Abstract
ObjectiveTo analyze the efficacy and safety of low dose rate stereotactic ablative brachytherapy (L-SABT) for treatment of unresectable early-stage non-small cell lung cancer (NSCLC).MethodsData of patients with early-stage NSCLC who received CT-guided L-SABT (radioactive I-125 seeds implantation) at eight different centers from December 2010 to August 2020 were retrospectively analyzed. Treatment efficacy and complications were evaluated.ResultsA total of 99 patients were included in this study. Median follow-up duration was 46.3 months (6.1-119.3 months). The 1-year, 3-year, and 5-year local control rates were 89.1%, 77.5%, and 75.7%, respectively. The 1-year, 3-year, and 5-year overall survival rates were 96.7%, 70.1%, and 54.4%, respectively. Treatment failure occurred in 38.4% of patients. Local/regional recurrence, distant metastasis, and recurrence combined with metastasis accounted for 15.1%, 12.1%, and 11.1%, respectively. Pneumothorax occurred in 47 patients (47.5%) with 19 cases (19.2%) needing closed drainage. The only radiation-related adverse reaction was two cases of grade 2 radiation pneumonia. KPS 80–100, T1, the lesion was located in the left lobe, GTV D90 ≥150 Gy and the distance between the lesion and chest wall was < 1 cm, were associated with better local control (all P < 0.05); on multivariate analysis KPS, GTV D90, and the distance between the lesion and chest wall were independent prognostic factors for local control (all P < 0.05). KPS 80–100, T1, GTV D90 ≥150 Gy, and the distance between the lesion and chest wall was < 1 cm were also associated with better survival (all P < 0.05); on multivariate analysis KPS, T stage, and GTV D90 were independent prognostic factors for survival (all P < 0.05). The incidence of pneumothorax in patients with lesions <1 cm and ≥1cm from the chest wall was 33.3% and 56.7%, respectively, and the differences were statistically significant (P = 0.026).ConclusionL-SABT showed acceptable efficacy in the treatment of unresectable early-stage NSCLC. But the incidence of pneumothorax is high. For patients with T1 stage and lesions <1 cm from the chest wall, it may have better efficacy. Prescription dose greater than 150 Gy may bring better results.
Highlights
Surgery is the main treatment for early non-small cell lung cancer (NSCLC)
The distribution of seeds in the lesion can be adjusted during the operation to ensure that the dose distribution in the target area conforms to the actual tumor outline; with low dose rate stereotactic ablative brachytherapy (L-SABT) it is possible to achieve intensitymodulated radiation in a true sense, with better treatment efficacy and less risk of adverse reactions
The g-rays generated continuously by implanted seeds kill tumor cells over a long period, which could well overcome the errors caused by internal target volume (ITV) and planning target volume (PTV) during treatment
Summary
Surgery is the main treatment for early non-small cell lung cancer (NSCLC). For unresectable early NSCLC, stereotactic ablative radiotherapy (SABR) is considered the best option [1]. There are some patients who cannot be operated on who did not receive external beam radiotherapy (EBRT) because of various reasons. For these patients, the prognosis is poor, with a 5-year survival rate of less than 10% [2]. With the development of clinical practice, radioactive I-125 seed implantation (RISI) is more widely used in the local treatment of tumors. This study retrospectively analyzed the data of patients with early NSCLC who received L-SABT, in order to further clarify the clinical efficacy and safety of L-SABT and provide data for the actual clinical practice of the real world
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