Intraoperative 125I Vicryl mesh brachytherapy after sublobar resection for high-risk stage I nonsmall cell lung cancer

Abstract

Purpose To assess the feasibility and outcomes of 125I Vicryl mesh brachytherapy after sublobar resection in stage I nonsmall cell lung cancer (NSCLC) patients with poor pulmonary function. Methods and materials Between January 1997 and July 2004, patients with poor cardiopulmonary reserve who had stage IA and IB (T1-2 N0 M0) NSCLC and a forced expiratory volume in 1 s (FEV 1) of ≥0.6 L were considered for limited surgical resection either by an open or video-assisted thoracoscopic procedure and for a subsequent 125I Vicryl mesh brachytherapy implant. Mediastinal and hilar lymph node staging was performed routinely in all patients. After clear margins were obtained grossly and on frozen section, a single-plane 125I implant was designed to encompass a plane consisting of the staple line and a 2-cm margin of surrounding visceral pleura. The implant was introduced through the surgical incision and sutured to the visceral pleura. A prescribed dose of 100–120 Gy was delivered to a volume within 0.5 cm from the plane of the implant. Follow-up orthogonal films or CTs were obtained for dosimetric analysis. Kaplan–Meier analyses were used to estimate the local control, locoregional control, and overall survival rates. Results Of the 110 patients, 65 had stage IA and 45 had stage IB NSCLC. The mean preoperative FEV 1 was 47% of the predicted volume. With a median follow-up of 11 months (range 1–68 months), there were four recurrences within the radiation volume. The estimated 5-year local (in-field) control, locoregional control, and overall survival rates were 90%, 61%, and 18%, respectively. Conclusion Vicryl mesh brachytherapy after sublobar resection for high-risk stage I NSCLC patients is a feasible procedure, which results in an excellent local (in-field) control rate.