Treatment of recurrent mediastinal lymph node metastasis using CT-guided nontranspulmonary puncture interstitial implantation of (125)I seeds: Evaluation of initial effect and operative techniques

Abstract

Purpose: To evaluate the initial effects and operative techniques for treating recurrent mediastinal lymph node metastasis using CT-guided nontranspulmonary puncture interstitial implantation of (125)I seeds.

Methods and materials: Thirteen patients (eight men and five women) with a total of 14 recurrent mediastinal lymph node metastatic lesions underwent CT-guided nontranspulmonary puncture interstitial implantation of (125)I seeds.

Results: We used the transpleural cavity approach for six cases (air injection of 200-600 mL), the transsternal approach for three cases, the supersternal approach for one case, and the parasternal/paraspinal approach for the remaining cases (including two cases using the salinoma window technique). All patients had good operational tolerance. Mean followup was 16.3 months, with 12 complete response lesions and 2 partial response lesions.

Conclusions: Treating recurrent mediastinal lymph node metastasis using CT-guided nontranspulmonary puncture interstitial implantation of (125)I seeds is safe and effective, with minimal trauma, evident local therapeutic effects, and does not damage lung tissue. However, comprehensive application of multiple puncture assistive technologies, and skill, is required due to the important, anatomically complex structures in the mediastinum.

Keywords: Brachytherapy; Iodine 125; Lymph node; Mediastinum; X-ray computed tomography.