Combination of computed tomography-guided iodine-125 brachytherapy and bronchial arterial chemoembolization for locally advanced stage III non-small cell lung cancer after failure of concurrent chemoradiotherapy.

Abstract

OBJECTIVES:

To evaluate the efficacy and safety of the combination of computed tomography (CT)-guided iodine-125 brachytherapy and bronchial arterial chemoembolization (BACE) for locally advanced stage III non-small cell lung cancer (NSCLC) after failure of concurrent chemoradiotherapy.

MATERIAL AND METHODS:

We retrospectively evaluated 28 patients with locally advanced stage III NSCLC in whom concurrent chemoradiotherapy had failed and were consequently, treated with radioactive iodine-125 seed implantation followed by BACE. The prescribed radiation dose was 140 Gy, with a median radioactivity of 0.60 mCi. The tumor-feeding arteries were detected on angiography, and chemotherapeutic agents (gemcitabine 1000 mg/m2 + lobaplatin 30 mg/m2) were then administered via arterial infusion. The tumor-feeding arteries were embolized using 300-500 μm embosphere microspheres. The endpoints were treatment response rate, progression-free survival (PFS), and toxicity.

RESULTS:

The median number of implanted iodine-125 seeds was 58 pellets (range, 44-114 pellets). The median post-operative dose covering 90 % of the target volume (D90) was 143.4 Gy (range, 123.6-159.9 Gy). A total of 73 cycles of BACE were conducted (2.61 cycles per case). The bronchial arteries were the main tumor-feeding arteries. In total, 11 patients had hemoptysis, and it was significantly alleviated within 24 h after BACE. There was no serious procedure-related complication. The 6-month objective response and disease control rates were 71.42 % and 92.86 %, respectively. No severe complications occurred during the follow-up. Local control duration ranged from 5-12 months, and the median PFS was 8 months (95 % confidence interval: 7.3-8.8 months).

CONCLUSIONS:

The combination of CT-guided iodine-125 brachytherapy and BACE is an effective and safe approach for the treatment of NSCLC after failure of concurrent chemoradiotherapy and is worthy of clinical application.

• Authors: Chao Chen, Wei Wang, Zhe Yu, Shilin Tian, Yuliang Li, Yongzheng Wang
• Journal: Lung cancer (Amsterdam, Netherlands) (Lung Cancer) Vol. 146 Pg. 290-296 (08 2020) ISSN: 1872-8332 [Electronic] Ireland
• PMID: 32615523 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.

Chemical References

• Iodine Radioisotopes
• Iodine-125

Topics

• Antineoplastic Combined Chemotherapy Protocols
• Arteries (pathology)
• Brachytherapy
• Carcinoma, Non-Small-Cell Lung (drug therapy, therapy)
• Chemoradiotherapy
• Humans
• Iodine Radioisotopes (therapeutic use)
• Lung Neoplasms (drug therapy, therapy)
• Neoplasm Staging
• Retrospective Studies
• Thyroid Neoplasms
• Tomography, X-Ray Computed
• Treatment Outcome