Ming-Wei Huang

A digital model individual template and CT-guided 125I seed implants for malignant tumors of the head and neck

To enhance the accuracy of radioactive seed implants in the head and neck, a digital model individual template, containing information simultaneously on needle pathway and facial features, was designed to guide implantation with CT imaging. Thirty-one patients with recurrent and local advanced malignant tumors of head and neck after prior surgery and radiotherapy were involved in this study. Before 125I implants, patients received CT scans based on 0.75mm thickness. And the brachytherapy treatment planning system (BTPS) software was used to make the implantation plan based on the CT images. Mimics software and Geomagic software were used to read the data containing CT images and implantation plan, and to design the individual template. Then the individual template containing the information of needle pathway and face features simultaneously was made through rapid prototyping (RP) technique. All patients received 125I seeds interstitial implantation under the guide of the individual template and CT. The individual templates were positioned easily and accurately, and were stable. After implants, treatment quality evaluation was made by CT and TPS. The seeds and dosages distribution (D90,V100,V150) were well meet the treatment requirement. Clinical practice confirms that this approach can facilitate easier and more accurate implantation.

Preliminary results of (125)I interstitial brachytherapy for locally recurrent parotid gland cancer in previously irradiated patients.

The purpose of this study was to analyze the treatment of recurrent parotid gland cancers with radioactive iodine (125I) seed implantation.

Survival analysis of oral squamous cell carcinoma in a subgroup of young patients.

Oral squamous cell carcinoma (OSCC) is predominantly a disease of middle-aged men with long-term exposure to tobacco and alcohol. An increasing trend has been reported at a younger age worldwide. Clinical records of 100 patients under the age of 45 years treated specifically for oral cavity SCC in our hospital during a 10-year period were retrospectively analyzed to calculate the survival rates. An obvious male predominance coincided with smoking trend among Chinese young individuals and female patients were more likely to have no traditional risk factors such as smoking or drinking. The 5-year overall survival rate and disease-free survival rate were 61.0% and 75.5%, respectively, consistent with other published series over the decade showing a relatively better survival among the young. No significant differences clearly correlated with outcome when comparing non-smokers non-drinkers to ever-smokers and ever drinkers (P>0.05). Overall survival rate and disease free survival rate was found to be significantly higher in patients with early-stage disease than with advanced stage disease (P=0.001, P=0.009 respectively). The strong influence of clinical stage on prognosis emphasizes the importance of early diagnosis and treatment of oral malignancies for this unique clinical subgroup.

Nimotuzumab suppresses epithelial-mesenchymal transition and enhances apoptosis in low-dose UV-C treated salivary adenoid cystic carcinoma cell lines in vitro.

Salivary adenoid cystic carcinoma (SACC), which is one of the most common malignant tumors of the salivary glands, is associated with a poor long-term outcome. There are currently few therapeutic options for patients with SACC. Recent studies have shown the potential of the application of ultraviolet-C (UV-C) irradiation for the treatment of human cancer. In the present study, we investigated the effects of UV-C in the SACC cell lines SACC-83 and SACC-LM. High-dose UV-C (200 J/m2) induced apoptosis and inhibited colony formation significantly. However, low-dose UV-C (10 J/m2), which had little effect on apoptosis and colony formation, increased the ability of migration in SACC cells accompanied by a decrease in E-cadherin and an increase in vimentin, suggesting the occurrence of epithelial–mesenchymal transition (EMT). Low-dose UV-C (10 J/m2) also resulted in upregulation of the phosphorylated forms of epidermal growth factor receptor (EGFR) and Akt (p-EGFR and p-Akt, respectively). Pretreatment with Nimotuzumab, an anti-EGFR monoclonal antibody, reversed the EMT as well as upregulation of p-EGFR/p-Akt induced by UV-C. Moreover, Nimotuzumab enhanced UV-C induced apoptosis and inhibition of colony formation. Our results indicate that EMT exerts a protective effect against apoptosis induced by low-dose UV-C. Thus, the combined application of Nimotuzumab and low-dose UV-C in vitro has an advantageous antitumor effect in SACC compared with the application of UV-C alone.

Oncocytic carcinoma of the parotid gland

The incidence of oncocytic carcinoma of the parotid gland is low, so a systematic evaluation of treatment strategies is lacking. We aimed to describe our experiences in treating this malignancy.

Postoperative 125I brachytherapy delivered by digital model obturators for recurrent or locally advanced maxillary cancers

We aimed to evaluate the feasibility and effectiveness of postoperative 125I brachytherapy delivered by use of digital model obturators for recurrent or locally advanced maxillary cancers.

Accuracy evaluation of a 3D-printed individual template for needle guidance in head and neck brachytherapy

To transfer the preplan for the head and neck brachytherapy to the clinical implantation procedure, a preplan-based 3D-printed individual template for needle insertion guidance had previously been designed and used. The accuracy of needle insertion using this kind template was assessed in vivo. In the study, 25 patients with head and neck tumors were implanted with 125I radioactive seeds under the guidance of the 3D-printed individual template. Patients were divided into four groups based on the site of needle insertion: the parotid and masseter region group (nine patients); the maxillary and paranasal region group (eight patients); the submandibular and upper neck area group (five patients); and the retromandibular region group (six patients). The distance and angular deviations between the preplanned and placed needles were compared, and the complications and time required for needle insertion were assessed. The mean entrance point distance deviation for all 619 needles was 1.18 ± 0.81 mm, varying from 0.857 ± 0.545 to 1.930 ± 0.843 mm at different sites. The mean angular deviation was 2.08 ± 1.07 degrees, varying from 1.85 ± 0.93 to 2.73 ± 1.18 degrees at different sites. All needles were manually inserted to their preplanned positions in a single attempt, and the mean time to insert one needle was 7.5 s. No anatomical complications related to inaccurately placed implants were observed. Using the 3D-printed individual template for the implantation of 125I radioactive seeds in the head and neck region can accurately transfer a CT-based preplan to the brachytherapy needle insertion procedure. Moreover, the addition of individual template guidance can reduce the time required for implantation and minimize the damage to normal tissues.

Three-dimensional verification of 125I seed stability after permanent implantation in the parotid gland and periparotid region

ObjectiveTo evaluate seed stability after permanent implantation in the parotid gland and periparotid region via a three-dimensional reconstruction of CT data.Material and methodsFifteen patients treated from June 2008 to June 2012 at Peking University School and Hospital of Stomatology for parotid gland tumors with postoperative adjunctive 125I interstitial brachytherapy were retrospectively reviewed in this study. Serial CT data were obtained during follow-up. Mimics and Geomagic Studio software were used for seed reconstruction and stability analysis, respectively.ResultsSeed loss and/or migration outside of the treated area were absent in all patients during follow-up (23–71 months). Total seed cluster volume was maximized on day 1 post-implantation due to edema and decreased significantly by an average of 13.5 % (SD = 9.80 %; 95 % CI, 6.82–17.68 %) during the first two months and an average of 4.5 % (SD = 3.60 %; 95 % CI, 2.29–6.29 %) during the next four months. Volume stabilized over the subsequent six months.Conclusions125I seed number and location were stable with a general volumetric shrinkage tendency in the parotid gland and periparotid region. Three-dimensional seed reconstruction of CT images is feasible for visualization and verification of implanted seeds in parotid brachytherapy.

Mandibular growth in survivors of pediatric parotid gland carcinoma treated with interstitial brachytherapy

The aim of the study was to present long‐term results of mandibular growth in pediatric parotid gland carcinoma survivors treated with interstitial brachytherapy.

Postoperative iodine-125 interstitial brachytherapy for the early stages of minor salivary gland carcinomas of the lip and buccal mucosa with positive or close margins.

The purpose of this study was to present our preliminary exploration of safety and efficacy of postoperative low‐dose‐rate brachytherapy for the early clinical stages of minor salivary gland carcinomas of the lip and buccal mucosa.