Wedge resection and brachytherapy for lung cancer in patients with poor pulmonary function.
BACKGROUND
Although lobectomy is the standard for lung cancer because a wedge resection has a 3 to 5 times greater incidence of local recurrence, poor pulmonary function may preclude lobectomy. For these patients, low-dose-rate brachytherapy has recently been used to decrease local recurrence after sublobar resection. Current techniques expose operating room personnel and patient contacts to unnecessary radioactivity risks. We present our technique of sublobar resection combined with afterload catheters for high-dose-rate brachytherapy for patient benefit with minimal risk to others.


METHODS
Forty-eight patients (25 women, 23 men) underwent wedge resection, node dissection, and brachytherapy. A remote-afterloading high-dose-rate unit for radiation produced a median dose of 2450 cGy (350 cGy per fraction over 7 fractions twice daily for 4 days). The dose was prescribed to 1 cm deep to the stapled line. Biologically, this dose is approximately 5000 cGy and above (180 cGy/d equivalent) at the depth of 5 mm in reference to the resection margin.


RESULTS
Two patients died. The length of mean stay was 5.5 days (median, 5 days). Complications included prolonged air leak in 5 patients, atrial fibrillation in 5, pneumonia in 3, trapped lung in 2, and 1 each with empyema, bleeding, and recurrent laryngeal nerve injury. Three patients required a blood transfusion. Within the follow-up of 1 to 27 months, there were four recurrences.


CONCLUSIONS
Wedge resection and brachytherapy appears to be a reasonable treatment for patients with lung cancer and pulmonary function that prohibits a lobectomy.
McKenna
Robert J
RJ
Department of Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. mckennar@cshs.org
Mahtabifard
Ali
A
Yap
Johnnie
J
McKenna
Robert
R
Fuller
Clark
C
Merhadi
Amin
A
Hakimian
Behrooz
B
D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality; D018714:Radiotherapy, Adjuvant; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013536:Suture Techniques; D013537:Sutures; D016896:Treatment Outcome