Evaluating the efficacy of 8Spheres microsphere embolization combined with iodine‑125 seed implantation in advanced refractory lung cancer: A retrospective study

Abstract

Patients with advanced non-small cell lung cancer (NSCLC) have seen improvements in care; however, outcomes remain poor for certain individuals despite treatment with radiation, chemotherapy, targeted therapies and immunotherapy. The present study aimed to assess the safety and efficacy of combining 8Spheres microsphere embolization with iodine-125 seed implantation for treating advanced refractory NSCLC. The retrospective analysis included 45 patients with advanced refractory NSCLC. Using the surv_cutpoint function in R, the optimal maximum tumor diameter threshold was determined as 53 mm, dividing patients into two groups: ≤53 mm and >53 mm. The study evaluated the association between treatment regimen, tumor diameter, and progression-free survival (PFS) and overall survival (OS). The findings demonstrated that the experimental group achieved a significantly longer median PFS (12 vs. 10 months; P=0.006) and OS (19 vs. 12 months; P=0.032) compared with the control group. Both the treatment approach and tumor size were identified as independent factors influencing survival. The risk of death was 2.291-fold higher for patients on the control regimen than for those in the experimental group. Similarly, patients with a tumor diameter of >53 mm had a 2.723-fold higher risk of death than those with a tumor diameter of ≤53 mm. Adverse events were mild and resolved in both groups. In summary, the combination of 8Spheres microsphere embolization and iodine-125 seed implantation demonstrate promising clinical outcomes and it may be a viable treatment for advanced refractory NSCLC. Additionally, maximum tumor diameter was strongly associated with patient survival and therefore it may serve as a valuable prognostic indicator to guide treatment decisions.

Keywords: 8Spheres microspheres; NSCLC; bronchial artery infusion chemotherapy embolization; iodine-125 seeds.

Figure 1.

Optimal Cut-off value for the maximum tumor diameter of treatment-related continuous variables was calculated using the surv_cutpoint function in the R package ‘survminer’. The original continuous variable type of tumor diameter was converted to a binary index, resulting in a Cut-off value of 53 mm, and the association between tumor diameter and the progression-free survival and overall survival of patients was analyzed comparatively.

Figure 2.

Imaging assessment and follow-up of 8Spheres microsphere embolization combined with iodine-125 seed implantation in the treatment of non-small cell lung cancer. (A) Enhanced CT imaging revealed an irregular mass in the lower lobe of the left lung, which was in close proximity to the adjacent blood vessels and bronchial tubes. The red arrow indicates the tumor lesion. (B) Intraoperative CT guidance was used in real-time, with the iodine-125 seed puncture needle inserted parallel to the tumor tissue. The red arrow highlights the puncture needle and the released iodine-125 seeds. (C) Iodine-125 seed implantation was reviewed in real-time to assess the distribution of the particles post-operation. The red arrow points to the iodine-125 seeds. (D) Bronchial arteriography, performed 4 days post-surgery, revealed tortuous thickening of the left bronchial artery with prominent tumor staining, as indicated by the red circle. (E) Following embolization with 8Spheres microspheres, the left bronchial artery displayed a characteristic pestle-like shape, and the tumor staining in the was no longer visible (red circle). (F) A follow-up examination 4 months after surgery demonstrated complete tumor resolution, with residual iodine-125 seeds observed, as indicated by the red arrows.

Figure 3.

Median progression-free survival for the experimental group was 12 months, compared with 10 months for the control group (P<0.05).

Figure 4.

Median overall survival for the experimental group was 19 months, compared with 12 months for the control group (P<0.05).