Investigate the radiographic changes following 125Iodine mesh brachytherapy after sublobar resection in stage I NCSLC patients with poor pulmonary function.
Between January 1997 and January 2008, 147 patients with poor cardiopulmonary reserve and stage IA and IB NSCLC underwent sublobar resection followed by implantation of 125I vicryl mesh brachytherapy. The brachytherapy implant was placed over the wedge resection staple line delivering a total dose of 100–120 Gy over the lifetime of the implant. Follow-up consisted of clinical exam and surveillance chest xray/CT scans of the chest. All postoperative follow-up radiographic studies performed at Allegheny General Hospital were reviewed with a chest radiologist at our institution. We defined complications as penumothorax, pleural thickening, loss of seeds, cavitary lesion, persistent effusions, local fibrosis at the site of brachytherapy and recurrence.
A total of 147 high risk patients with stage I NSCLC underwent sublobar resection followed by implantation of 125I mesh brachytherapy. Of these patients, 33 had available post operative follow-up radiographic studies (performed at AGH) for review with an average follow up of 12 months. Seven patients had CXR & CT scans, ten only had CT scans and sixteen patients had CXRs. The average follow-up time was 18.8 months (range 3–48 months). Of these thirty-three patients, seven had local fibrosis at the site of the brachytherapy, six had persistent small loculated penumothorax, four had persistent loculated effusions, six patients had pleural thickening and one patient had cavitary lesion with the disappearance of the seeds. Four patients had recurrence, of which one was regional & three were distant.
Radiographic changes following 125 Iodine brachytherapy placed along the wedge resection staple line are confined to the site of implantation and are not associated with radiation pneumonitis nor impact pulmonary function.
In patients with impaired cardiopulmonary reserve, sublobar resection and Iodine brachytherapy appears to be a reasonable approach.
Ghazaleh Bigdeli, No Financial Disclosure Information; No Product/Research Disclosure Information