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. (August 2020)

• Record Type: Journal Article
• Authors: Chen, Chao; Wang, Wei; Yu, Zhe; Tian, Shilin; Li, Yuliang; Wang, Yongzheng
• Is Part Of: Lung cancer. Volume 146(2020)
• Page Start: 290
• Page End: 296
• Publication Date: 2020-08
• Subjects: BAII bronchial arterial infusion -- BACE bronchial arterial chemoembolization -- CR complete response -- CT computed tomography -- D90 dose covering 90 % of the target volume -- NSCLC non-small cell lung cancer -- OS overall survival -- PR partial response -- PFS progression-free survival -- PD progressive disease -- SD stable disease -- TPS treatment planning system; Brachytherapy -- Angiography -- Chemotherapy -- Non-small cell lung cancer -- Progression-Free survival; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2020.06.010
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Locally advanced NSCLC failed first-line CCRT is a treatment challenge. Combined iodine-125 brachytherapy and BACE can achieve a good local tumor control for NSCLC after CCRT failed. Combined iodine-125 brachytherapy and BACE is effective and safe for NSCLC after CCRT failed. 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/m 2 + lobaplatin 30 mg/m 2 ) 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.