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Ji Z, Huo B, Liu S, Liang Q, Xing C, Hu M, Ma Y, Wang Z, Zhao X, Song Y, Wang Y, Han H, Zhang K, Wang R, Chai S, Huang X, Hu X, Wang J. Clinical Outcome of CT-Guided Stereotactic Ablative Brachytherapy for Unresectable Early Non-Small Cell Lung Cancer: A Retrospective, Multicenter Study. Front Oncol 2021; 11:706242. [PMID: 34604042 PMCID: PMC8480264 DOI: 10.3389/fonc.2021.706242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/23/2021] [Indexed: 12/25/2022] Open
Abstract
Objective To analyze the efficacy and safety of low dose rate stereotactic ablative brachytherapy (L-SABT) for treatment of unresectable early-stage non-small cell lung cancer (NSCLC). Methods Data of patients with early-stage NSCLC who received CT-guided L-SABT (radioactive I-125 seeds implantation) at eight different centers from December 2010 to August 2020 were retrospectively analyzed. Treatment efficacy and complications were evaluated. Results A total of 99 patients were included in this study. Median follow-up duration was 46.3 months (6.1-119.3 months). The 1-year, 3-year, and 5-year local control rates were 89.1%, 77.5%, and 75.7%, respectively. The 1-year, 3-year, and 5-year overall survival rates were 96.7%, 70.1%, and 54.4%, respectively. Treatment failure occurred in 38.4% of patients. Local/regional recurrence, distant metastasis, and recurrence combined with metastasis accounted for 15.1%, 12.1%, and 11.1%, respectively. Pneumothorax occurred in 47 patients (47.5%) with 19 cases (19.2%) needing closed drainage. The only radiation-related adverse reaction was two cases of grade 2 radiation pneumonia. KPS 80-100, T1, the lesion was located in the left lobe, GTV D90 ≥150 Gy and the distance between the lesion and chest wall was < 1 cm, were associated with better local control (all P < 0.05); on multivariate analysis KPS, GTV D90, and the distance between the lesion and chest wall were independent prognostic factors for local control (all P < 0.05). KPS 80-100, T1, GTV D90 ≥150 Gy, and the distance between the lesion and chest wall was < 1 cm were also associated with better survival (all P < 0.05); on multivariate analysis KPS, T stage, and GTV D90 were independent prognostic factors for survival (all P < 0.05). The incidence of pneumothorax in patients with lesions <1 cm and ≥1cm from the chest wall was 33.3% and 56.7%, respectively, and the differences were statistically significant (P = 0.026). Conclusion L-SABT showed acceptable efficacy in the treatment of unresectable early-stage NSCLC. But the incidence of pneumothorax is high. For patients with T1 stage and lesions <1 cm from the chest wall, it may have better efficacy. Prescription dose greater than 150 Gy may bring better results.
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Affiliation(s)
- Zhe Ji
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Bin Huo
- Department of Thoracic Surgery/Department of Oncology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Shifeng Liu
- Department of Intervention Therapy, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qinghua Liang
- Center of Minimally Invasive Intervention, Southwest Hospital of Army Medical University (The First Hospital Affiliated to the Army Medical University), Chongqing, China
| | - Chao Xing
- Department of Oncology, Tengzhou Central People's Hospital, Tengzhou, China
| | - Miaomiao Hu
- Department of Oncology, Tengzhou Central People's Hospital, Tengzhou, China
| | - Yanli Ma
- Department of Oncology, Staff Hospital of Chengde Iron and Steel Group Co. Ltd., Chengde, China
| | - Zhe Wang
- Department of Radiation Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Xinxin Zhao
- Department of Oncology Radiotherapy, The First People's Hospital of Kerqin District, Tongliao, China
| | - Yuqing Song
- Department of Oncology, Staff Hospital of Chengde Iron and Steel Group Co. Ltd., Chengde, China
| | - Yufeng Wang
- Department of Nuclear Medicine, Xuzhou Cancer Hospital, Xuzhou, China
| | - Hongmei Han
- Department of Oncology Radiotherapy, The First People's Hospital of Kerqin District, Tongliao, China
| | - Kaixian Zhang
- Department of Oncology, Tengzhou Central People's Hospital, Tengzhou, China
| | - Ruoyu Wang
- Department of Radiation Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Shude Chai
- Department of Thoracic Surgery/Department of Oncology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xuequan Huang
- Center of Minimally Invasive Intervention, Southwest Hospital of Army Medical University (The First Hospital Affiliated to the Army Medical University), Chongqing, China
| | - Xiaokun Hu
- Department of Intervention Therapy, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
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Stewart A, Parashar B, Patel M, O'Farrell D, Biagioli M, Devlin P, Mutyala S. American Brachytherapy Society consensus guidelines for thoracic brachytherapy for lung cancer. Brachytherapy 2015; 15:1-11. [PMID: 26561277 DOI: 10.1016/j.brachy.2015.09.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 08/28/2015] [Accepted: 09/02/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To update brachytherapy recommendations for pretreatment evaluation, treatment, and dosimetric issues for thoracic brachytherapy for lung cancer. METHODS AND MATERIALS Members of the American Brachytherapy Society with expertise in thoracic brachytherapy updated recommendations for thoracic brachytherapy based on literature review and clinical experience. RESULTS The American Brachytherapy Society consensus guidelines recommend the use of endobronchial brachytherapy for disease palliation in patients with central obstructing lesions, particularly in patients who have previously received external beam radiotherapy. The use of interstitial implants after incomplete resection may improve outcomes and provide enhanced palliation. Early reports support the use of CT-guided intratumoral volume implants within clinical studies. The use of brachytherapy routinely after sublobar resection is not generally recommended, unless within the confines of a clinical trial or a registry. CONCLUSIONS American Brachytherapy Society recommendations for thoracic brachytherapy are provided. Practitioners are encouraged to follow these guidelines and to develop further clinical trials to examine this treatment modality to increase the evidence base for its use.
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Affiliation(s)
- A Stewart
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK; University of Surrey, Guildford, UK.
| | - B Parashar
- Department of Stich Radiation Oncology, Weill Cornell Medical College, New York, NY
| | - M Patel
- Department of Radiation Oncology, Baylor Scott and White Health, Temple, TX
| | - D O'Farrell
- Dana Faber Cancer Centre, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - M Biagioli
- Florida Hospital Cancer Institute, Department of Radiation Oncology, H.Lee Moffitt Cancer Center, Tampa, FL
| | - P Devlin
- Dana Faber Cancer Centre, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - S Mutyala
- Department of Radiation Medicine, St. Joseph's Hospital and Medical Center, University of Arizona Cancer Center at Dignity Health, Phoenix, AZ
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Mutyala S, Stewart A, Khan AJ, Cormack RA, O'Farrell D, Sugarbaker D, Devlin PM. Permanent Iodine-125 Interstitial Planar Seed Brachytherapy for Close or Positive Margins for Thoracic Malignancies. Int J Radiat Oncol Biol Phys 2010; 76:1114-20. [DOI: 10.1016/j.ijrobp.2009.02.067] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 02/25/2009] [Accepted: 02/27/2009] [Indexed: 10/20/2022]
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Stewart AJ, Mutyala S, Holloway CL, Colson YL, Devlin PM. Intraoperative seed placement for thoracic malignancy-A review of technique, indications, and published literature. Brachytherapy 2008; 8:63-9. [PMID: 19056322 DOI: 10.1016/j.brachy.2008.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 09/24/2008] [Accepted: 09/25/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE This review examines the role of permanent radioactive seed implantation in thoracic malignancy. This technique can be used intraoperatively to provide additional highly localized radiation therapy in cases where optimal oncologic margins are unattainable or to palliate unresectable disease. METHODS AND MATERIALS Relevant trials were identified through a systematic literature search using Pubmed. RESULTS The intraoperative placement of brachytherapy seeds has been described after sublobar resection for non-small-cell lung cancer (NSCLC), where surgical margins are close or microscopically positive and in the presence of macroscopic residual disease. This brachytherapy technique is currently the focus of a randomized prospective trial in the USA in patients unfit for lobectomy for early-stage NSCLC. CONCLUSIONS This review summarizes the methods of brachytherapy seed placement and the published experience of brachytherapy implants within the thorax, also examining radiation safety and postoperative dosimetry. This technique has the potential to improve local control with optimal sparing of normal tissue owing to its highly conformal radiotherapy delivery.
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Affiliation(s)
- Alexandra J Stewart
- Department of Radiotherapy, Royal Surrey County Hospital, Guildford, England, UK.
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