Limited resection for lung cancer: improved local control with the implantation of iodine-125 seeds

Abstract

Objectives: Many patients with early lung cancer may not be candidates for definitive lobectomy or pneumonectomy. Lesser surgery, however has been associated with a relatively high incidence of local recurrence. This restrospective study evaluates that impact of implanting Iodine-125 seeds along the resection margin in these patients.Methods: Forty patients with limited pulmonary function (24), significant cardiac disease (5), advanced age (4), or another limiting disease underwent wedge resection (35), segmentectomy (3), or lobectomy with tumor crossing the fissure (2). Iodine-125 seeds embedded in suture material were implanted along the resection margin. Survivals by the Kaplan-Meier method and sites of recurrence were documented with a median followup of 39 months.Results: The median age was 69 (range 46 to 86). Median FEV-1 was 1.34 L (range 0.43 to 2.74 L). Median tumor size was 2.0 cm (range 1.0 to 10 cm). Thirty-three patients had Stage I tumors. Twenty-one were T1 and 12 were T2. In 34 patients, the operation was considered curative (group 1). The operation was considered palliative in six with more advanced synchronous cancer (Group 2). The overall five-year survival was 51%, and for Group I it was 57%. The median survival for Group 2 was 12 months and the longest survival 34 months. Ten patients experienced recurrence with only one local recurrence and four regional nodal recurrences.Conclusions: Implantation of Iodine-125 seeds along the resection margin in compromised patients undergoing limited resection for lung cancer results in a relatively low incidence of local recurrence and may prolong survival. Objectives: Many patients with early lung cancer may not be candidates for definitive lobectomy or pneumonectomy. Lesser surgery, however has been associated with a relatively high incidence of local recurrence. This restrospective study evaluates that impact of implanting Iodine-125 seeds along the resection margin in these patients. Methods: Forty patients with limited pulmonary function (24), significant cardiac disease (5), advanced age (4), or another limiting disease underwent wedge resection (35), segmentectomy (3), or lobectomy with tumor crossing the fissure (2). Iodine-125 seeds embedded in suture material were implanted along the resection margin. Survivals by the Kaplan-Meier method and sites of recurrence were documented with a median followup of 39 months. Results: The median age was 69 (range 46 to 86). Median FEV-1 was 1.34 L (range 0.43 to 2.74 L). Median tumor size was 2.0 cm (range 1.0 to 10 cm). Thirty-three patients had Stage I tumors. Twenty-one were T1 and 12 were T2. In 34 patients, the operation was considered curative (group 1). The operation was considered palliative in six with more advanced synchronous cancer (Group 2). The overall five-year survival was 51%, and for Group I it was 57%. The median survival for Group 2 was 12 months and the longest survival 34 months. Ten patients experienced recurrence with only one local recurrence and four regional nodal recurrences. Conclusions: Implantation of Iodine-125 seeds along the resection margin in compromised patients undergoing limited resection for lung cancer results in a relatively low incidence of local recurrence and may prolong survival.