Computerized tomography-guided percutaneous high-dose-rate interstitial brachytherapy for malignant lung lesions

Purpose: To study the feasibility of computerized tomography (CT)-guided percutaneous high-dose-rate interstitial brachytherapy (HDRIBT) in patients with malignant lung lesions (MLL), not suitable for surgery. Materials and Methods: From June 2007 to December 2008, eight patients with MLL (primary lung carcinoma, two; solitary lung metastases, six); were enrolled in this prospective trial. All patients had either refused surgery or had been found ineligible due to comorbidities. Under CT guidance, a single stainless steel needle for lesions up to 4 cm and two needles for lesions up to 6 cm in diameter were inserted percutaneously through the intercostal space. A single dose of 20 Gy with HDRIBT was prescribed at the periphery of the lesion. The needles were removed immediately after treatment. The endpoints of the study were acute perioperative complications like pneumothorax, hemothorax, hemoptysis, and so on, and short term (six-month) tumor control. Results: There were six males and two females with a median age of 55 years. The lesion size ranged from 3.0 - 5.5 cm (median 4.0 cm). The average time taken for the interstitial brachytherapy (IBT) procedure was 50 minutes. None of the patients had fatal complications. Two patients had minor complications (one hemoptysis and one minimal pleural effusion). Six of the eight patients had more than 50% reduction in the tumor dimensions at the end of six months. Conclusions: CT-guided HDRIBT is a safe and feasible non-surgical treatment option for patients with MLL. It provides effective tumor control and needs to be studied further.