Intraoperative I-125 brachytherapy for high-risk stage I non-small cell lung carcinoma

Purpose: Preliminary assessment of feasibility, efficacy, acute and chronic side effects associated with permanent intraoperative placement of I-125 v icryl mesh brachytherapy in a select group of high-risk Stage I NSCLC who h ave undergone video-assisted thoracoscopic resection (VATR). Methods and Materials: From January 8, 1997 to March 16, 1998, 23 patients with Stage I NSCLC at high risk for conventional surgery due to cardiopulmo nary compromise underwent combined VATR and intraoperative placement of I-1 25 seeds embedded in vicryl mesh. Seeds embedded in vicryl suture were atta ched with surgical clips to a sheet of vicryl mesh, and thoracoscopically i nserted over the target area (tumor bed and staple line) with nonabsorbable suture or surgical clips. A total dose of 100-120 Gy prescribed to the per iphery of the target area (defined as the staple line and tumor bed with a l-cm margin) was delivered. Results: The mean target area covered was 48 cm(2) (range 40-72) and mean t otal activity was 22 mCi (range 17.2-28.2). The median length of postoperat ive stay was 7 days. The median follow-up was 11 months (range 2-20). Posto perative CT scans of the chest revealed no dislodgement of the seeds and no local recurrence in any patient. Three patients developed distant metastas is (1 died 6 months postoperatively; the other 2 are currently alive with d isease). One patient developed an ipsilateral recurrence in the right lower lobe after having had a right upper lobe resection, There were 3 postopera tive deaths due to medical comorbid conditions or surgical complications (1 in the immediate postoperative period). Pulmonary function testing perform ed 3 months after implantation revealed no significant difference between p reoperative and postoperative values: mean preoperative FVC was 2.3 L (rang e 1.31-3.0) and postoperative FVC was 2.2 L (range 1.1-3.9), p = 0.42; mean preoperative FEV, was 1.2 L (range 0.71-2.2), and postoperative FEV, was 1 .5 L (range 0.8-2.9), p = 0.28. Conclusion: Review of early data suggests that intraoperative I-125 vicryl mesh brachytherapy in high-risk Stage INSCLC is potentially effective and w ell tolerated, with no significant decline in measurable pulmonary function studies and no increase in postoperative complications. Longer follow-up i s needed to determine ultimate local control and survival. (C) 1999 Elsevie r Science Inc.