Intraoperative seed placement for thoracic malignancy-A review of technique, indications, and published literature.
OBJECTIVE
This review examines the role of permanent radioactive seed implantation in thoracic malignancy. This technique can be used intraoperatively to provide additional highly localized radiation therapy in cases where optimal oncologic margins are unattainable or to palliate unresectable disease.


METHODS
Relevant trials were identified through a systematic literature search using Pubmed.


RESULTS
The intraoperative placement of brachytherapy seeds has been described after sublobar resection for non-small-cell lung cancer (NSCLC), where surgical margins are close or microscopically positive and in the presence of macroscopic residual disease. This brachytherapy technique is currently the focus of a randomized prospective trial in the USA in patients unfit for lobectomy for early-stage NSCLC.


CONCLUSIONS
This review summarizes the methods of brachytherapy seed placement and the published experience of brachytherapy implants within the thorax, also examining radiation safety and postoperative dosimetry. This technique has the potential to improve local control with optimal sparing of normal tissue owing to its highly conformal radiotherapy delivery.
Stewart
Alexandra J
AJ
Department of Radiotherapy, Royal Surrey County Hospital, Guildford, England, UK. alexandra.stewart@royalsurrey.nhs.uk
Mutyala
Subhakar
S
Holloway
Caroline L
CL
Colson
Yolonda L
YL
Devlin
Phillip M
PM
D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy*; D002986:Clinical Trials as Topic; D006801:Humans; D007457:Iodine Radioisotopes; D008479:Mediastinal Neoplasms / Q000532:radiotherapy*; D016019:Survival Analysis
D007457:Iodine Radioisotopes