Mature follow-up for high-risk stage I non-small-cell lung carcinoma treated with sublobar resection and intraoperative iodine-125 brachytherapy.
OBJECTIVE
To update the Allegheny General Hospital experience of high-risk Stage I non-small-cell lung cancer patients treated with sublobar resection and intraoperative (125)I Vicryl mesh brachytherapy.


METHODS
Between January 5, 1996 and February 19, 2008, 145 patients with Stage I non-small-cell lung cancer who were not lobectomy candidates because of cardiopulmonary compromise underwent sublobar resection and placement of (125)I seeds along the resection line. The (125)I seeds embedded in Vicryl suture were attached with surgical clips to a sheet of Vicryl mesh, inserted over the target area, and prescribed to a 0.5-cm planar margin.


RESULTS
The mean target area, total activity, number of seeds implanted, and prescribed total dose was 33.3 cm(2) (range, 18.0-100.8), 20.2 mCi (range, 11.1-29.7), 46 (range, 30-100), and 117 Gy (range, 80-180), respectively. The median length of the surgical stay was 6 days (range, 1-111), with a perioperative mortality rate of 3.4%. At a median follow-up of 38.3 months (range, 1-133), 6 patients had developed local recurrence (4.1%), 9 had developed regional failure (6.2%), and 25 had distant failure (17.2%). On multivariate analysis, no patient- or tumor-specific factors or surgical or dosimetric factors were predictive of local recurrence. The overall median survival was 30.5 months with a 3- and 5-year overall survival rate of 65% and 35%, respectively.


CONCLUSIONS
(125)I brachytherapy for high-risk, Stage I non-small-cell lung cancer after sublobar resection is well tolerated and associated with a low local failure rate.
Colonias
Athanasios
A
Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA 15212, USA. acolonia@wpahs.org
Betler
James
J
Trombetta
Mark
M
Bigdeli
Ghazaleh
G
Gayou
Olivier
O
Keenan
Robert
R
Werts
E Day
ED
Parda
David S
DS
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D029681:Arabidopsis Proteins; D001918:Brachytherapy / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005287:Ferredoxin-NADP Reductase; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D007902:Length of Stay; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010414:Pennsylvania; D011013:Pneumonectomy / Q000379:methods; D011098:Polyglactin 910; D011879:Radiotherapy Dosage; D013526:Surgical Mesh; D016019:Survival Analysis
D029681:Arabidopsis Proteins; D007457:Iodine Radioisotopes; D011098:Polyglactin 910; D005287:Ferredoxin-NADP Reductase; C478153:MFDR protein, Arabidopsis