Sublobar resection with I-125 brachytherapy for early-stage non-small cell lung cancer (NSCLC) using prefabricated mesh
| Autor: | M. Manning, D. P. Burney, Mohamed K. Mohamed |
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| Rok vydání: | 2009 |
| Předmět: | |
| Zdroj: | Journal of Clinical Oncology. 27:7586-7586 |
| ISSN: | 1527-7755 0732-183X |
| DOI: | 10.1200/jco.2009.27.15_suppl.7586 |
| Popis: | 7586 Background: Lobectomy is standard of care for stage I NSCLC, but it reduces pulmonary reserve. Patients with pulmonary dysfunction may tolerate curative wedge resection with a permanent I-125 mesh implant. We report results using this technique with and without a novel prefabricated mesh device. Methods: Between 7/06 and 5/08, 56 patients with clinical stage I NSCLC had wedge resection and brachytherapy. All had PET-CT staging and were ineligible for lobectomy. Median age was 72 (48–87) and median FEV-1 was 1.3 liters (0.6–3.4 liters). At surgery, a significant proportion were upstaged. Pathologic staging confirmed 60.7% to be stage IA and 23.2% stage IB. Others were IIA (3.6%), IIB (5.4%), IIIA (1.8%), IIIB (1.8%), and IV (3.6%). All implants consisted of absorbable polyglactin mesh containing a median of 40 (30–50) I-125 seeds with a median seed activity of 0.536 mCi (0.47 - 0.63 mCi). Half of the patients received mesh prepared intraoperatively, while the second half received patient-specific prefabricated mesh (BrachyMESH - Oncura). Results: The median hospital stay was 5 days. All were immediately extubated. Common toxicities included air leak delaying chest tube removal, leukocytosis, paroxysmal atrial fibrillation, and increased secretions. Two required repeat chest tube placement for subsequent pneumothorax. Two patients with severe pre-op pulmonary dysfunction (pre-op FEV-1 of 0.6 and 0.68 liters) experienced respiratory failure and expired following prolonged hospital stays. With a median follow-up of 7 months (0–23 months), overall survival is 87.5% and disease free survival is 89%. The local control was 96.4% with the intraoperative mesh and 100% with the prefabricated mesh. Conclusions: Wedge resection with permanent I-125 mesh implant is a generally well-tolerated procedure leading to acceptable early local control in patients ineligible for lobectomy. This technique may not be suitable for patients with pre-op FEV-1 < 0.7 liters; but, it provides accurate surgical staging conferring a diagnostic advantage over non-invasive treatment modalities. The prefabricated device offers similar results to manually prepared devices. No significant financial relationships to disclose. |
| Databáze: | OpenAIRE |
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