Sublobar resection with brachytherapy mesh for stage I non-small cell lung cancer

Lobar resection is currently the standard approach for the treatment of stage I non-small cell lung cancer. Sublobar resection is generally considered a compromise, reserved for high-risk patients because of greater rates of local recurrence compared with lobar resection. Adjuvant radiation therapy may decrease these increased local recurrence rates, but because of respiratory motion and difficulties in identifying the staple line, radiation delivery can be challenging with an external beam approach. Adjuvant intraoperative brachytherapy with the use of low-dose rate iodine-125 seeds placed alongside the surgical staple has been used with success in several centers. A randomized multicenter North American study has also recently completed accrual, but the results of this are not yet available. In the following review, we outline the techniques used, safety considerations, and currently available outcomes of sublobar resection with adjuvant brachytherapy for non-small cell lung cancer.