Outcomes with multi-disciplinary management of central lung tumors with CT-guided percutaneous high dose rate brachyablation

Abstract

Background Centrally located lung tumors present treatment challenges given their proximity to mediastinal structures including the central airway, esophagus, major vessels, and heart. Therapeutic options can be limited for medically inoperable patients, particularly if they have received previous thoracic radiotherapy. High dose rate (HDR) brachyablation was developed to improve the therapeutic ratio for patients with central lung tumors. The purpose of this study is to report initial safety and efficacy outcomes with this treatment for central lung malignancies. Methods From September 2015 to August 2019, a total of 25 patients with 37 pulmonary tumors were treated with percutaneous HDR brachyablation. Treatment was delivered by a multi-disciplinary team of interventional radiologists, pulmonologists, and radiation oncologists. Twenty-three patients received a median dose of 21.5 Gy (range 15–27.5) in a single fraction, whereas two patients received median dose of 24.75 Gy (range 24–25.5) over 2–3 fractions. Tumor local control (LC) was evaluated by Response Evaluation Criteria in Solid Tumors v1.1. Treatment-related toxicities were graded by Common Terminology Criteria for Adverse Events v5.0, with adverse events less than 90 days defined as acute, and those occurring later were defined as late. LC, progression-free survival (PFS), and overall survival (OS) rates were estimated by the Kaplan–Meier method. Results Of 37 treated tumors, 88% were metastatic. Tumor location was central and ultra-central in 24.3% and 54.1%, respectively. Average tumor volume was 11.6 cm3 (SD 12.4, range 0.57–62.8). Median follow-up was 19 months (range 3–48). Two–year LC, PFS, and OS were 96.2%, 29.7%, and 65.5%, respectively. Thirteen of 39 (33.3%) catheter implantation procedures were associated with trace minor pneumothorax requiring no intervention, 1 (2.5%) procedure with minor radiographic pulmonary hemorrhage, and 4 (10.3%) with major pneumothorax requiring chest tube insertions. All procedural complications resolved within 24 h from treatment. Acute grade 1–2 toxicity was identified in 4 patients, whereas none developed late toxicity beyond 90 days of follow-up. Conclusion Percutaneous HDR brachyablation is a safe and promising treatment option for centrally located primary and metastatic lung tumors. Future comparisons with stereotactic body radiotherapy and other ablative techniques are warranted to expand multi-disciplinary management options.

High-dose-rate endobronchial brachytherapy in the management of advanced lung cancer - comparison according to the presence of lung atelectasis

“…Comparing our results to those obtained by other authors describing the application of palliative endoscopy procedures such as laser therapy, electrocautery, diathermy, electrocoagulation, phototherapy, cryotherapy, endobronchial stent insertion, and combinations of these techniques, similar results have been obtained regarding the OS of the patients with a central airway obstruction (CAO) [20][21][22][23]. Future comparisons with stereotactic body radiotherapy and other ablative techniques are warranted to expand multi-disciplinary management options [24].…”

Salvage percutaneous high-dose-rate brachyablation after stereotactic body radiation therapy for early-stage non-small cell lung cancer

“…Secondary treatment options for isolated primary tumor site progression after SBRT include salvage lung resection, re-irradiation with external beam radiation therapy (EBRT), or percutaneous ablative procedures (cryotherapy, microwave ablation, radio-frequency ablation) [ 6 , 7 ]. A more novel approach is percutaneous high-dose-rate (HDR) brachyablation that is a minimally invasive treatment involving implantation of temporary catheters into lung tumors to deliver high doses of radiotherapy in a single fraction with minimal exposure of previously irradiated tissues [ 8 , 9 ].…”

Single-fraction high-dose-rate brachytherapy: a scoping review on outcomes and toxicities for all disease sites

“…Eleven published studies met the inclusion criteria in assessing the efficacy of single-fraction high-dose brachytherapy for cancers other than prostate, breast, and liver. The studies were published by groups in the following locations: 4 from the USA, 3 from Germany, 1 from Italy, 1 from the United Kingdom, 1 from China, and 1 from Spain [43][44][45][46][47][48][49][50][51][52][53]. Table 4 summarizes the oncological outcomes and toxicities for these eleven publications.…”

“…Amongst these studies, lung appears to have promising data. Yoon et al reported on 23 patients treated with 21.5 Gy single-fraction HDR brachytherapy, with local control of 96% at 2 years for centrally located primary and metastatic lung cancer, and no G3 or higher toxicities were reported [52]. Xiang et al also reported on single-fraction HDR lung brachytherapy in a phase I clinical trial.…”

“…Yoon et al . reported on 23 patients treated with 21.5 Gy single-fraction HDR brachytherapy, with local control of 96% at 2 years for centrally located primary and metastatic lung cancer, and no G3 or higher toxicities were reported [ 52 ]. Xiang et al .…”