Preliminary experience of high dose rate (HDR) brachytherapy following video assisted thoracoscopic surgery (VATS) based sublobar resection in patients with peripheral non-small cell lung cancer and poor pulmonary functions

Abstract

7269 Background: To describe the initial experience of delivering adjuvant radiotherapy following sublobar resection using HDR brachytherapy after VATS resection of lung lesions. Methods: Between March and November 2004, 14 patients were treated with VATS sublobar resection and HDR brachytherapy to 16 peripheral lung lesions that were pathologically proven to be non-small cell lung carcinoma. Intraoperatively, brachytherapy catheters were sutured and anchored over the stapled line and to the chest wall. Brachytherapy planning was done using a CT-based planning system. A remote afterloading HDR unit was used for treatment. A median dose of 2,450 cGy was given at 350 cGy per fraction over 7 fractions twice a day, 6 hours apart, over 4 days as inpatient. Dose was prescribed to 1 cm deep to the stapled line. Biologically, this dose is approximately 5,000 cGy and above (180 cGy per fraction equivalent) at the depth of 5 mm in reference to the resection margin. Results: At median and average followup times of 3 months and 4 months respectively, patients tolerated the postoperative brachytherapy well with no pneumonitis or excess complication. Average hospital stay was one week. There was one case of empyema which may or may not be related to radiation treatment. There were 2 incidents of catheter migration due to inadvertent catheter movement during wound care. Consequently, re-planning was needed in order to continue accurate radiation delivery for these patients. Conclusions: Low dose rate brachytherapy has been described in literature for this subgroup of patients for improving local control rate. This is a first report of using HDR brachytherapy with VATS. In our initial experience, patients tolerate this method of brachytherapy well with no significant acute side effect. HDR technique complements with VATS efficiently and does not prolong hospital stay. Remote afterloading technique allows no radiation exposure to staff members or others. Further data are needed to determine the clinical impact of HDR brachytherapy in this subgroup of patients. No significant financial relationships to disclose.