Computed tomography-guided interstitial high-dose-rate brachytherapy in the local treatment of primary and secondary intrathoracic malignancies

Our plain-English summary of Computed tomography-guided interstitial high-dose-rate brachytherapy in the local treatment of primary and secondary intrathoracic malignancies, by N. Tselis, K. Ferentinos, C. Kolotas, et al (Journal of Thoracic Oncology, 2011).

The study

• Authors: N. Tselis, K. Ferentinos, C. Kolotas, J. Schirren, D. Baltas, A. Antonakakis, H. Ackermann, N. Zamboglou
• Journal: Journal of Thoracic Oncology
• Published: 2011;6(3):545-52
• Cited by: 26 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: 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.

In plain English

This article reported the experience of authors from a radiation oncology department in Offenbach, Germany, treating chest cancers with CT-guided interstitial high-dose-rate brachytherapy. In this treatment, catheters were placed into the tumor under CT guidance and an Iridium-192 source delivered radiation. Between January 1997 and December 2007, 55 patients who were not surgical candidates had 68 procedures for 60 lesions. Five had primary malignant pleural mesothelioma, 36 had primary non-small cell lung cancer, and others had lung metastases. The article did not discuss asbestos, and it did not report results separately for mesothelioma. At a median of 11 weeks after treatment, 67.2% (37 patients) responded. Median overall survival was 15.5 months. Survival was 63% at 1 year, 26% at 2 years and 7% at 3 years. Estimated local control was 88%, 81% and 75% at 1, 2 and 3 years. There were 16 acute adverse events across 68 procedures, including 8 pneumothoraces, one of which needed a chest tube. The authors concluded their data showed promising control rates. They named the retrospective design and small population as limitations.

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: Retrospective case series of the authors' own treated patients (the authors also call it a 'review' of their clinical experience)
• Who was studied: 55 patients (37 men, 18 women; median age 64, range 31 to 93) with inoperable primary or secondary intrathoracic tumors, treated January 1997 to December 2007. They had 60 lesions and 68 procedures. By patient: 36 primary non-small cell lung cancer, 5 primary malignant pleural mesothelioma, 14 with pulmonary metastases (2 colorectal carcinoma, 7 soft-tissue sarcoma, 2 hypernephroid renal carcinoma, 2 metastases of NSCLC, 1 unknown primary).
• Exposure: No asbestos exposure was studied or reported. The intervention was CT-guided interstitial high-dose-rate brachytherapy with an Iridium-192 afterloading source. For each patient's first procedure, 27 patients received twice-daily fractions (median 6.0 Gy) and 28 received once-daily fractions (median 8.0 Gy), to a median total dose of 20.0 Gy (range 7.0 to 32.0 Gy).
• Main results:
  • Overall response at a median of 11 weeks after treatment was 67.2% (37 patients): 10 (18.1%) had complete response and 27 (49.0%) had partial response. Of the rest, 15 had stable disease and 3 had progressive disease.
  • Among all 55 patients, median overall survival was 15.5 months; overall survival was 63% at 1 year, 26% at 2 years and 7% at 3 years.
  • Estimated overall local control was 88% at 1 year, 81% at 2 years and 75% at 3 years.
  • Local control was 93%, 82% and 82% for metastatic tumors, and 86%, 79% and 73% for primary intrathoracic cancers, at 1, 2 and 3 years.
  • 31 patients (56.3%) died of intercurrent causes, such as myocardial infarction, pulmonary embolism or suicide. Intrapulmonary disease progression was the cause of death in 4 patients (7.2%).
  • There were 16 acute adverse events (printed as 23.5%) across 68 procedures, with no procedure-related deaths and no late toxicities. Eight of the events were pneumothoraces: 7 resolved on their own and 1 required chest-tube drainage.
  • The authors found no statistically significant correlation between survival and tumor volume reduction, pretreatment tumor volume, or treatment dose.
  • Local control at 12 months was 84% for tumors with volume reduction less than 85%, versus 100% for the remaining tumors (p value printed as 0.048).
• The authors' conclusion: The authors concluded that, despite the study's limitations, their data showed promising control rates. They said the results supported using CT-guided interstitial high-dose-rate brachytherapy for primary and secondary intrathoracic malignancies in patients who are not surgical candidates.
• Limitations the authors state:
  • Retrospective design and a relatively small population mixing metastases and primary cancers
  • Biopsies were not routinely done with follow-up imaging.
  • Almost half of patients received further chemotherapy, so it was difficult to tell which findings were due to the brachytherapy itself.
  • Treatment selection bias may have affected survival.

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: Interstitial, Brachytherapy, Intrathoracic, Overall Survival.

Related studies

• 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)
• Brachytherapy for non-small cell lung cancer and selected neoplasms of the chest — A. Raben, B. Mychalczak (1997)
• Integrated positron emission tomography-computed tomography does not accurately stage intrathoracic disease of patients undergoing trimodality therapy for malignant pleural mesothelioma — J. Pilling, J.A. Dartnell, et al. (2010)
• Early detection of interstitial lung disease in asbestos exposed non-smoking workers by mid-expiratory flow rate and high resolution computed tomography — Z. Dujić, J. Tocilj, et al. (1991)
• Role of integrated 18-fluorodeoxyglucose position emission tomography-computed tomography in patients surveillance after multimodality therapy of malignant pleural mesothelioma — C. Tan, S. Barrington, et al. (2010)
• High performance of F-fluorodeoxyglucose positron emission tomography and contrast-enhanced CT in a rapid outpatient diagnostic program for patients with suspected lung cancer — P. Brocken, H.F. van der Heijden, et al. (2014)

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