Computed tomography-guided interstitial high-dose-rate brachytherapy in the local treatment of primary and secondary intrathoracic malignancies.
BACKGROUND
Image-guided interstitial (IRT) brachytherapy (BRT) is an effective treatment option as part of a multimodal approach to the treatment of isolated lung tumors. In this study, we report our results of computed tomography-guided IRT high-dose-rate (HDR) BRT in the local treatment of inoperable primary and secondary intrathoracic malignancies.


METHODS
Between 1997 and 2007, 55 patients underwent a total of 68 interventional procedures for a total of 60 lung lesions. The median tumor volume was 160 cm³ (range, 24-583 cm³). Thirty-seven patients were men and 18 were women, with a median age of 64 years (range, 31-93 years). The IRT-HDR-BRT delivered a median dose of 25.0 Gy (range, 10.0-32.0 Gy) in twice-daily fractions of 4.0 to 15.0 Gy in 27 patients and 10.0 Gy (range, 7.0-32.0 Gy) in once-daily fractions of 4.0 to 20.0 Gy in 28 patients.


RESULTS
The median follow-up was 14 months (range, 1-49 months). The overall survival rate was 63% at 1 year, 26% at 2 years, and 7% at 3 years. The local control rate for metastatic tumors was 93%, 82%, and 82% and for primary intrathoracic cancers 86%, 79%, and 73% at 1, 2, and 3 years, respectively. Pneumothoraces occurred in 11.7% of interventional procedures, necessitating postprocedural drainage in one (1.8%) patient.


CONCLUSIONS
In patients with inoperable intrathoracic malignancies, computed tomography-guided IRT-HDR-BRT is a safe and effective alternative to other locally ablative techniques.
Department of Radiation Oncology, Klinikum Offenbach, Offenbach, Germany. ntselis@hotmail.com
Nikolaos
N
Tselis
Konstantinos
K
Ferentinos
Christos
C
Kolotas
Joachim
J
Schirren
Dimos
D
Baltas
Angela
A
Antonakakis
Hanns
H
Ackermann
Nikolaos
N
Zamboglou
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D005462:Fluorine Radioisotopes; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy* / Q000556:secondary; D008297:Male; D008654:Mesothelioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy; D009367:Neoplasm Staging; D016066:Pleural Effusion, Malignant / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy; D049268:Positron-Emission Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals; D011879:Radiotherapy Dosage; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals