Intraoperative (125)I Vicryl mesh brachytherapy after sublobar resection for high-risk stage I non-small cell lung...

To assess the feasibility and outcomes of (125)I Vicryl mesh brachytherapy after sublobar resection in stage I non small cell lung cancer (NSCLC) patients with poor pulmonary function.

Between January 1997 and July 2004, patients with poor cardiopulmonary reserve who had stage IA and IB (T1-2 N0 M0) NSCLC and a forced expiratory volume in 1s (FEV(1)) of > micro=0.6L were considered for limited surgical resection either by an open or video-assisted thoracoscopic procedure and for a subsequent (125)I Vicryl mesh brachytherapy implant. Mediastinal and hilar lymph node staging was performed routinely in all patients. After clear margins were obtained grossly and on frozen section, a single-plane (125)I implant was designed to encompass a plane consisting of the staple line and a 2-cm margin of surrounding visceral pleura. The implant was introduced through the surgical incision and sutured to the visceral pleura. A prescribed dose of 100-120 y was delivered to a volume within 0.5 cm rom the plane of the implant. Follow-up orthogonal films or CTs were obtained for dosimetric analysis. Kaplan-Meier analyses were used to estimate the local control, locoregional control, and overall survival rates.

Of the 110 patients, 65 had stage IA and 45 had stage IB NSCLC. The mean preoperative FEV(1) was 47% of the predicted volume. With a median follow-up of 11 months (range 1-68 months), there were four recurrences within the radiation volume. The estimated 5-year local (in-field) control, locoregional control, and overall survival rates were 90%, 61%, and 18%, respectively.

Vicryl mesh brachytherapy after sublobar resection for high-risk stage I NSCLC patients is a feasible procedure, which results in an excellent local (in-field) control rate.