Radioactive Seed Therapy Shows Significant Reduction In Lung Cancer Recurrence

Main Category: Lung Cancer
Also Included In: Radiology / Nuclear Medicine;  Clinical Trials / Drug Trials
Article Date: 24 Sep 2008 - 0:00 PDT

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Radiation oncologists at Allegheny General Hospital (AGH) in Pittsburgh will report to the American Society for Therapeutic Radiology and Oncology (ASTRO) in Boston that a newer, minimally invasive approach to treating high risk patients with Stage I non-small cell lung carcinoma (NSCLC) may significantly reduce the risk of local disease recurrence.

Developed at AGH over the past decade, the procedure involves removing only the cancerous section of the lung and enveloping the surgical site in a mesh material that is embedded with radioactive seeds. The seeds emit a low dose of radiation over a prolonged period of time in an effort to eradicate any remaining cancer cells.

Lung cancer is the leading cause of cancer death in the United States. Non-small cell lung carcinoma is the most common form of the disease, accounting for an estimated 85% of all cases. Stage I NSCLC is characterized by disease that is localized in the lung with no metastasis to the lymph node system.

"The standard of care for patients with this particular disease is a lobectomy, or surgical removal of the entire lobe of the lung. Many patients, however, are considered high risk for this procedure due to cardiopulmonary complications or other co-morbidities. In these cases, sublobar wedge resection is a more tolerable approach, but one that carries a much higher chance of local cancer recurrence," said Athanasios Colonias, MD, an AGH radiation oncologist and the study's principal investigator.

"Our study suggests that when intraoperative 125I Vicryl(R) mesh brachytherapy is added to sublobar resection, the local treatment failure rate is substantially reduced," Dr. Colonias said.

Dr. Colonias and his AGH colleagues examined the outcomes of 145 high-risk patients with Stage I NSCLC who underwent sublobar resection (SLR) with adjuvant intraoperative mesh brachytherapy between January 1996 to February 2008. Local treatment failure was defined as a cancer recurrence within the involved lobe.

At a median follow-up of 38 months, the AGH team documented just six local recurrences (4.1%) with the group, compared to an expected cancer recurrence rate of 20% with SLR only based on previously published data. No patient/tumor specific factors (age, histology, gender, stage, location of tumor, tumor size) or surgical/dosimetric factors (margin status, open vs. video assisted approach, total activity, number of seeds, dose prescribed, target area) were predictive of local recurrence. All of the procedures were well tolerated by patients with regard to pulmonary function and morbidity.

"Of the more than 150,000 people diagnosed each year with lung cancer, less than 20% are identified with disease in its earliest and most curable stage. For high risk patients, however, even a Stage I diagnosis poses significant therapeutic challenges and generally poor odds of a long-term recovery. It would appear that those odds may be improved considerably by combining sublobar resection with intraoperative mesh brachytherapy," said Robert Keenan, M.D., director of AGH's Center for Thoracic Surgery.

Dr. Keenan said a large, randomized multi-center clinical trial of SLR +/- brachytherapy is currently underway and will more definitively establish the efficacy of the procedure. The study is being coordinated by the American College of Surgeons Oncology Group and involves more than a dozen major U.S. Hospitals, including AGH.

Allegheny General Hospital
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