CT and template-guided radioactive seed implantation for inoperable early stage non-small cell lung cancer

Abstract

Objective To investigate the efficacy and side effects of radioactive seed implantation in the treatment of non-surgical early stage non-small cell lung cancer (NSCLC) based on CT guidance combined with template. Methods Twenty-one patients with inoperable T1-2N0M0 NSCLC who underwent CT-guided radioactive seed implantation therapy were retrospectively analyzed from December 2010 to October 2016 in the Second Hospital of Tianjin Medical University. All patients were diagnosed by histopathology. All seeds, with the activity of 18.5-29.6 MBq and prescription dose of 120-160 Gy, were completed in an operation of the radioactive seed implantation. The preoperative and postoperative TPS treatment plans and quality verification were corducted. In addition, the local control rate of tumors, overall survival (OS), progression free survival time (PFS), satisfaction rate of dose validation and adverse reactions were evaluated. Results The median follow-up was 25.1 months (range 4.4-72.7 months). The local control rate of primary tumor in 1-, 2- and 3-year was 100%, 95.2% and 95.2%, respectively. Of all patients, the median OS was 48 months with the median PFS 43.4 months. In particular, the 1-, 2- and 3-year survival rate was 100%, 91.7% and 72.9%, respectively. Moreover, the rate of 3-year PFS was 70.2% and the satisfactory rate of postoperative quality verification was 100%. The treatment-related adverse events included pneumothorax, bronchial hemorrhage, pleural effusion, cough, pulmonary fibrosis and seed shifts. In all, 7 (33.3%) patients had grade 1 adverse events and 4 (19%) patients with grade 2, but no grade 3 adverse event. Conclusions CT and template-guided radioactive seed implantation in NSCLC with T1-2N0M0 has a high tumor local control rate and low treatment-related adverse reactions, suggesting that it might provide an alternative way for the treatment of inoperable early stage NSCLC. Key words: Template; CT guided; Brachytherapy; Radioactive seeds implantation; Non small cell lung cancer(NSCLC)