Objective To explore the value of refined intraoperative real-time treatment plan in 125I seed brachytherapy for lumbar lymph node metastases.Methods Twenty-six patients with lumbar lymph node metastases receiving 125I seed implantation from Janu-ary 2015 to December 2021 at Hebei General Hospital were enrolled.According to the operation duration,the patients were divided into conventional treatment plan group(＜1.5 h,n=13)and refined intraoperative real-time treatment plan group(≥1.5 h,n=13),and received 125I seed implantation with the guidance of either conventional treatment plan or refined intraoperative real-time treatment plan.The dif-ferences of dosimetric parameters including D90,V90,V100,V150 and D2cc of intestinal tube and abdominal aorta before and afer the procedure were compared in each group,and the percentage differences of the above dosimetric parameters before and afer the procedure were com-pared between the two groups.The curative effect and side effects 6 months after the procedure were analyzed.Results Before and afer the procedure,there were no significant differences in all dosimetric parameters in the refined intraoperative real-time treatment plan group(all P＞0.05),and only significant difference in V150 was observed in the conventional treatment plan group(P＜0.01).The percentage differ-ence of V150 was significantly different between the two groups(P=0.035),and the percentage differences of the rest dosimetric parameters showed no significant differences between the two groups(all P＞0.05).6 months after the brachytherapy,the effective rates of the refined intraoperative real-time treatment plan group and the conventional treatment plan group were 76.9％(10/13)and 46.2％(6/13),respectively(P=0.226).No peritonitis and hemorrhage were observed.Conclusions The application of refined intraoperative real-time treatment plan improves the accuracy of dose distribution,reduces high dose area,and guarantees the safety of 125I seed implantation for lumbar lymph node metastases.
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