Efficacy and safety of iodine-125 brachytherapy combined with chemotherapy in the treatment of advanced NSCLC in the elderly

Abstract

BackgroundAdvanced non-small-cell lung cancer (NSCLC) is a huge challenge for physicians. Traditional chemoradiotherapy is associated with high rates of toxicities, especially when treating gerontal patients. Our study was focused on investigating the safety and efficacy of permanent iodine-125 seed implantation and chemotherapy for the treatment of advanced NSCLC in the elderly.MethodsFifty elderly patients with stage III or IV NSCLC at our hospital from January 2011 to June 2017 were treated with the chemotherapy regimens (paclitaxel/cisplatin) and computed tomography (CT)-guided iodine-125 brachytherapy (group A), 50 patients who received chemotherapy consisting of paclitaxel and cisplatin only (group B) were matched-up with the patients in group A. The local response rate was evaluated by CT. Progression-free survival (PFS) and overall survival (OS) data were obtained through clinical follow-up.ResultsThe patients were followed-up for 3–46 months. With a median follow-up time of 20 months, the OS and PFS were 20 months (95% CI: 19.09–20.90 months) vs 15 months (95% CI: 14.48–15.51 months) (P<0.05) and 13 months (95% CI: 11.96–14.04 months) vs 8 months (95% CI: 7.63–8.37 months) (P<0.05) in group A and group B, respectively. The symptoms of patients in group A were significantly relieved when compared with group B. Severe complications were not observed in either of the groups.ConclusionThe combination of iodine-125 seed brachytherapy and chemotherapy is an effective and safe therapy and is superior to chemotherapy alone for advanced NSCLC in the elderly.

Efficacy and Safety Aiming at the Combined-Modality Therapy of External Beam Radiotherapy (40Gy) and Iodine-125 Seed Implantation for Locally Advanced NSCLC in the Elderly

“…With respect to severe complications in the research, there was no occurrence, consistent with previous reports (3,10,11,16,32). Except for grade 2 irradiation-related myelosuppression (1 case), there were no other grade 3 or higher toxicity effects.…”

“…small-cell lung cancer (NSCLC) may lose the chance to undergo operation when diagnosed in the hospital at rst (3).Therefore the mainstream treatment patterns are external beam radiotherapy (EBRT) and/or chemotherapy for locally advanced NSCLC patients without positive EGFR mutation or ALK-positive status according to related guidelines and criterions (4). In the real world, given the appreciable toxicity and low effectiveness of chemotherapy, patients may be reluctant to choose it as an optimal treatment, especially for the elderly (5).…”

Iodine‑125 seed radiation induces ROS‑mediated apoptosis, autophagy and paraptosis in human esophageal squamous cell carcinoma cells

“…125 I seed brachytherapy was first used for the treatment of prostate cancer in the 1970s (34). Because of its high efficacy and low complication rate, 125 I seed radiation was eventually used for treatment of various unresectable and/or locally recurrent types of cancer, including malignant glioma (5), non-small cell lung cancer (35) and esophageal cancer (11). Multiple studies demonstrated that, compared with EBRT, 125 I seed brachytherapy has greater RBE values, suggesting that cancer cells are more sensitive to 125 I seed radiation (8,9,36).…”

<p>¹²⁵I Seed Brachytherapy Combined with Single-Agent Chemotherapy in the Treatment of Non-Small-Cell Lung Cancer in the Elderly: A Valuable Solution</p>

“… 15 Meanwhile, owing to their poor general condition and other factors, 125 I seed brachytherapy may be an alternative method for elderly NSCLC. 16 …”

“…Although chemotherapy can prolong OS compared to best supportive care, considering higher toxicity rates, single-agent chemotherapy was recommended especially for elderly patients, combination chemotherapy recommended according to individual conditions. 15,48 Wu et al 16 explored the effectiveness of 125 I brachytherapy combined with chemotherapy vs chemotherapy alone for stage III or IV NSCLC in the elderly (100 patients were equally divided into two groups), and the PFS was 13 months vs 8 months (P<0.05) with a median follow-up time of 20 months, and no severe complications. The findings of our study show that CT-guided 125 I seed brachytherapy combined with single-agent chemotherapy was safe and effective for elderly patients with NSCLC.…”