Salvage treatment of NSCLC recurrence after first-line chemotherapy failure: Iodine-125 seed brachytherapy or microwave ablation?

Recent progress in radioactive seed implantation brachytherapy of non-small cell lung cancer: a narrative review

Background and Objective

Brachytherapy, a new form of radiation therapy, has been used to treat lung cancer and consists of two main forms of treatment: endobronchial brachytherapy and radioactive seed implantation brachytherapy (RSI-BT), the latter of which is used to treat non-small cell lung cancer (NSCLC). The use of RSI-BT in the treatment of NSCLC at our centre has yielded some positive results.

Methods

To more fully consider the context of this application, we conducted a search of PubMed from 2018 to March 5, 2023. The search included a combination of the MeSH terms: "brachytherapy" and "lung neoplasm".

Key Content and Findings

The majority of NSCLC patients who received RSI-BT achieved positive benefits. Most patients had a progression-free survival (PFS) of between 12 and 18 months. Additionally, radioactive particle stent implantation as a specific RSI-BT has shown therapeutic potential in the treatment of malignant airway obstruction. With the application of new technologies, RSI-BT will become more precise, efficient and inexpensive.

Conclusions

This review demonstrates that RSI-BT can be therapeutic in the treatment of both early and advanced NSCLC with manageable complications. There have also been reports on the combination of RSI-BT with other therapies, but more research is needed on the combination of RSI-BT with them.

Computed tomography-guided iodine-125 radioactive seed implantation in small-cell lung cancer: A retrospective study

Purpose

To explore the efficacy of computed tomography (CT)-guided iodine-125 (¹²⁵I) radioactive seed implantation for the treatment of small-cell lung cancer (SCLC).

Material and methods

A total of 12 SCLC patients were retrospectively enrolled. All patients underwent CT-guided ¹²⁵I seed implantation therapy, and were followed up until death, the last visit time, or study end time. Primary endpoint was the overall response rate (ORR). Secondary endpoints were local control rate (LCR), progression-free survival (PFS), overall survival (OS), and safety.

Results

All patients were successfully implanted with ¹²⁵I radioactive seeds. The ORR at 2, 6, 12, and 24 months after implantation was 83.3%, 63.6%, 50%, and 40%, respectively; the LCR at 1 and 2 years were 75% (6/8) and 60% (3/5), respectively; the median PFS and OS were 8 and 12 months, respectively; and the OS rate at 6, 12, and 24 months after implantation was 91.67%, 66.67%, and 41.67%, respectively. No surgery-related deaths occurred. During the follow-up period, mild complications were observed in patients, including worsening cough, hemoptysis, and pneumothorax.

Conclusions

CT-guided ¹²⁵I seed implantation therapy is a safe and effective supplementary treatment for SCLC patients, who cannot tolerate radiotherapy.

Efficacy and Safety of Radioactive 125I Seed Implantation for Patients with Oligo-Recurrence Soft Tissue Sarcomas

PURPOSE

To evaluate the efficacy and safety of computed tomography-guided radioactive iodine-125 (¹²⁵I) seed implantation for oligo-recurrence soft tissue sarcomas following surgical resection.

MATERIALS AND METHODS

Patients with oligo-recurrence soft tissue sarcomas after curative surgical resection between June 2013 and December 2020 were included. The primary outcome measure was objective response rate according to the Response Evaluation Criteria in Solid Tumors (RECIST 1.1). The secondary outcomes included progression-free survival, overall survival, and safety profiles.

RESULTS

Twenty-nine patients receiving computed tomography-guided ¹²⁵I seed implantation were included in the study. The objective response rates at 2-, 6- and 12-month follow-up were 48.3%, 65.5% and 40.9%, respectively. The median progression-free survival was 11.3 months. The median overall survival was 25.1 months, with a 1- and 2-year overall survival rate of 81.5% and 50.0%, respectively. No severe treatment-related adverse effects occured.

CONCLUSION

¹²⁵I seed implantation has the potential to be an effective and safe treatment for oligo-recurrence soft tissue sarcomas after surgical resection.

Radioactive Iodine-125 in Tumor Therapy: Advances and Future Directions

Radioactive iodine-125 (I-125) is the most widely used radioactive sealed source for interstitial permanent brachytherapy (BT). BT has the exceptional ability to deliver extremely high doses that external beam radiotherapy (EBRT) could never achieve within treated lesions, with the added benefit that doses drop off rapidly outside the target lesion by minimizing the exposure of uninvolved surrounding normal tissue. Spurred by multiple biological and technological advances, BT application has experienced substantial alteration over the past few decades. The procedure of I-125 radioactive seed implantation evolved from ultrasound guidance to computed tomography guidance. Compellingly, the creative introduction of 3D-printed individual templates, BT treatment planning systems, and artificial intelligence navigator systems remarkably increased the accuracy of I-125 BT and individualized I-125 ablative radiotherapy. Of note, utilizing I-125 to treat carcinoma in hollow cavity organs was enabled by the utility of self-expandable metal stents (SEMSs). Initially, I-125 BT was only used in the treatment of rare tumors. However, an increasing number of clinical trials upheld the efficacy and safety of I-125 BT in almost all tumors. Therefore, this study aims to summarize the recent advances of I-125 BT in cancer therapy, which cover experimental research to clinical investigations, including the development of novel techniques. This review also raises unanswered questions that may prompt future clinical trials and experimental work.

Clinical analysis of systemic administration combined with microwave ablation in the treatment of lung cancer

OBJECTIVE

To explore the therapeutic effect of systemic administration combined with microwave ablation (MWA) under computed tomography (CT) and fiberoptic bronchoscope for treating lung cancer.

METHODS

Sixty-six patients with advanced lung cancer admitted to our hospital from February 2019 to February 2020 were collected and divided into control group and experimental group with 33 patients in each group. The control group was treated with systemic administration, and the experimental group was treated with systemic administration combined with MWA under CT and fiberoptic bronchoscope. Overall response rate (ORR), adverse events (AEs) during treatment, and survival analysis were used to evaluate the curative effect of lung cancer treatment in each group.

RESULTS

MWA under CT and fiberoptic bronchoscope could safely remove the cancerous tissues by point burning without destroying the adjacent normal tissues with high success rate. The ORR of the control group was 24.4%, and that of the experimental group was 63.6%, which was better than the control group. The AEs occurred during treatment in each group were of level 1 or level 2, and no serious life-threatening AEs occurred. Progression-free survival (PFS) time and overall survival (OS) time in the experimental group were both longer than those in the control group. Patients treated with MWA had a lower risk of disease progression and death than those treated with systemic administration alone.

CONCLUSION

The treatment of lung cancer using systemic administration combined with MWA under CT and fiberoptic bronchoscope is more effective than using systemic administration alone, which can be promoted in clinical treatment.

Clinical Research on Systemic Chemotherapy Combined With Bronchoscopic Seed Implantation in the Treatment of Advanced Lung Cancer

Objective:

This study aims to explore the clinical value of systemic chemotherapy combined with bronchoscopic seed implantation in advanced lung cancer treatment.

Methods:

The study enrolled 253 patients with advanced lung cancer in Cangzhou People’s Hospital from March 2018 to March 2020, and they were divided into test group and control group. Test group was given systemic chemotherapy combined with bronchoscopic seed implantation, while control group was given systemic chemotherapy. The objective response rate of tumor (ORR), disease control rate (DCR), serum tumor marker level, survival time and adverse reactions of 2 groups were compared.

Results:

After treatment, the levels of serum tumor markers including carcino-embryonic antigen, neuro-specific enolase, cytokeratin-19 and pro-gastrin-releasing peptide were markedly decreased in test group compared with those in control group (P < 0.05). Therein, the serum tumor marker level of non-small cell lung cancer (NSCLC) patients was significant decreased compared with that of small cell lung cancer (SCLC) patients in test group. Meanwhile, in test group, the serum tumor marker level of lung adenocarcinoma (LUAD) patients was significant decreased compared with that of lung squamous cell carcinoma (LUSC, P < 0.05). The ORR and DCR in test group were superior to those in control group (63.4%, 92.5% vs 38.7%, 72.3%, P < 0.05), while those were much higher in patients with NSCLC and LUAD relative to those in patients with SCLC and LUSC, respectively (P < 0.05). Furthermore, the progression-free survival (PFS) and overall survival (OS) in test group were significantly greater than those in control group. In test group, the PFS and OS of patients with NSCLC and LUAD were higher than those of patients with SCLC and LUSC.

Conclusion:

The efficacy of systemic chemotherapy combined with bronchoscopic seed implantation was superior to that of systemic chemotherapy, which is worthy of promoting in clinical practice.