Computed tomography fluoroscopy-guided percutaneous 125I seed implantation for safe, effective and real-time monitoring radiotherapy of inoperable stage T1-3N0M0 non-small-cell lung cancer

Abstract

The management of inoperable lung cancer remains a challenge. It has been proven that computed tomography (CT)-guided iodine-125 (¹²⁵I) seed implantation is a safe and efficient method for treating lung cancer. Computed tomographic fluoroscopy (CTF) is superior to traditional CT for percutaneous management of lung lesions, due to the real-time guidance and accurate localization of the lesions. The aim of the present prospective study was to evaluate the feasibility, safety and efficacy of CTF-guided percutaneous permanent implantation of ¹²⁵I seeds for the treatment of selected patients with inoperable stage T1-3N0M0 non-small-cell lung cancer (NSCLC). A total of 24 patients with resectable but inoperable stage T1-3N0 NSCLC, with a total of 28 lesions, underwent CTF-guided percutaneous implantation of radioactive ¹²⁵I seeds. A prescription dose of 100-120 Gy was delivered to each lesion. The complications and local tumor control rates were documented. Survival was estimated using the Kaplan-Meier method. All the patients successfully completed the procedure, with a mean procedure duration of 45.7 min (range, 30-75 min). No severe complications occurred. Small asymptomatic pneumothorax with lung volume compression of <10% and minor hemorrhage along the needle track without hemoptysis occurred immediately after the procedure in 3 (12.5%) and 4 (16.7%) of the 24 patients, respectively. At a median follow-up of 31.5 months (range, 8-46 months), the local control rate (LCR) of the lesions was 78.6% (22/28). The 1-, 2- and 3-year overall survival rate was 95.8, 78 and 55%, respectively. In conclusion, CTF is the favourable imaging guidance method for the percutaneous implantation of ¹²⁵I seeds. CTF-guided brachytherapy with implantation of ¹²⁵I seeds is a safe, feasible and effective modality for the treatment of inoperable early-stage NSCLC and may be considered an alternative option in selected patients with medically inoperable NSCLC.