eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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2/2019
vol. 11
 
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abstract:
Case report

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

Stephen W. Doggett, Shigeru Chino, Todd Lempert

J Contemp Brachytherapy 2019; 11, 2: 174–179
Online publish date: 2019/04/17
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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 D90 was but 90% and repeat implant achieved a D90 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 D90 doses appear to be required to achieve complete response. Further studies are essential to confirm these findings.

keywords:

lung cancer, brachytherapy, salvage, seeds, LDR

 
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