Impact of target area selection in ¹²⁵ Iodine seed brachytherapy on locoregional recurrence in patients with non‐small cell lung cancer

Abstract

Background

Computed tomography (CT)‐guided percutaneous implantation of ¹²⁵Iodine radioactive seeds requires the precise arrangement of seeds by tumor shape. We tested whether selecting target areas, including subclinical areas around tumors, can influence locoregional recurrence in patients with non‐small cell lung cancer ( NSCLC).

Method

We divided 82 patients with NSCLC into two groups. Target areas in group 1 ( n = 40) were defined along tumor margins based on lung‐window CT. Target areas in group 2 ( n = 42) were extended by 0.5 cm in all dimensions outside tumor margins. Preoperative plans for both groups were based on a treatment plan system, which guided ¹²⁵ I seed implantation. Six months later, patients underwent chest CT to evaluate treatment efficacy (per Response Evaluation Criteria in Solid Tumors version 1). We compared locoregional recurrences between the groups after a year of follow‐up. We then used the treatment plan system to extend target areas for group 1 patients by 0.5 cm (defined as group 3 data) and compared these hypothetical group 3 planned seeds with the actual seed numbers used in group 1 patients.

Results

All patients successfully underwent implantation; none died during the follow‐up period. Recurrence was significantly lower in group 2 than in group 1 ( P  < 0.05). Group 1 patients and group 3 data significantly differed in seed numbers ( P  < 0.01).

Conclusion

Our results imply that extending the implantation area for ¹²⁵ I seeds can decrease recurrence risk by eradicating cancerous lymph‐duct blockades within the extended areas.