Chao Chen1, Wei Wang2, Zhe Yu3, Shilin Tian4, Yuliang Li5, Yongzheng Wang6. 1. Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, China; Interventional Oncology Institute of Shandong University, China. Electronic address: chenchao318@email.sdu.edu.cn. 2. Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, China; Interventional Oncology Institute of Shandong University, China. Electronic address: wwei0125@126.com. 3. Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, China; Interventional Oncology Institute of Shandong University, China. Electronic address: 1106446702@qq.com. 4. Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, China; Interventional Oncology Institute of Shandong University, China. Electronic address: 903328019@qq.com. 5. Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, China; Interventional Oncology Institute of Shandong University, China. Electronic address: lyl.pro@sdu.edu.cn. 6. Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, China; Interventional Oncology Institute of Shandong University, China. Electronic address: shuijing_0318@126.com.
Abstract
OBJECTIVES: To evaluate the efficacy and safety of the combination of computed tomography (CT)-guided iodine-125 brachytherapy and bronchial arterial chemoembolization (BACE) for locally advanced stage III non-small cell lung cancer (NSCLC) after failure of concurrent chemoradiotherapy. MATERIAL AND METHODS: We retrospectively evaluated 28 patients with locally advanced stage III NSCLC in whom concurrent chemoradiotherapy had failed and were consequently, treated with radioactive iodine-125 seed implantation followed by BACE. The prescribed radiation dose was 140 Gy, with a median radioactivity of 0.60 mCi. The tumor-feeding arteries were detected on angiography, and chemotherapeutic agents (gemcitabine 1000 mg/m2 + lobaplatin 30 mg/m2) were then administered via arterial infusion. The tumor-feeding arteries were embolized using 300-500 μm embosphere microspheres. The endpoints were treatment response rate, progression-free survival (PFS), and toxicity. RESULTS: The median number of implanted iodine-125 seeds was 58 pellets (range, 44-114 pellets). The median post-operative dose covering 90 % of the target volume (D90) was 143.4 Gy (range, 123.6-159.9 Gy). A total of 73 cycles of BACE were conducted (2.61 cycles per case). The bronchial arteries were the main tumor-feeding arteries. In total, 11 patients had hemoptysis, and it was significantly alleviated within 24 h after BACE. There was no serious procedure-related complication. The 6-month objective response and disease control rates were 71.42 % and 92.86 %, respectively. No severe complications occurred during the follow-up. Local control duration ranged from 5-12 months, and the median PFS was 8 months (95 % confidence interval: 7.3-8.8 months). CONCLUSIONS: The combination of CT-guided iodine-125 brachytherapy and BACE is an effective and safe approach for the treatment of NSCLC after failure of concurrent chemoradiotherapy and is worthy of clinical application.
OBJECTIVES: To evaluate the efficacy and safety of the combination of computed tomography (CT)-guided iodine-125 brachytherapy and bronchial arterial chemoembolization (BACE) for locally advanced stage III non-small cell lung cancer (NSCLC) after failure of concurrent chemoradiotherapy. MATERIAL AND METHODS: We retrospectively evaluated 28 patients with locally advanced stage III NSCLC in whom concurrent chemoradiotherapy had failed and were consequently, treated with radioactive iodine-125 seed implantation followed by BACE. The prescribed radiation dose was 140 Gy, with a median radioactivity of 0.60 mCi. The tumor-feeding arteries were detected on angiography, and chemotherapeutic agents (gemcitabine 1000 mg/m2 + lobaplatin 30 mg/m2) were then administered via arterial infusion. The tumor-feeding arteries were embolized using 300-500 μm embosphere microspheres. The endpoints were treatment response rate, progression-free survival (PFS), and toxicity. RESULTS: The median number of implanted iodine-125 seeds was 58 pellets (range, 44-114 pellets). The median post-operative dose covering 90 % of the target volume (D90) was 143.4 Gy (range, 123.6-159.9 Gy). A total of 73 cycles of BACE were conducted (2.61 cycles per case). The bronchial arteries were the main tumor-feeding arteries. In total, 11 patients had hemoptysis, and it was significantly alleviated within 24 h after BACE. There was no serious procedure-related complication. The 6-month objective response and disease control rates were 71.42 % and 92.86 %, respectively. No severe complications occurred during the follow-up. Local control duration ranged from 5-12 months, and the median PFS was 8 months (95 % confidence interval: 7.3-8.8 months). CONCLUSIONS: The combination of CT-guided iodine-125 brachytherapy and BACE is an effective and safe approach for the treatment of NSCLC after failure of concurrent chemoradiotherapy and is worthy of clinical application.