| Background:Lung cancer is one of the malignant tumors that threat the health and life of people. About 733.3 thousands new cases are diagnosed in 2015 in China, and 610.2 thousands died because of lung cancer. In China, lung cancer has become the first cause of death in all cancers. Multidisciplinary methods including surgery, radiotherapy, chemotherapy and molecular targeted therapy are recommended for treatment of the disease. Surgery is important in the treatment of early stage of lung cancer. However, most patients are diagnosed in advanced stage, and some patients are not good candidates because of age or poor cardiopulmonary function, and even some patients reject surgical treatment. Radiotherapy has an obvious local tumor control effect, but the damage to the surrounding normal tissues should not be ignored. In recent years, minimally invasive therapies have attained increasing attention for the treatment of inoperable lung cancer patients. Computed tomography (CT) guided iodine-125 seed implantation brachytherapy has been applied widely in the treatment of various kinds of tumors, and it has shown significant efficacy especially in prostate cancer and thyroid cancers. Compared with radiotherapy, iodine-125 seed implantation in tumors can significantly improve the therapeutic dose delivered to the tumor target area while reducing the probability of unnecessary damage to the surrounding healthy tissues.Purpose:The aim of this study was to assess the technical feasibility, efficacy and complications of CT-guided percutaneous iodine-125 seed implantation brachytherapy for treating stage III non-small-cell lung cancer.Methods:29 patients were included in this study. They were all pathology confirmed by biopsy of surgical specimens. The median age was 57 years (49-79). A preoperative chest enhanced CT scan was performed to show the location and size of the tumor and its relation with surrounding organs. Hematologic studies were examined to exclude patients with coagulant function abnormality, and the patients were trained by nurses to respire properly in the surgery. The treatment planning system (TPS) was used preoperatively to reconstruct three dimensional images of the tumor and to calculate the estimated seed number and distribution. The median matched peripheral dose (MPD) was 120 Gy. After 4h fasting, tumors were treated with percutaneous iodine-125 seed implantation brachytherapy that was positioned under CT. All procedures were performed with local anesthesia. Patients got electrocardiograph monitoring after surgery for 4 hours, and it was recorded whether complications turned up. A follow-up CT was performed 1 month later and every 3 months post percutaneous iodine-125 seed implantation brachytherapy. Therapeutic effect was evaluated according to RECIST (Response Evaluation Criteria in Solid Tumors).Results:The mean volume of the 29 lung tumors was 36.5cm3 (range 2.0-162cm3). Among the 26 patients with available follow-up, the median follow-up was 3 months(1-14 months), and overall responding rate (CR+PR) was 76.9%. Local tumor control rate (CR+PR+SD) was 88.5%. One (3.8%) patient died in a month since the seed implantation. One (3.8%) patient died in two months since the seed implantation. One (3.8%) patient’s target lesion progressed 7 months after the treatment. One (3.8%) patient’s target lesion progressed 8 months after the treatment. One (3.8%) patient’s target lesion progressed 9 months after the treatment. No major complications were observed, minor complications (65.4%) included Pulmonary hemorrhage (n=5, 27.6%), pneumothorax (n=12,41.4%). fever (n=1,3.4%), hemoptysis(n=6. 20.7%), subcutaneous emphysema (n=1,3.4%), subcutaneous hematoma (n=1, 3.4%).Conclusion:CT-guided percutaneous iodine-125 seed implantation brachytherapy for treating patients with Stage III non-small-cell lung cancer is effective in local control, so it can both reduce the tumor load and relieve symptoms. It is safe and can be considered as a palliative treatment option for inoperable non-small-cell lung cancer. |
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