PURPOSE: Lobectomy is generally preferred for early stage lung cancer. Many lung cancer patients have co-morbid disease and are not candidates for lobectomy. The objective of this study was to see if I-125 brachytherapy (I-125) would reduce lung cancer recurrence.
METHODS: With IRB approval data were collected prospectively on 120 patients who underwent thoracoscopic wedge resection with I-125 for lung cancer and compared with 100 retrospective cases without I-125 (no I-125). I-125 vicryl mesh was placed over the suture line at the tumor site in the I-125 group.
RESULTS: The groups were similar for sex, tumor location, size, tumor cell type, pulmonary function and for co-morbid disease. More patients had COPD in the I-125 group (81/120, 68% vs 51/100, 51% p=0.01). The I-125 patients were older (73.0 ± 8 vs 69.4 ± 9, p=.002). Postoperative complications of airleak, pneumonia, and atrial fibrillation were similar. There were no complications in 76 (63.3%) I-125 and 68 (68%) no I-125 patients. The use of I-125 was more recent and follow-up days were longer for no I-125 (1017 ± 803 vs 548 ± 482). Hospital mortality was similar (I-125 2/120, 1.7% vs no I-125 3/100, 3%; p=.66). Recurrent disease was more common in the no I-125 60/100 (60%) versus the I-125 34/120 (29%) group, p<0.0001. Recurrence was less overtime in the I-125 group. Resection site recurrence was 16% for no I-125 versus 6.7% for I-125, p=0.047. Only 43 (43%) no I-125 had external radiation. The majority refused radiation due to time and travel. A higher proportion of no I-125 patients with external radiation had resection site recurrence (5/43, 11.6%) as compared to the I-125 patients (8/120, 6.7% p=0.011).
CONCLUSION: I-125 appears to reduce resection site recurrence. Placement of I-125 assures radiation treatment in patients who might otherwise not do external beam radiation.
CLINICAL IMPLICATIONS: This study suggests reduce cancer recurrence when using I-125 in patients who have NCSLC and are not candidates for lobectomy.
DISCLOSURE: Stephen Hazelrigg, No Financial Disclosure Information; No Product/Research Disclosure Information