CT-guided 125I brachytherapy for mediastinal metastatic lymph nodes recurrence from esophageal carcinoma: effectiveness and safety in 16 patients.

OBJECTIVES: To retrospectively evaluate effectiveness and safety of CT-guided (125)I brachytherapy in 16 patients with mediastinal metastatic lymph nodes recurrence from esophageal carcinoma.

MATERIALS AND METHODS: Sixteen metastatic lymph nodes in 16 patients were percutaneously treated in 19 (125)I brachytherapy sessions. Each metastatic lymph node was treated with computed tomographic (CT) guidance. Follow-up contrast material-enhanced CT or positron emission tomographic (PET) scans were reviewed and the treatment's effectiveness was evaluated.

RESULTS: Months are counted from the first time of (125)I brachytherapy and the median duration of follow-up was 11 months (range, 5-16 months). The local control rates after 3, 6, 10 and 15 months were 75.0, 50.0, 42.9 and 33.3% respectively. At the time of writing, four patients are alive without evidence of recurrence at 16, 9, 16 and 9 months. The 4 patients presented good control of local tumor and no systemic recurrence, and survived throughout the follow-up period. The other 12 patients died of multiple hematogenous metastases 5-15 months after brachytherapy. A small amount of local hematoma occurred in 2 patients that involved applicator insertion through the lung. Two patients presented pneumothorax with pulmonary compression of 30 and 40% after the procedure and recovered after drainage. One patient had minor displacement of radioactive seeds. Severe complications such as massive bleeding and radiation pneumonitis did not occur.

CONCLUSION: (125)I radioactive seed implantation is effective and may be safely applied to mediastinal metastatic lymph nodes recurrence from esophageal carcinoma.