Abstract
Purpose
Interstitial brachytherapy for pulmonary tumours is an alternative to stereotactic radiotherapy, allowing high conformity despite it being an invasive technique. The aim of the study was the analysis of dose distribution, toxicity and tumour response rates.
Methods
In the years 2014–2019, 27 patients with pulmonary tumours received 36 interstitial brachytherapies with Ir-192: 11 patients with non-small cell lung cancer, 16 patients with pulmonary metastases of other entities.
Results
Patients were treated with a median (interquartile range) prescription dose of 20 (20–26) Gy in a single fraction. Mean lung dose to the ipsilateral lung was 2.8 (1.6–4.7) Gy. Maximum doses to the heart, oesophagus, thoracic wall and spinal cord were 2.4 (1.8–4.6) Gy, 2.0 (1.2–6.2) Gy, 12.6 (8.0–18.2) Gy and 1.5 (0.6–3.9) Gy.
Median survival after treatment was 15 months, with a 1- and 2‑year local control of 84% and 60%. Median overall survival after initial cancer diagnosis was 94 months; 2 years following brachytherapy, 75% of patients with colorectal cancer vs. 37% with other histologies were alive; p = 0.14.
In 69% (n = 25), brachytherapy could be performed without acute complications. A self-limiting bleeding occurred in 8% (n = 3), fever in 3% (n = 1), pneumothorax in 17% (n = 6), and pulmonary failure in 3% (n = 1). Patients with > 20 Gy in 95% of planning target volume had higher pneumothorax rates needing intervention (31% vs. 5%, p = 0.04).
Conclusions
Interstitial brachytherapy for pulmonary tumours is a highly conformal therapy with minimal doses to the organs at risk. For the majority of patients, treatment can be performed without relevant complications in a single fraction with a satisfactory local control.
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References
Gomez DR, Tang C, Zhang J et al (2019) Local consolidative therapy vs. maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer: long-term results of a multi-institutional, phase II, randomized study. J Clin Oncol 37:1558–1565
Iyengar P, Wardak Z, Gerber DE et al (2018) Consolidative radiotherapy for limited metastatic non-small-cell lung cancer: a phase 2 randomized clinical trial. JAMA Oncol 4:e173501
Palma DA, Olson R, Harrow S et al (2019) Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial. Lancet 393:2051–2058
Palma DA, Olson R, Harrow S et al (2020) Stereotactic ablative radiotherapy for the comprehensive treatment of oligometastatic cancers: long-term results of the SABR-COMET phase II randomized trial. J Clin Oncol 38(25):2830–2838. https://doi.org/10.1200/JCO.20.00818
Chang JY, Senan S, Paul MA et al (2015) Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol 16:630–637
Loi M, Franceschini D, Dominici L et al (2020) Dose coverage impacts local control in ultra-central lung oligometastases treated with stereotactic radiotherapy. Strahlenther Onkol. https://doi.org/10.1007/s00066-020-01687-9
Nicosia L, Cuccia F, Mazzola R et al (2020) Disease course of lung oligometastatic colorectal cancer treated with stereotactic body radiotherapy. Strahlenther Onkol 196:813–820
Hellman S, Weichselbaum RR (1995) Oligometastases. J Clin Oncol 13:8–10
Tselis N, Ferentinos K, Kolotas C et al (2011) Computed tomography-guided interstitial high-dose-rate brachytherapy in the local treatment of primary and secondary intrathoracic malignancies. J Thorac Oncol 6:545–552
Guckenberger M, Baus WW, Blanck O et al (2020) Definition and quality requirements for stereotactic radiotherapy: consensus statement from the DEGRO/DGMP working group stereotactic radiotherapy and radiosurgery. Strahlenther Onkol 196:417–420
Youroukou A, Gkiozos I, Kalaitzi Z et al (2017) The potential role of brachytherapy in the irradiation of patients with lung cancer: a systematic review. Clin Transl Oncol 19:945–950
Chatzikonstantinou G, Zamboglou N, Archavlis E et al (2018) CT-guided interstitial HDR-brachytherapy for recurrent glioblastoma multiforme: a 20-year single-institute experience. Strahlenther Onkol 194:1171–1179
Chatzikonstantinou G, Zamboglou N, Baltas D, Ferentinos K, Bon D, Tselis N (2019) Image-guided interstitial high-dose-rate brachytherapy for dose escalation in the radiotherapy treatment of locally advanced lung cancer: a single-institute experience. Brachytherapy 18:829–834
Mohnike K, Neumann K, Hass P et al (2017) Radioablation of adrenal gland malignomas with interstitial high-dose-rate brachytherapy: efficacy and outcome. Strahlenther Onkol 193:612–619
Pech M, Wieners G, Kryza R et al (2008) CT-guided brachytherapy (CTGB) versus interstitial laser ablation (ILT) of colorectal liver metastases: an intraindividual matched-pair analysis. Strahlenther Onkol 184:302–306
Peters N, Wieners G, Pech M et al (2008) CT-guided interstitial brachytherapy of primary and secondary lung malignancies: results of a prospective phase II trial. Strahlenther Onkol 184:296–301
Hass P, Mohnike K, Kropf S et al (2019) Comparative analysis between interstitial brachytherapy and stereotactic body irradiation for local ablation in liver malignancies. Brachytherapy 18:823–828
Chan MK, Lee VW, Kadoya N et al (2018) Single fraction computed tomography-guided high-dose-rate brachytherapy or stereotactic body radiotherapy for primary and metastatic lung tumors? J Contemp Brachytherapy 10:446–453
Le QT, Loo BW, Ho A et al (2006) Results of a phase I dose-escalation study using single-fraction stereotactic radiotherapy for lung tumors. J Thorac Oncol 1:802–809
Morias S, Marcu LG, Short M et al (2018) Treatment-related adverse effects in lung cancer patients after stereotactic ablative radiation therapy. J Oncol 2018:6483626
Ricke J, Wust P, Wieners G et al (2005) CT-guided interstitial single-fraction brachytherapy of lung tumors: phase I results of a novel technique. Chest 127:2237–2242
Hosten N, Stier A, Weigel C et al (2003) Laser-induced thermotherapy (LITT) of lung metastases: description of a miniaturized applicator, optimization, and initial treatment of patients. Rofo 175:393–400
Steinke K, Sewell PE, Dupuy D et al (2004) Pulmonary radiofrequency ablation—an international study survey. Anticancer Res 24:339–343
Londero F, Grossi W, Morelli A et al (2020) Surgery versus stereotactic radiotherapy for treatment of pulmonary metastases. A systematic review of literature. Future Sci OA 6:FSO471
Von Einem JC, Stintzing S, Modest DP, Wiedemann M, Furweger C, Muacevic A (2020) Frameless single robotic radiosurgery for pulmonary metastases in colorectal cancer patients. Cureus 12:e7305
Khadige M, Salleron J, Marchesi V, Oldrini G, Peiffert D, Beckendorf V (2018) Cyberknife® stereotactic radiation therapy for stage I lung cancer and pulmonary metastases: evaluation of local control at 24 months. J Thorac Dis 10:4976–4984
Mihai A, Mu Y, Armstrong J et al (2017) Patients with colorectal lung oligometastases (L-OMD) treated by dose adapted SABR at diagnosis of oligometastatic disease have better outcomes than patients previously treated for their metastatic disease. J Radiosurg SBRT 5:43–53
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A. Rashid, M. Pinkawa, H. Haddad, H. Hermani, S. Temming, A. Schäfer, P. Bischoff and A. Kovács declare that they have no competing interests.
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Rashid, A., Pinkawa, M., Haddad, H. et al. Interstitial single fraction brachytherapy for malignant pulmonary tumours. Strahlenther Onkol 197, 416–422 (2021). https://doi.org/10.1007/s00066-021-01758-5
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DOI: https://doi.org/10.1007/s00066-021-01758-5