Chest
Volume 112, Issue 4, Supplement, October 1997, Pages 276S-286S
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Brachytherapy for Non-small Cell Lung Cancer and Selected Neoplasms of the Chest

https://doi.org/10.1378/chest.112.4_Supplement.276SGet rights and content

This article reviews the indications, techniques, and results of brachytherapy in the treatment of non-small cell lung cancer (NSCLC) and selected chest neoplasms. Various isotopes and techniques are used to place radioactive sources directly into a tumor, tumor bed, or the chest. Brachytherapy techniques can be tailored to the clinical situation and can be in the form of permanent interstitial volume or planar implants (radioactive sources permanently imbedded into the tumor or tumor bed) or in the form of temporary interstitial or endoluminal implants (where radioactive sources irradiate a tumor bed over a certain length of time and then are removed). These treatments can be delivered over a short interval (high-dose rate [HDR]) or over a more protracted time (low-dose rate). HDR treatments can be used intraoperatively to deliver a large dose of radiation to a determined target area with selective sparing of surrounding normal structures. Different methods of delivering HDR intraoperative radiation are under investigation. Most reports on brachytherapy for chest malignancies are retrospective and come from a few single institutions. Most of the published data relate to the treatment of NSCLC, but other intrathoracic malignancies, such as malignant pleural mesothelioma and malignant thymoma, have been treated with brachytherapy. To our knowledge, no major randomized trials accurately assess or confirm these retrospective studies yet, complicating the interpretation of these results. Nevertheless, brachytherapy is of value in selected situations and offers the clinician and the patient an innovative method of delivering conformal high-dose radiation to a defined target with preferential sparing of normal surrounding structures. With continued innovations in the development of radioactive isotopes, computerized treatment planning and targeting, and source delivery, brachytherapy should continue to offer an attractive alternative and complement to conventional treatment approaches, and may offer patients improved local control and survival.

Section snippets

Interstitial Permanent Volume or Planar Implantation

The optimal technique of intraoperative implantation and the selection of radioactive sources depend on the location of the tumor, the amount of residual gross disease, and the biological behavior of the tumor. When residual tumor volume exceeds 1 cm, a permanent volume implant is usually required. The area to be implanted is determined preoperatively by the surgeon and the radiation oncologist, then reevaluated intraoperatively. The dimensions are recorded. A volume nomogram is applied to

Stage I and II NSCLC

Surgical resection is widely recognized as the treatment of choice for early-stage NSCLC. Although EBRT has historically been used as an acceptable primary treatment for medically inoperable disease, the overall results have generally been inferior to surgical resection, with local control rates ranging from 20 to 90% and 5-year survival rates ranging from 10 to 50% for radiation therapy.15, 15a, 15b Dose-response data for EBRT alone for unresectable early lesions show poor local control for

Conclusion

Despite current advances in multimodality therapy for malignancies arising in the chest, a large proportion of patients develop local and/or regional failures. To improve the therapeutic ratio, radiation oncologists have attempted to develop novel strategies for delivering high-dose radiation to the tumor or tumor bed with selective sparing of surrounding normal structures. Some of these strategies include interstitial permanent and temporary implantation, LDR- and HDR-ILBRT, and intraoperative

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    Reprint requests: Adam Raben, MD, Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021

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