Clinical application value of template-assisted CT-guided radioactive seed implantation for pancreatic carcinoma

Objective: To investigate the clinical value of coplanar template-assisted CT guided radioactive seeds implantation in the treatment of pancreatic carcinoma. Methods: A total of 22 advanced pancreatic carcinoma patients underwent CT guided radioactive seeds implantation were retrospectively analyzed. Ten patients were treated with coplanar template-assisted with an average age of (65 ± 10) years (48 to 77 years). Twelve patients were treated without coplanar template assist with an average age of (68 ± 13) years (47 to 84 years). The preoperative planning designs and postoperative dosimetry verifications were performed for all patients. The dose related parameters including D₉₀, MPD, V₁₀₀, V₁₅₀ and V₂₀₀ were compared between pre and post operation by t test. The operating time were also evaluated between the two groups. Results: Overall the 22 patients were treated successfully without serious surgery-related complications. An average of 26 seeds were implanted in the coplanar template assisted implantation group, and 23 seeds were implanted in the non template-assisted implantation group. Preoperative V₁₀₀ in coplanar template group and non template group were (94.45 ± 1.32)% and (93.27 ± 1.37)% separately. Postoperative V₁₀₀ in both groups were (89.31 ± 2.58)% and (85.25 ± 4.35)% separately. Postoperative D₉₀ in both groups were (147.32 ± 7.12) Gy and (149.25 ± 4.86) Gy separately. Postoperative V₁₅₀ in both groups were (57.83 ± 7.74)% and (63.97 ± 7.75)% separately. Preoperative D₉₀ in both groups were (152.41 ± 6.78) Gy and (153.30 ± 7.79) Gy separately. Preoperative V₁₅₀ in both groups were (58.61 ± 14.11)% and (62.45 ± 6.49)% separately. Postoperative MPD in both groups were (87.64 ± 10.60) Gy and (87.12 ± 7.66) Gy separately. Postoperative V₂₀₀ in both groups were (34.12 ± 7.67)%, (39.42 ± 7.18)% separately. Preoperative MPD in both groups were (82.12 ± 7.81) Gy and (83.43 ± 4.86) Gy separately. Preoperative V₂₀₀ in both groups were (29.04 ± 10.64)%, (36.11 ± 7.22)% separately. Compared with preoperative plans, the mean value of D₉₀ and V₁₀₀ decreased while the mean value of MPD and V₂₀₀ increased in postoperative verifications in both coplanar template assist CT guided radioactive seeds implantation group and non template-assisted group. However, there was no significant difference between pre and post operation except for V₁₀₀ (P < 0.05). The operating time of coplanar template assist group and non template-assisted group were (44.3 ± 12.4) min and (60.0 ± 12.8) min respectively. The difference of operating time between two groups were statistically significant (P < 0.05). Conclusion: Compared with the treatment without template assist, coplanar template-assisted brachytherapy could be more accurate in preoperative plans optimization, and shorten the operation time and improve the patients' tolerance. (authors)