Brachytherapy for non-small cell lung cancer and selected neoplasms of the chest

Our plain-English summary of Brachytherapy for non-small cell lung cancer and selected neoplasms of the chest, by A. Raben, B. Mychalczak (Chest, 1997).

The study

• Authors: A. Raben, B. Mychalczak
• Journal: Chest
• Published: 1997;112(4 Suppl):276S-286S
• Type of article: Review
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

This article reviews the indications, techniques, and results of brachytherapy in the treatment of non-small cell lung cancer (NSCLC) and selected chest neoplasms. Various isotopes and techniques are used to place radioactive sources directly into a tumor, tumor bed, or the chest. Brachytherapy techniques can be tailored to the clinical situation and can be in the form of permanent interstitial volume or planar implants (radioactive sources permanently imbedded into the tumor or tumor bed) or in the form of temporary interstitial or endoluminal implants (where radioactive sources irradiate a tumor bed over a certain length of time and then are removed). These treatments can be delivered over a short interval (high-dose rate [HDR]) or over a more protracted time (low-dose rate). HDR treatments can be used intraoperatively to deliver a large dose of radiation to a determined target area with selective sparing of surrounding normal structures. Different methods of delivering HDR intraoperative radiation are under investigation. Most reports on brachytherapy for chest malignancies are retrospective and come from a few single institutions. Most of the published data relate to the treatment of NSCLC, but other intrathoracic malignancies, such as malignant pleural mesothelioma and malignant thymoma, have been treated with brachytherapy. To our knowledge, no major randomized trials accurately assess or confirm these retrospective studies yet, complicating the interpretation of these results. Nevertheless, brachytherapy is of value in selected situations and offers the clinician and the patient an innovative method of delivering conformal high-dose radiation to a defined target with preferential sparing of normal surrounding structures. With continued innovations in the development of radioactive isotopes, computerized treatment planning and targeting, and source delivery, brachytherapy should continue to offer an attractive alternative and complement to conventional treatment approaches, and may offer patients improved local control and survival.

In plain English

This article was a review, not a new study. The authors described the techniques, uses and published results of brachytherapy for non-small cell lung cancer and other selected chest cancers, including malignant pleural mesothelioma and invasive thymoma. Brachytherapy places radioactive sources directly into a tumor, the tumor bed or the chest. The article did not discuss asbestos exposure. For malignant pleural mesothelioma, the review described earlier reports from Memorial Sloan-Kettering Cancer Center. A 1984 report covered 41 patients who had surgery followed, when feasible, by radioactive implants, or by radioactive phosphorus placed in the chest after surgery, plus external radiation. For the whole group, median survival was 21 months, and survival was 65% at 1 year and 40% at 2 years. An update on 105 patients reported a median survival of 12.6 months. Patients with the epithelial type of mesothelioma had a median survival of 18 months. The authors noted that most reports were retrospective and that no major randomized trials had yet confirmed them. The authors concluded that the data appeared to suggest brachytherapy may improve local control and, possibly, survival in selected situations.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review of published reports on brachytherapy for chest cancers
• Who was studied: Published reports on brachytherapy for non-small cell lung cancer (stages I to IV, including superior sulcus tumors), malignant pleural mesothelioma and invasive thymoma, many from Memorial Sloan-Kettering Cancer Center (MSKCC)
• Exposure: No asbestos exposure was studied. The article concerns brachytherapy, a radiation treatment that places radioactive sources directly into a tumor, tumor bed or the chest.
• Main results:
  • Reviewed 1984 MSKCC report (Hilaris et al), malignant pleural mesothelioma: 41 patients with disease confined to one side of the chest underwent thoracotomy from 1976 to 1982. Surgery was followed, when feasible, by implantation of residual gross disease with permanent iodine-125 seeds.
  • In that 1984 report, residual diffuse disease was treated either with temporary iridium-192 implants or with phosphorus-32 instilled after surgery.
  • For all 41 patients in the 1984 report, median survival was 21 months; 1-year survival was 65% and 2-year survival was 40%.
  • In the reviewers' reading, the 1984 results appeared to improve on historical survival rates (median 6 months; 1-year survival 25% and 2-year survival 7%).
  • Reviewed update (Mychalczak et al), malignant pleural mesothelioma: 105 patients were treated from 1976 through 1988, and 54 of them received implants. Overall median survival was 12.6 months; 1-year survival was 52% and 2-year survival was 23%.
  • In the same update, patients with epithelial histologic types had a median survival of 18 months, with 1-year survival of 60% and 2-year survival of 30%. Patients with sarcomatous or mixed types had a median survival of 11 months, with 1-year survival of 30% and 2-year survival of 11%.
  • In the same update, the article described the role of brachytherapy in the reported complications as not clear.
  • The reviewers' reading of the mesothelioma update: debulking surgery appeared to be of benefit, with possible benefit from brachytherapy only for minimal residual gross disease.
  • A phase II trial was underway at MSKCC for malignant pleural mesothelioma. It combined surgery, intraoperative high-dose-rate radiation and external radiation.
• The authors' conclusion: The authors concluded that the data to date appear to suggest brachytherapy may improve local control and, possibly, survival in selected situations.
• Limitations the authors state:
  • Most reports were retrospective, and no major randomized trials had yet assessed or confirmed them, which complicates interpretation.
  • Longer follow-up is needed to assess long-term complications.
  • Patients with locally advanced disease who died of distant spread may not have lived long enough to develop complications.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Brachytherapy, Non-Small Cell Lung Cancer, Neoplasm, Interstitial, Intrathoracic, Pleural Mesothelioma.

Related studies

• Computed tomography-guided interstitial high-dose-rate brachytherapy in the local treatment of primary and secondary intrathoracic malignancies — N. Tselis, K. Ferentinos, et al. (2011)
• High-dose-rate surface brachytherapy to boost elongated, curvilinear incisional scars after extrapleural pneumonectomy for malignant pleural mesothelioma treated with adjuvant intensity-modulated radiation therapy — L.A. Doyle, T.N. Showalter, et al. (2010)
• P-32 bremsstrahlung SPECT helps assess intracavitary therapy — B. Petri, R. Nance, et al. (1992)
• Randomised phase II study of cisplatin-etoposide versus infusional carboplatin in advanced non-small-cell lung cancer and mesothelioma — S.C. White, H. Anderson, et al. (2000)
• Phase I study of paclitaxel as a radiation sensitizer in the treatment of mesothelioma and non-small-cell lung cancer — L.L. Herscher, S.M. Hahn, et al. (1998)
• Antibody drug conjugates in thoracic malignancies — J.M. Pacheco, D.R. Camidge (2018)

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