CT-guided interstitial brachytherapy of primary and secondary lung malignancies: results of a prospective phase II trial.
OBJECTIVE
CT-guided interstitial brachytherapy of primary lung malignancies and pulmonary metastases represents a novel interventional technique, combining conventional high-dose-rate (HDR) iridium-192 ((192)Ir) brachytherapy with modern CT guidance for applicator positioning and computer-aided 3-D radiation treatment planning. The purpose of this study was to assess safety and efficacy of this technique.


METHODS
30 patients with 83 primary or secondary lung malignancies were recruited in a prospective nonrandomized trial (Table 1). After catheter positioning under CT fluoroscopy, a spiral CT was acquired for treatment planning (Figure 1). All but two patients received a defined single dose (coverage > 99%) of at least 20 Gy from a (192)Ir source in HDR technique.


RESULTS
Adverse effects were nausea (n = 3, 6%), minor (n = 6, 12%) and one major pneumothorax (2%). Post intervention, no changes of vital capacity and forced expiratory volume could be detected. The median follow-up period was 9 months (1-21 months) with a local tumor control of 91% at 12 months (Figure 2).


CONCLUSIONS
CT-guided interstitial brachytherapy proved to be safe and effective for the treatment of primary and secondary lung malignancies.
Peters
Nils
N
Department of Radiology and Nuclear Medicine, Otto von Guericke University, Leipziger Strasse 44, Magdeburg, Germany.
Wieners
Gero
G
Pech
Maciej
M
Hengst
Susanne
S
Rühl
Ricarda
R
Streitparth
Florian
F
Lopez Hänninen
Enrique
E
Felix
Roland
R
Wust
Peter
P
Ricke
Jens
J
D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy*; D015179:Colorectal Neoplasms / Q000532:radiotherapy; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005541:Forced Expiratory Volume / Q000528:radiation effects; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D007495:Iridium / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D011030:Pneumothorax / Q000209:etiology; D011446:Prospective Studies; D011868:Radioisotopes / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D011881:Radiotherapy, Computer-Assisted / Q000295:instrumentation*; D036542:Tomography, Spiral Computed / Q000379:methods*; D014797:Vital Capacity / Q000528:radiation effects
D011868:Radioisotopes; D007495:Iridium