Radioguided surgery of mesenchymal tumors with 125I seeds

Abstract

Introduction: Radioguided surgery uses radioactive substances to identify and remove hard-to-locate lesions. Mesenchymal tumors constitute a heterogeneous group of neoplasms derived from the mesoderm, including benign lesions and malignant sarcomas. The aim of this study was to evaluate the ability of ¹²⁵I radioactive seeds to guide intraoperative localization of mesenchymal tumors, analyzing the complication rates and evaluating the margins of the surgical specimens retrieved.

Methods: Retrospective observational study of all consecutive patients undergoing radioguided surgery of a mesenchymal tumor with a ¹²⁵I radioactive seed from January 2012 to January 2020 at a tertiary referral center in Spain. The seed was inserted percutaneously guided by ultrasound or computed tomography in an outpatient setting.

Results: Fifteen lesions were resected in 11 interventions in 11 patients, recovering all lesions marked (100%) with a ¹²⁵I seed. The lesions included areas of benign fibrosis (26.7%), cellular angiofibroma (6.7%), desmoid tumor (20%), solitary fibrous tumor (13.3%), chondrosarcoma (6.7%), and pleomorphic sarcoma (26.7%), with a high rate of recurrent tumors (60%). There was only one complication (6.7%) due to the seed falling within the surgical bed. According to the UICC classification of residual tumors, 80% of the lesions resulted in an R0 resection, 6.7% were R1 resections, and 13.3% were R2 resections.

Conclusion: Radioguided surgery is an accurate technique for the resection of hard-to-locate mesenchymal tumors.

Keywords: Cirugía; Cirugía radioguiada; Iodine radioisotopes; Iodine-125; Iodine-125 seed; Neoplasm recurrence, local; Radioguided surgery; Radioisótopos de yodo; Recurrencia local de neoplasia; Sarcoma; Semilla de Yodo-125; Surgery; Yodo-125.