Percutaneous computed tomography/ultrasonography-guided permanent iodine-125 implantation as salvage therapy for recurrent squamous cell cancers of head and neck

Objective: To assess the feasibility, efficacy and morbidity of permanent percutaneous I-125 seed implantation under computed tomography (CT)/ultrasonography guidance for recurrent squamous cell carcinomas of head and neck. Results: The median local disease-free progression was 12 mo (95% CI, 4.8-19.2), and the 1 and 2 y local tumor control rates were 48.7 and 39.9%, respectively. The 1 and 2 y survival rates were 42.5 and 28.3%, respectively (median: 11 mo) (95% CI, 8.2-13.8). Of the 25 patients, six (24%) died of local recurrence and five (20%) died of metastases; two patients showed recurrences at 3 and 8 mo after seed implantation and subsequently died of pneumonia. One patient died of heart disease. One developed ulceration with tumor progression. Blood vessel damage and neuropathy were not observed. Methods: Twenty-five patients underwent I-125 seed implantation under CT or ultrasonography guidance. Postoperative dosimetry was routinely performed for all the patients. The actuarial D90 of the implanted I-125 seeds ranged from 90-160 Gy (median: 130 Gy). The activity of I-125 seed ranged from 0.35-0.8 mCi (median: 0.6 mCi). The total number of seeds implanted ranged from 3-61 (median: 22). The follow-up period ranged from 3-40 mo (median: 8 mo). Conclusion: The high local tumor control rates, minimal invasion, and low morbidity suggest that percutaneous I-125 seed implantation is a feasible and safe salvage for patients with recurrent squamous cell carcinomas of the head and neck.