A novel approach for salvage treatment of non-small-cell lung cancer: percutaneous CT fluoroscopy-guided permanent seed brachytherapy for salvage treatment of lung cancer: long-term results of a case series

摘要

Purpose We sought a?curative technique to treat recurrent or primary non-small cell lung cancer (NSCLC) with a?minimally invasive outpatient technique that could be repeated multiple times, had minimal pulmonary toxicity, and was readily available in the community setting. Percutaneous outpatient computed tomography (CT) fluoroscopy-guided permanent seed brachytherapy fits these criteria. Material and methods Eight lesions in five patients (three patients had two lesions each) with NSCLC were treated using outpatient percutaneous CT fluoroscopy-guided palladium-103 seed brachytherapy. At initial presentation, seven lesions had recurred following external beam radiation therapy (EBRT) and initial chemotherapy, and one lesion was treated with brachytherapy as a?primary treatment. Results In five patients with eight lesions, there were no recurrences at follow-up from final implant, average follow-up of 58.1 months (range, 15-145 months). There were no acute complications requiring intervention and no long-term complications. One lesion required a?second salvage implant 10 months after first implant. This lesion’s original salvage Dsub90/sub was but 90% and repeat implant achieved a?Dsub90/sub of 273%. This salvaged site had not recurred at 43-month follow-up after the second salvage implant. Conclusions Percutaneous CT fluoroscopy-guided permanent seed brachytherapy is a?safe, efficacious, and cost effective primary and salvage treatment for lung cancer. CT-fluoroscopy resources are readily available in the community and are an effective alternative to stereotactic body radiation therapy (SBRT), intensity-modulated radiation therapy (IMRT)/proton beam, radiofrequency ablation (RFA), and cryoablation (CA). Percutaneous CT fluoroscopy-guided permanent seed brachytherapy has an equivalent or better local control rate, a?lower resource cost, and a?far lower integral radiation dose than other therapies. We believe this is the first published article documenting the curative potential of percutaneous CT fluoroscopy-guided permanent seed brachytherapy for recurrent NSCLC with long-term follow-up. High Dsub90/sub doses appear to be required to achieve complete response. Further studies are essential to confirm these findings.