Minimally invasive rib-sparing video-assisted thoracoscopic surgery resections with high-dose-rate intraoperative brachytherapy for selected chest wall tumors
| Autor: | Daniel J. Bourgeois, J. Gomez, Todd L. Demmy, Harish K. Malhotra, Mark Hennon, Sai Yendamuri, L Kumaraswamy, Iris Z. Wang |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Lung Neoplasms Pleural effusion medicine.medical_treatment Pleural Neoplasms Brachytherapy Ribs Soft Tissue Neoplasms 030204 cardiovascular system & hematology 03 medical and health sciences Pneumonectomy 0302 clinical medicine Carcinoma Non-Small-Cell Lung Medicine Humans Minimally Invasive Surgical Procedures Radiology Nuclear Medicine and imaging Thoracic Wall Rib cage Intraoperative Care business.industry Thoracic Surgery Video-Assisted Margins of Excision medicine.disease Chest Wall Pain Surgery medicine.anatomical_structure Oncology Cardiothoracic surgery 030220 oncology & carcinogenesis Video-assisted thoracoscopic surgery Radiology business Organ Sparing Treatments Thoracic wall |
| Zdroj: | Practical radiation oncology. 6(6) |
| ISSN: | 1879-8519 |
| Popis: | Background By avoiding chest wall resection, iridium-192 (Ir-192) high-dose-rate (HDR) intraoperative brachytherapy (IOBT) and video-assisted thoracoscopic surgery (VATS) might improve outcomes for high-risk patients requiring surgical resection for pulmonary malignancy with limited pleura and/or chest wall involvement. Methods and materials Seven patients with non-small cell lung cancer involving the pleura or chest wall underwent VATS pulmonary resections combined with HDR IOBT. After tumor extraction, an Ir-192 source was delivered via a Freiburg applicator to intrathoracic sites with potential for R1-positive surgical margins. The number of catheters, dwell position along each catheter, prescription depth, and dose were customized based on clinical needs. Results Six patients had pT3N0M0 non-small cell lung cancers. A seventh case was a recurrent sarcomatoid carcinoma. One case required conversion to open thoracotomy for pneumonectomy with en bloc chest wall resection. There were no intraoperative complications and average operative time was 5.8 hours. Five of seven patients without transmural chest wall involvement underwent rib-sparing resection. Four of the 6 patients treated with VATS and IORT remain alive in follow-up without evidence of local recurrence (median follow-up, 25 months). Noted toxicities were recurrent postoperative pneumothorax, pleural effusion with persistent chest wall pain, avid fibrosis at 2 years of follow-up, and a late traumatic rib fracture. Conclusions HDR IOBT with Ir-192 via VATS is technically feasible and safe for intrathoracic disease with pleural and/or limited chest wall involvement. Short-term morbidity associated with chest wall resection may be reduced. Additional study is required to define long-term benefits. |
| Databáze: | OpenAIRE |
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