125I Brachytherapy in Locally Advanced Nonsmall Cell Lung Cancer After Progression of Concurrent Radiochemotherapy

Abstract

To investigate the safety and effectiveness of computed tomography (CT)-guided I seed implantation for locally advanced nonsmall cell lung cancer (NSCLC) after progression of concurrent radiochemotherapy (CCRT).We reviewed 78 locally advanced NSCLC patients who had each one cycle of first-line CCRT but had progressive disease identified from January 2006 to February 2015 at our institution. A total of 37 patients with 44 lesions received CT-guided percutaneous I seed implantation and second-line chemotherapy (group A), while 41 with 41 lesions received second-line chemotherapy (group B).Patients in group A and B received a total of 37 and 41 first cycle of CCRT treatment. The median follow-up was 19 (range 3-36) months. After the second treatment, the total response rate (RR) in tumor response accounted for 63.6% in group A, which was significantly higher than that of group B (41.5%) (P = 0.033). The median progression-free survival time (PFST) was 8.00 ± 1.09 months and 5.00 ± 0.64 months in groups A and B (P = 0.011). The 1-, 2-, and 3-year overall survival (OS) rates for group A were 56.8%, 16.2%, and 2.7%, respectively. For group B, OS rates were 36.6%, 9.8%, and 2.4%, respectively. The median OS time was 14.00 ± 1.82 months and 10.00 ± 1.37 months for groups A and B, respectively (P = 0.059). Similar toxicity reactions were found in both groups. Tumor-related clinical symptoms were significantly reduced and the patients' quality of life was obviously improved.CT-guided I seed implantation proved to be potentially beneficial in treating localized advanced NSCLC; it achieved good local control rates and relieved clinical symptoms without increasing side effects.

FIGURE 1

Isodose curves plotted by the TPS. The red line shows the PTV, from inside to outside: the brown, green, orange, blue, and white line were covered by 100%, 90%, 70%, 50%, and 30% of the prescribed dose, respectively. PTV = planned tumor volume, TPS = treatment planning system.

FIGURE 2

(A) Dose-volume histograms (DVH). The prescription dose is 120 Gy during the planning. A total of 90% of the tumor target (D90) received 132.0 Gy, and 95.4% of the tumor received 100% of the prescribed dose (V100 = 95.4%). D90 was 0, 60 Gy, 0, 0 and V100 were 0.9%, 0, 0, 0 in normal lung, pulmonary, trachea, and spinal cord, respectively. (B) After ¹²⁵I seed implantation, the dose intensity was verified. D90 was 139.2, 1.2, 7.2, 1.2 Gy, 0 and V100 was 96.4%, 0.8%, 0, 0, 0 in tumor, normal lung, trachea, and spinal cord, respectively.

FIGURE 3

Computed tomography (CT)-guided percutaneous ¹²⁵I seed implantation was performed. (A) The 18 G spinal needle reached the tumor. (B) From deep to shallow, the particles were released, and a small amount of pulmonary hemorrhage was marked by the arrows.

FIGURE 4

Comparison of progression-free survival time in groups A and B (χ² = 6.392, P = 0.011, log-rank test).

FIGURE 5

Comparison of the overall survival in groups A and B (χ² = 3.562, P = 0.059, log-rank test).

FIGURE 6

A 70-year-old male patient. (A) CT scan before treatment, (B–D) 1, 2, and 3 months after ¹²⁵I implantation treatment, the lesion apparently shrunk (CR). The particles gathered and did not shift to the normal lung. CT = computed tomography, CR = complete response.