CT-guided high-dose-rate interstitial brachytherapy for malignant lung lesions in a resource-limited setting

Several nonsurgical techniques are available for the management of inoperable primary and metastatic lung diseases. While Stereotactic body radiotherapy is a well-established technique, its access in low and middle-income countries (LMICs) is restricted. This study aims to present our experience on the feasibility of the high-dose-rate interstitial brachytherapy (IBT) in inoperable lung lesions, including technique and outcomes in LMICs.

Eleven patients/12 primary and metastatic lung lesions were treated with the IBT at a single cancer center between June 2022 and June 2024. The patients were treated by a multidisciplinary team comprising intervention radiologists, radiation oncologists, and medical oncologists. Treatment response was assessed using RECIST version 1.1.

The study cohort included 6 males and 5 females with a median age of 55 years (range, 39-75). The median volume of the lesions treated was 8.1 cc (range, 1.7-30.8). All the lesions were treated with a 20 Gy dose. The best response included complete responses in 6, partial responses in 1, stable disease in 4 and progressive disease in 1 lesion treated. The local control was 75 % for a median follow-up of 18.7 months (range, 8.3-35.9). Patients experienced no major procedural complications except self-limiting minor pneumothorax (27.3%), hemoptysis (27.3%) and fever (18.2%).

Our findings present the CT-guided IBT as an effective, safe, and minimally invasive treatment approach for patients with primary or metastatic lung lesions who pose challenges for surgery, with a good local control rate.