CT-guided trans-sternal iodine-125 seeds implantation for masses in the anterior or middle mediastinum

PURPOSE: The aim of this study was to explore the feasibility and clinical value of computed tomography (CT)-guided trans-sternal puncture to implant (125)I seeds to treat masses in the anterior or middle mediastinum. MATERIAL AND METHODS: From September 2017 to December 2019, twenty patients with masses in the anterior or middle mediastinum were enrolled and treated with CT-guided trans-sternal (125)I seeds implantation. Dosimetry parameters were compared between post-operative and pre-operative plans. Satisfaction rate of (125)I seed distribution, complications, and local efficacy were evaluated. RESULTS: A total of 22 lesions were treated with (125)I implantation in twenty patients, all procedures being successfully completed. The dosimetry parameters of the 20 patients immediately after surgery were as follows: mean D(90) = 134.30 ±14.53 Gy; mean V(90), V(100), V(150), and V(200) were 96.10 ±1.55%, 92.69 ±1.93%, 66.86 ±7.53%, and 42.95 ±9.11%, respectively; mean conformity index (CI), external index (EI), and homogeneity index (HI) were 0.65 ±0.06, 40.79 ±13.72%, and 27.90 ±7.53%, respectively. The satisfaction rate of (125)I seed distribution was 90%. The mean follow-up duration was 12 ±4.75 months (range, 4-24 months). The local control rates of 2 months, 6 months, and 1 year after surgery were 65.0%, 64.7%, and 53.8%, respectively. One patient had a small degree of pneumothorax, and one had hemoptysis after surgery. CONCLUSIONS: CT-guided trans-sternal puncture plant (125)I seeds for the treatment of masses in the anterior or middle mediastinum might serve as an alternative approach for treating specific mediastinal metastatic tumors.