Clinical role of guidance by C-arm CT for 125I brachytherapy on pulmonary tumors

To evaluate the clinical value of C-arm CT (CACT)-guided interstitial iodine-125 (I-125) brachytherapy on pulmonary tumors. 30 patients with 40 solid pulmonary tumors were enrolled to undergo CACT-guided interstitial I-125 brachytherapy between November 2011 and November 2014. The needle path was planned on a CACT virtual navigation and real-time fluoroscopy system. Technical success, puncture score, procedure time, local control rate (LCR), radiation exposure, complications and survival were investigated. The technical success of interstitial I-125 brachytherapy under CACT guidance was 40/40 (100%). The performance score was 4.7 +/- 0.5 with a mean total procedure time of 17.7 +/- 5.6 min. LCR in small (aecurrency2.0 cm), intermediate (2.1-4.9 cm) and large (aeyen5.0 cm) pulmonary tumors was 100, 89.5 and 72.7% at the 4-month follow-up, respectively. The mean effective dose was 10.1 +/- 2.8 mSv. Major complications occurred in four patients (13.3%). The mean survival time was 28.4 +/- 2.3 months. CACT can provide virtual navigation and real-time fluoroscopy synchronously for interstitial I-125 seed implantation on pulmonary tumors.