Journal of Surgical Oncology 49:25-28 (1992)

Interstitial Brachytherapy in the Treatment of Carcinoma of the Lung ERIK H. FLEISCHMAN, DO, A. ROBERT KAGAN, MU, FACK, OSCAR E. STREETER, MD, JON TYRELL, MD, MYRON WOLLIN, ML, CHRISTOPHER A. LEAGRE, MD, AND JAMES C. HARVEY, MD From the Departments of Radiation Oncology (E.H.F., A.R.K., M.W., C.A.L.) and Surgery (/.T.), Southern California Permanente Medical Group, Department of Radiation Oncology (O.E.S.),Norris Cancer Center, Los Angeles, California; and the Department of Surgery (/.C.H.),David B . Kriser lung Cancer Center, Beth Israel Medical Center, New York, New York

In a prospective study, 14 patients with primary non-oat cell lung carcinoma were treated with intraoperative Iodine'25 (I'25) implantation of the lung tumor via lateral thoracotomy or median sternotomy . Staging mediastinal node dissection was performed in each case. Patients were selected when wedge or segmental resections were not technically feasible, such that lobectomy or completion pneumonectomy would have been required or pulmonary function studies were poor. Doses ranged from 8,000 cGy at the periphery to 20,000 cGy at the center. With a minimum 12 month follow-up, mean and median survivals were 16.7 and 15.1 months, respectively. Local control was achieved in 10 of 14 patients (71%) with all local failures occurring in pathologic stage 111 patients. When separated according to tumor size, local control was obtained in six of seven tumors of less than 3 cm and four of five tumors of 3-5 cm. Both cases with masses greater than 5 cm failed locally. There was one operative mortality and two postoperative complications. All other patients were discharged within one week of surgery. There was no radiation pneumonitis. lung brachytherapy is an excellent alternative treatment for TI and T2 tumors when medical conditions preclude curative resection. KEYWORDS:non-small cell lung cancer, pulmonary radiation, mediastinal node dissection

INTRODUCTION Early non-oat cell carcinoma of the lung is best managed by surgical resection. Five year survivals of 5377% [l-61 have been reported in modern series when procedures ranging from wedge resection to pneumonectomy have been employed. Unfortunately only 1540% [ l ] of patients present with early disease anatomically compatible with resection. A number of resectable patients are considered medically inoperable due to preexistent pulmonary insufficiency as a result of obstructive or restrictive lung disease, previous lung resection, advanced age, medical infirmity, or poor exercise capacity. Removal of a large amount of normal lung in these patients places them at risk for crippling pulmonary insufficiency or even ventilator dependence. Usually external 0 1992 Wiley-Liss, Iuc.

beam irradiation is prescribed in such circumstances, although survival and local control, even with high doses and altered fractionation, are inferior to surgery [7-91. High dose irradiation has a significant risk of irreversible parenchymal damage depending upon the volume irradiated. In the departments of Thoracic Surgery and Radiation Oncology at the Kaiser Permanente-Los Angeles Medical Center we have adopted a policy of Iodine'25 (I'25)interstitial brachytherapy in patients with clinically localized non-oat cell carcinoma when conservative resections are not technically feasible and major resections Accepted for publication September 17, 1991. Address reprint requests to James C . Harvey, MD, Department of Surgery, David B. Kriser Lung Cancer Center, Beth Israel Medical Center, 16th Street at First Avenue, New York, NY 10003.

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with chest wall fixation where seeds were placed into the surrounding chest wall. In cases where tumor was fixed or adjacent to large vessels placement of needles exFactor No. of patients tended to the tumor periphery carefully avoiding puncture of the abutting vessel. Pleural airleaks and minor bleed1. Pa02

Iodine125 interstitial brachytherapy in the treatment of carcinoma of the lung.

In a prospective study, 14 patients with primary non-oat cell lung carcinoma were treated with intraoperative Iodine125 (I125) implantation of the lun...
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