Iodine-125 radioactive seed brachytherapy as a treatment for spine and bone metastases: A systematic review and meta-analysis

Ruhi Sharma, Navraj S. Sagoo, Ali S. Haider, Neha Sharma, Maryam Haider, Ishaan K. Sharma, Matthew Igbinigie, Kessiena L. Aya, Salah G. Aoun, Shaleen Vira

Research output: Contribution to journalArticlepeer-review

Abstract

Aim: To evaluate the analgesic efficacy, safety, and local tumor control of iodine-125 (125I) seed brachytherapy (BT) for the management of spine and bone metastases. Methods: A systematic literature search was conducted using PubMed, the Cochrane Library, and Scopus databases. Data regarding patient demographics, tumor characteristics, procedural parameters, and clinical outcomes were extracted and analyzed. Results: Fourteen studies (7 prospective, 7 retrospective) were included, accounting for 689 patients, in our review. Analgesic efficacy was assessed at baseline and various postoperative time points. Significant improvement in pain was noted at 4- and 24-week follow-ups (p < 0.01). Interestingly, all studies that combined 125I seed BT with cement augmentation reported relatively higher levels of pain reduction (mean pain reduction ≥4 points) as compared to the studies which applied 125I seed BT as a stand-alone therapy (mean pain reduction ≥2 points), at the last follow-up. Local tumor control rates ranged widely from 14% to 100% at varying follow-ups. Median overall survival ranged between 10 months and 25 months. The overall complication rate was 19% (130/689) and mainly included minor subcutaneous hemorrhage, fever, myelosuppression, and seed displacement. Metrics assessing performance and quality of life demonstrated significant improvements from baseline to posttreatment. Conclusion: 125I seed BT, alone or in conjunction with cement augmentation, may be a viable salvage therapy in appropriately selected patients. However, further studies are needed to analyze the long-term efficacy of this intervention as a palliative and curative modality.

Original languageEnglish (US)
Article number101618
JournalSurgical Oncology
Volume38
DOIs
StatePublished - Sep 2021

Keywords

  • Bone metastases
  • Brachytherapy
  • Spine metastases

ASJC Scopus subject areas

  • Surgery
  • Oncology

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