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.
Department of Radiology and Nuclear Medicine, Otto von Guericke University, Leipziger Strasse 44, Magdeburg, Germany.
Nils
N
Peters
Gero
G
Wieners
Maciej
M
Pech
Susanne
S
Hengst
Ricarda
R
Rühl
Florian
F
Streitparth
Enrique
E
Lopez Hänninen
Roland
R
Felix
Peter
P
Wust
Jens
J
Ricke
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