A novel approach for salvage treatment of non-small-cell lung cancer: percutaneous CT fluoroscopy-guided permanent seed brachytherapy for salvage treatment of lung cancer: long-term results of a case series

Abstract

Purpose We sought a curative technique to treat recurrent or primary non-small cell lung cancer (NSCLC) with a minimally invasive outpatient technique that could be repeated multiple times, had minimal pulmonary toxicity, and was readily available in the community setting. Percutaneous outpatient computed tomography (CT) fluoroscopy-guided permanent seed brachytherapy fits these criteria. Material and methods Eight lesions in five patients (three patients had two lesions each) with NSCLC were treated using outpatient percutaneous CT fluoroscopy-guided palladium-103 seed brachytherapy. At initial presentation, seven lesions had recurred following external beam radiation therapy (EBRT) and initial chemotherapy, and one lesion was treated with brachytherapy as a primary treatment. Results In five patients with eight lesions, there were no recurrences at follow-up from final implant, average follow-up of 58.1 months (range, 15-145 months). There were no acute complications requiring intervention and no long-term complications. One lesion required a second salvage implant 10 months after first implant. This lesion’s original salvage D 90 was but 90% and repeat implant achieved a D 90 of 273%. This salvaged site had not recurred at 43-month follow-up after the second salvage implant. Conclusions Percutaneous CT fluoroscopy-guided permanent seed brachytherapy is a safe, efficacious, and cost effective primary and salvage treatment for lung cancer. CT-fluoroscopy resources are readily available in the community and are an effective alternative to stereotactic body radiation therapy (SBRT), intensity-modulated radiation therapy (IMRT)/proton beam, radiofrequency ablation (RFA), and cryoablation (CA). Percutaneous CT fluoroscopy-guided permanent seed brachytherapy has an equivalent or better local control rate, a lower resource cost, and a far lower integral radiation dose than other therapies. We believe this is the first published article documenting the curative potential of percutaneous CT fluoroscopy-guided permanent seed brachytherapy for recurrent NSCLC with long-term follow-up. High D 90 doses appear to be required to achieve complete response. Further studies are essential to confirm these findings.

Computed tomography-guided implantation of 125I radioactive seeds in patients with malignant airway compression induced by advanced lung cancer: effectiveness and safety in 40 patients

“…Moreover, a placement with stent re-stenosis offers limited survival benefits in the absence of locoregional therapy for endobronchial lesions. Recently, a novel therapy with 125 I seed was developed and exhibited promising outcomes in lung cancer [ 10 , 12 , 13 ]. In the present study, we also confirmed that CT-guided 125 I implantation was safe and efficient in MAC patients.…”

“…Typically, the choice of therapy was based on the type and location of airway stenosis, pulmonary function, comorbidities, previous treatments, and life expectancy. Recently, 125 I radioactive seed implantation had proved its efficacy in various malignant tumors [10,11,12,13]. The results of Lu et al revealed that trans-bronchoscopy 125 I radioactive seed implantation brachytherapy could improve the survival and quality of life of patients with pulmonary atelectasis induced by intralumi-nal airway obstruction [14].…”

“…Typically, the choice of therapy was based on the type and location of airway stenosis, pulmonary function, comorbidities, previous treatments, and life expectancy. Recently, 125 I radioactive seed implantation had proved its efficacy in various malignant tumors [ 10 , 11 , 12 , 13 ]. The results of Lu et al .…”

Stereotactic Ablative Brachytherapy: Recent Advances in Optimization of Radiobiological Cancer Therapy

“…In early-stage lung cancers that are not suitable for surgical resection or EBRT, LDR-SABT could be used as an alternative anti-cancer treatment with interstitial radioactive seed implantation and image guidance [ 27 , 29 ]. The prescription dose of radioactive seed was generally 100–120 Gy in lung cancer studies [ 6 , 42 , 77 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 ]. Another study reported that the local cancer control rate was 80–100% with promising 1- and 2-year survival rates (90–95% and 70–80%, respectively) for early-stage lung cancer [ 27 ].…”

CT-guided palladium-103 seed brachytherapy for metastatic adenoid cystic carcinoma: a retrospective study to assess initial safety and effectiveness of percutaneous CT fluoroscopy-guided permanent seed brachytherapy

“…Subsequent to our initial experience with treatment of recurrent non-small cell lung cancer (NSCLC) with computed tomography (CT)-guided 103 Pd permanent seed brachytherapy (CTGPSB) [7], we have had a high-volume community hospital experience with multiple pulmonary metastatic ACC lesions utilizing CTGPSB, and here, present a part of the data showing that multiple pulmonary metastases can be rapidly, safely, and effectively treated.…”