. 1976; 37: 2861-2865
        • Hughes ES
        • Mcdermott FT
        • Polglase AL
        • Johnson WR.
        Tumor recurrence in the abdominal wall scar tissue after large-bowel cancer surgery.
        Dis Colon Rectum. 1983; 26: 571-572
        • Reilly WT
        • Nelson H
        • Schroeder G
        • Wieand HS
        • Bolton J
        • O'Connell MJ
        Wound recurrence following conventional treatment of colorectal cancer. A rare but perhaps underestimated problem.
        Dis Colon Rectum. 1996; 39: 200-207
        • Koea JB
        • Lanouette N
        • Paty PB
        • Guillem JG
        • Cohen AM.
        Abdominal wall recurrence after colorectal resection for cancer.
        Dis Colon Rectum. 2000; 43: 628-632
        • Welch JP
        • Donaldson GA.
        The clinical correlation of an autopsy study of recurrent colorectal cancer.
        Ann Surg. 1979; 189: 496-502
        • Ledesma EJ
        • Tseng M
        • Mittelman A.
        Surgical treatment of isolated abdominal wall metastasis in colorectal cancer.
        Cancer-Am Cancer Soc. 1982; 50: 1884-1887
        • Trotti A
        • Byhardt R
        • Stetz J
        • et al.
        Common toxicity criteria: version 2.0. an improved reference for grading the acute effects of cancer treatment: impact on radiotherapy.
        Int J Radiat Oncol Biol Phys. 2000; 47: 13-47
        • Minsky BD.
        Radiation plus chemotherapy as adjuvant therapy for rectal cancer.
        Best Pract Res Clin Gastroenterol. 2002; 16: 267-282
        • Zhao J
        • Zhi Z
        • Zhang H
        • et al.
        Efficacy and safety of CT-guided (125)I brachytherapy in elderly patients with non-small cell lung cancer.
        Oncol Lett. 2020; 20: 183-192
        • Hong D
        • Zhou Y
        • Wan X
        • Su H
        • Shao H.
        Brachytherapy with Iodine-125 seeds for treatment of portal vein-branch tumor thrombus in patients with hepatocellular carcinoma.
        Bmc Cancer. 2021; 21: 1020
        • Chen HH
        • Jia RF
        • Yu L
        • Zhao MJ
        • Shao CL
        • Cheng WY.
        Bystander effects induced by continuous low-dose-rate 125I seeds potentiate the killing action of irradiation on human lung cancer cells in vitro.
        Int J Radiat Oncol Biol Phys. 2008; 72: 1560-1566
        • Wang ZM
        • Lu J
        • Liu T
        • Chen KM
        • Huang G
        • Liu FJ.
        CT-guided interstitial brachytherapy of inoperable non-small cell lung cancer.
        Lung Cancer. 2011; 74: 253-257
        • Maki S
        • Itoh Y
        • Kubota S
        • et al.
        Clinical outcomes of 125I brachytherapy with and without external-beam radiation therapy for localized prostate cancer: results from 300 patients at a single institution in Japan.
        J Radiat Res. 2017; 58: 870-880
        • Zuber S
        • Weiss S
        • Baaske D
        • et al.
        Iodine-125 seed brachytherapy for early stage prostate cancer: a single-institution review.
        Radiat Oncol. 2015; 10: 49
        • Stewart A
        • Parashar B
        • Patel M
        • et al.
        American Brachytherapy Society consensus guidelines for thoracic brachytherapy for lung cancer.
        Brachytherapy. 2016; 15: 1-11
        • Han L
        • Li C
        • Wang J
        • et al.
        Iodine-125 radioactive seed tissue implantation as a remedy treatment for recurrent cervical cancer.
        J Cancer Res Ther. 2016; 12: C176-C180
        • Han Q
        • Deng M
        • Lv Y
        • Dai G.
        Survival of patients with advanced pancreatic cancer after iodine125 seeds implantation brachytherapy: a meta-analysis.
        Medicine (Baltimore). 2017; 96: e5719
        • Chen Y
        • Jiang Y
        • Ji Z
        • et al.
        Efficacy and safety of CT-guided (125)I seed implantation as a salvage treatment for locally recurrent head and neck soft tissue sarcoma after surgery and external beam radiotherapy: a 12-year study at a single institution.
        Brachytherapy. 2020; 19: 81-89
        • Davis BJ
        • Horwitz EM
        • Lee WR
        • et al.
        American Brachytherapy Society consensus guidelines for transrectal ultrasound-guided permanent prostate brachytherapy.
        Brachytherapy. 2012; 11: 6-19
        • Wang J
        • Chai S
        • Zheng G
        • et al.
        Expert consensus statement on computed tomography-guided (125)I radioactive seeds permanent interstitial brachytherapy.
        J Cancer Res Ther. 2018; 14: 12-17
        • Monk BJ
        • Tewari KS
        • Puthawala AA
        • Syed AM
        • Haugen JA
        • Burger RA.
        Treatment of recurrent gynecologic malignancies with iodine-125 permanent interstitial irradiation.
        Int J Radiat Oncol Biol Phys. 2002; 52: 806-815
        • Yamaguchi H
        • Ishimaru M
        • Suzuki H
        • et al.
        Isolated abdominal wound recurrence after lymph-node dissection for appendiceal adenocarcinoma.
        Am J Surg. 2010; 199: e7-e9
        • Deweese TL
        • Shipman JM
        • Dillehay LE
        • Nelson WG.
        Sensitivity of human prostatic carcinoma cell lines to low dose rate radiation exposure.
        J Urol. 1998; 159: 591-598
        • Koritzinsky M
        • Wouters BG
        • Amellem O
        • Pettersen EO.
        Cell cycle progression and radiation survival following prolonged hypoxia and re-oxygenation.
        Int J Radiat Biol. 2001; 77: 319-328
        • Wang Y
        • Guo JH
        • Zhu GY
        • et al.
        A novel self-expandable, radioactive airway stent loaded with (125)I seeds: a feasibility and safety study in healthy beagle dog.
        Cardiovasc Intervent Radiol. 2017; 40: 1086-1093
        • Yang G
        • Peng S
        • Zhang Y
        • et al.
        Cell-based assay system to estimate the effect of 125I seeds on cancer cells: effect of osteopontin.
        Recent Pat Anticancer Drug Discov. 2014; 9: 258-263
        • Wang G
        • Zhang F
        • Yang B
        • et al.
        Feasibility and clinical value of CT-guided (125)I brachytherapy for bilateral lung recurrences from colorectal carcinoma.
        Radiology. 2016; 278: 897-905
        • Sgouros G
        • Knox SJ
        • Joiner MC
        • Morgan WF
        • Kassis AI.
        MIRD continuing education: bystander and low dose-rate effects: are these relevant to radionuclide therapy?.
        J Nucl Med. 2007; 48: 1683-1691
        • Gao F
        • Li C
        • Gu Y
        • Huang J
        • Wu P.
        CT-guided 125I brachytherapy for mediastinal metastatic lymph nodes recurrence from esophageal carcinoma: effectiveness and safety in 16 patients.
        Eur J Radiol. 2013; 82: e70-e75
        • Zhang W
        • Li J
        • Li R
        • Zhang Y
        • Han M
        • Ma W.
        Efficacy and safety of iodine-125 radioactive seeds brachytherapy for advanced non-small cell lung cancer-A meta-analysis.
        Brachytherapy. 2018; 17: 439-448
        • Wang H
        • Lu J
        • Zheng XT
        • et al.
        Oligorecurrence non-small cell lung cancer after failure of first-line chemotherapy: computed tomography-guided (125)I seed implantation vs. second-line chemotherapy.
        Front Oncol. 2020; 10: 470
        • Kishi K
        • Takifuji K
        • Shirai S
        • Sonomura T
        • Sato M
        • Yamaue H.
        Brachytherapy technique for abdominal wall metastases of colorectal cancer: ultrasound-guided insertion of applicator needle and a skin preservation method.
        Acta Radiol. 2006; 47: 157-161
        • Shi D
        • Wu N
        • Zhao H
        • He M
        • Han D
        • Cheng G.
        A case report of ultrasound-guided interstitial brachytherapy for abdominal wall metastases of ovarian cancer.
        J Contemp Brachytherapy. 2015; 7: 81-85
        • Li H
        • Li J
        • Zhan Y
        • et al.
        Ultrasound-guided (125)I seed implantation in treatment of abdominal wall metastases.
        Cancer Biother Radiopharm. 2019; 34: 218-223
        • Nath R
        • Anderson LL
        • Luxton G
        • Weaver KA
        • Williamson JF
        • Meigooni AS.
        Dosimetry of interstitial brachytherapy sources: recommendations of the AAPM Radiation Therapy Committee Task Group No. 43. American Association of Physicists in Medicine.
        Med Phys. 1995; 22: 209-234
        • Lee EK
        • Gallagher RJ
        • Silvern D
        • Wuu CS
        • Zaider M.
        Treatment planning for brachytherapy: an integer programming model, two computational approaches and experiments with permanent prostate implant planning.
        Phys Med Biol. 1999; 44: 145-165
        • Kirisits C
        • Potter R
        • Lang S
        • Dimopoulos J
        • Wachter-Gerstner N
        • Georg D
        Dose and volume parameters for MRI-based treatment planning in intracavitary brachytherapy for cervical cancer.
        Int J Radiat Oncol Biol Phys. 2005; 62: 901-911