title: Mature follow-up for high-risk stage I non-small-cell lung carcinoma treated with sublobar resection and intraoperative iodine-125 brachytherapy.
abstract: 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.
authors.affiliation: Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA 15212, USA. acolonia@wpahs.org
authors.forename: Athanasios
authors.initials: A
authors.lastname: Colonias
authors.forename: James
authors.initials: J
authors.lastname: Betler
authors.forename: Mark
authors.initials: M
authors.lastname: Trombetta
authors.forename: Ghazaleh
authors.initials: G
authors.lastname: Bigdeli
authors.forename: Olivier
authors.initials: O
authors.lastname: Gayou
authors.forename: Robert
authors.initials: R
authors.lastname: Keenan
authors.forename: E Day
authors.initials: ED
authors.lastname: Werts
authors.forename: David S
authors.initials: DS
authors.lastname: Parda
mesh_terms: 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
chemical_list: D029681:Arabidopsis Proteins; D007457:Iodine Radioisotopes; D011098:Polyglactin 910; D005287:Ferredoxin-NADP Reductase; C478153:MFDR protein, Arabidopsis