Journal of contemporary brachytherapy · 2026
Predicting the efficacy of iodine-125 seed implantation therapy for metastatic lesions of radioiodine-refractory differentiated thyroid cancer using pre-operative PET/CT parameters: A clinical study.
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Jiang Yeqing, Chen Zhijun
Аннотация
PURPOSE: To analyze the clinical response of iodine-125 seed implantation (125I-SI) in patients with radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC), and to explore the association between metabolic parameters derived from pre-operative 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and treatment efficacy.
MATERIAL AND METHODS: This retrospective study included 48 RAIR-DTC patients, who underwent 125I-SI for metastatic lesions at Jiangxi Cancer Hospital from November 2019 to June 2025. Correlations between parameters, such as gender, age, metabolic tumor volume (MTV), standardized uptake value maximum (SUVmax), peak standard uptake value (SUVpeak), maximum standardized uptake value normalized by lean body mass (SULmax), peak standardized uptake value normalized by lean body mass (SULpeak), total lesion glycolysis (TLG), tumor-to-liver ratio (TLR), number of iodine-125 (125I) seeds, activity of 125I seeds, and 90% of dose received by gross tumor volume (D90), with efficacy of 125I-SI were analyzed. Statistical analyses included two independent-sample t-tests, Mann-Whitney U test, Fisher's exact test, and logistic and Cox regression analysis. Performance was assessed using area under the curve (AUC), calibration, and decision curve analysis (DCA).
RESULTS: Patients were regularly followed up after treatment. At 6 months, 18 patients achieved complete metabolic response (CMR), 18 partial metabolic response (PMR), and 12 stable metabolic disease (SMD). D90 was an independent predictor of 6-month efficacy (p = 0.031, OR = 0.798, 95% CI: 0.428-0.925), with an AUC of 0.742. DCA and calibration curves confirmed the model's robust predictive capability. Cox regression identified TLG as a significant predictor of local progression-free survival (LPFS) (HR = 4.106, 95% CI: 2.850-5.620, p = 0.036).
CONCLUSIONS: 125I seed implantation is an effective treatment for locally metastatic RAIR-DTC lesions. D90 is a reliable predictor of 6-month efficacy, and TLG is significantly associated with LPFS following 125I-SI.
MATERIAL AND METHODS: This retrospective study included 48 RAIR-DTC patients, who underwent 125I-SI for metastatic lesions at Jiangxi Cancer Hospital from November 2019 to June 2025. Correlations between parameters, such as gender, age, metabolic tumor volume (MTV), standardized uptake value maximum (SUVmax), peak standard uptake value (SUVpeak), maximum standardized uptake value normalized by lean body mass (SULmax), peak standardized uptake value normalized by lean body mass (SULpeak), total lesion glycolysis (TLG), tumor-to-liver ratio (TLR), number of iodine-125 (125I) seeds, activity of 125I seeds, and 90% of dose received by gross tumor volume (D90), with efficacy of 125I-SI were analyzed. Statistical analyses included two independent-sample t-tests, Mann-Whitney U test, Fisher's exact test, and logistic and Cox regression analysis. Performance was assessed using area under the curve (AUC), calibration, and decision curve analysis (DCA).
RESULTS: Patients were regularly followed up after treatment. At 6 months, 18 patients achieved complete metabolic response (CMR), 18 partial metabolic response (PMR), and 12 stable metabolic disease (SMD). D90 was an independent predictor of 6-month efficacy (p = 0.031, OR = 0.798, 95% CI: 0.428-0.925), with an AUC of 0.742. DCA and calibration curves confirmed the model's robust predictive capability. Cox regression identified TLG as a significant predictor of local progression-free survival (LPFS) (HR = 4.106, 95% CI: 2.850-5.620, p = 0.036).
CONCLUSIONS: 125I seed implantation is an effective treatment for locally metastatic RAIR-DTC lesions. D90 is a reliable predictor of 6-month efficacy, and TLG is significantly associated with LPFS following 125I-SI.