Radioactive seeds insertion with chemotherapy for advanced non-small-cell lung cancer: A meta-analysis

Non-small-cell lung cancers (NSCLCs) are only eligible to undergo curative surgical resection in <20% of patients. In patients with inoperable NSCLC, computed tomography (CT)-guided radioactive seed insertion (RSI) is a common treatment practice.

To assess the relative efficacy of chemotherapy alone versus chemotherapy in combination with CT-guided RSI in patients with advanced NSCLC.

We searched the Pubmed, Embase, and Cochrane Library databases for relevant articles published as of July 2020. Complete and total response rates (CR and TR, respectively) served as the primary endpoints for this meta-analysis, with disease control (DC) rate, myelosuppression rate, progression-free survival (PFS), overall survival (OS), and CT-guided RSI-related pneumothorax serving as secondary endpoints.

In total, eight studies incorporating 281 patients that underwent combination treatment and 297 patients that underwent chemotherapy along were included in this meta-analysis. The CR (21.5% vs. 4.0%, P < 0.00001), TR (73.8% vs. 42.6%, P < 0.00001), and DC (94.1% vs. 78.2%, P < 0.00001) rates were significantly higher for patients in the combined treatment group relative to patients in the chemotherapy only group. Furthermore, pooled PFS (P < 0.00001) and OS (P = 0.0006) were significantly longer for patients in the combined treatment group, whereas no differences in pooled myelosuppression rates were observed between groups (34.3% vs. 30.7%, P = 0.47). The pooled rate of CT-guided RSI-related pneumothorax was 15%.

Combination chemotherapy and CT-guided RSI can significantly improve clinical response and prolong survival in advanced-stage NSCLC patients without inducing other significant toxic side effects.