Evaluation of 192Ir-Based Hypofractionated Stereotactic Ablative Brachytherapy as A Neoadjuvant Treatment for Operable Peripheral Non-small Cell Lung Cancer

Abstract

Objective To evaluate the safety, feasibility and efficacy of template-assisted 192Ir-based hypofractionated stereotactic ablative brachytherapy (SABT) combined with surgery for peripheral non-small cell lung cancer (NSCLC) patients. Methods We enrolled the patients who were pathologically confirmed as operable peripheral NSCLC. The patients underwent template-assisted SABT (30 Gy delivered in one fraction) and were scheduled for tumor resection 4-6 weeks after SABT. The perioperative adverse reactions of SABT were recorded to evaluate the safety and feasibility of SABT as a neoadjuvant therapy. Imaging with 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) and dynamic contrast-enhanced computed tomography (DCECT) were scheduled before SABT and surgery to evaluate the efficacy of SABT by comparing the gross tumor volume, maximum standardized uptake value, tumor blood volume and tumor blood flow. Results All patients did not experience any serious adverse event. After 4-6 weeks, the indicators for the efficacy of neoadjuvant therapy significantly decreased in all patients: gross tumor volume (P < 0.001), maximum standardized uptake value (P < 0.001), tumor blood volume (P < 0.001) and tumor blood flow (P=0.009). Conclusion The efficacy of template-assisted SABT as a neoadjuvant therapy is significant in operable peripheral NSCLC patients, without any serious adverse reaction.

Keywords

• brachytherapy
• neoadjuvant
• non-small cell lung cancer
• safety
• efficacy