The Clinical Value of Computed Tomography (CT)-Guided 125I Brachytherapy for Locally Advanced Non-Small Cell Lung Cancer After Progression of Concurrent Radiochemotherapy

Zhanwang Xiang,1,&ast; Zhihui Zhong,2,&ast; Luwen Mu,1 Guohong Li,3 Churen Zhou,1 Haofan Wang,1 Mingsheng Huang1 1Interventional Radiology Program, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, People’s Republic of China; Guangdong Provincial Key Lab of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, People’s Republic of China; 2Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People’s Republic of China; 3Department of Radiology, Guangdong Second Provincial General Hospital, Guangdong Provincial Emergency Hospital, Guangzhou, 510000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Mingsheng Huang; Haofan WangInterventional Radiology Program, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People’s Republic of China; Guangdong Provincial Key Lab of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, People’s Republic of ChinaEmail huangmsh@mail.sysu.edu.cn; wanghaof@mail.sysu.edu.cnPurpose: To further evaluate the efficacy and safety of computed tomography (CT)-guided iodine 125 (125I) brachytherapy to treat locally advanced non-small cell lung cancer (NSCLC) after progression of concurrent radiochemotherapy (CCRT).Methods: This study obtained written consent from all patients and was approved by our institution. From January 2006 to June 2018, 210 NSCLC patients (progression of first-line CCRT) were retrospectively recruited and then divided into two groups. A total of 116 patients were given CT-guided 125I brachytherapy and second-line chemotherapy (group A), and 94 were treated with second-line chemotherapy alone (group B).Results: In group A, local response rate (LRR) within 3 years was significantly better (P< 0.05). Mean survival time [progression-free survival time (PFST) and overall survival (OS)] was 15.1± 1.4 months and 21.2± 1.6 months in group A compared with 10.0± 1.4 months and 16.2± 1.7 months in group B (PFST: P< 0.01, HR=1.472, 95% CI 1.097– 1.975; OS: P = 0.036, HR=1.342, 95% CI 1.005– 1.791). Tumor size and No. of first cycle chemotherapy were independent factors that affected survival, ≤ 3cm largest tumor diameter and more than 4 first cycles of chemotherapy showed longer PFST and OS (P< 0.05). Tumor-related clinical symptoms were relieved in group A (P< 0.01). No serious complications occurred in the two groups.Conclusion: 125I brachytherapy is effective and safe in locally advanced NSCLC after progression of CCRT.Keywords: 125I, brachytherapy, NSCLC, concurrent radiochemotherapy, efficacy, safety