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GRACE :: Radiation Oncology

“Brachytherapy” for Lung Cancer

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There some patients with early stage lung cancer that are not good candidates for standard lung surgery because of their underlying poor lung function. A standard lung surgery typically involves removing the entire lobe of the lung that contains the cancer. Unfortunately, for some patients with underlying COPD or emphysema – they can’t afford to lose a complete lobe of the their lung. In this situation, some surgeons have performed more limited surgery including doing a “sub-lobar” resection. The results for patients who have this limited surgical resection are not nearly as good as patients that have a complete lobectomy. In some series, the incidence of local recurrence can be as high as 20-40% if only a limited surgery is performed. The problem with these limited surgeries is that the surgeon often leaves microscopic disease behind along the edges of the surgical specimen. In other tumor types, the surgical margins are evaluated carefully and more tissue is often resected if the margins are involved. In lung cancer, evaluation the margins from the surgery specimen is more difficult, and the incidence of additional microscopic cells left in the area around the resection is probably quite high. This probably explains while the recurrence rate for small tumors is quite low with a conventional lobectomy, and much higher when less tissue is removed in a sub-lobar resection.

Brachytherapy means the use of locally placed radiation. In this case, radioactive seeds are placed in and around the surgical suture line after the surgery is complete. These seeds are sewed into the lung tissue or sewed into a mesh fabric that is then placed on the lung in the area that is at highest risk.

Brachy mesh (Click to enlarge)

Below is a model with seeds, and then CT image of the radiation to a region in the patient being modeled:

Model with seeds

4 view with dose color wash

The seeds are left there permanently. They deliver a small dose of radiation just in the vicinity of the where they are placed. Early studies have suggested that the placement of these seeds after a sublobar resection can considerably reduce the risk of recurrence of lung cancer. There doesn’t appear to be many side effects experienced by the patient who undergoes this procedure, so overall it appears relatively safe. There are some specific radiation precautions that must be taken. Studies have looked at lung function following the brachytherapy, and the brachytherapy doesn’t appear to reduce lung function.

There is an open study which is randomly allocating patients to a sub-lobar resection or a sub-lobar resection plus brachytherapy. It is hoped that this study will convincingly answer the question of whether this procedure reduces the risk of recurrence.


3 Responses to “Brachytherapy” for Lung Cancer

  • foxy says:

    Dr Mehta:
    Thank you so much for explaining how this works. You made it really easy to understand. Can this same procedure be used to further shrink non-resectable, existing tumors after standard radiation and chemotherapy?
    Thanks for your time. You are wonderful.
    Foxy

  • Dr. Mehta says:

    Brachytherapy (meaning the local placement of radiation seeds) is typically best used if you can place the radiation directly in the vicinity of the cancer. These radioactive seeds don’t give off much radiation and their “effective” treatment distance isn’t very far. It is ideally suited for use after sugery because you can place the seeds near the surgical scar (where the two affected tissues are brought together). It also makes sense to put seeds directly in or near a tumor that is causing local symptoms. We sometimes use this technique to treat a tumor that is growing inside of a bronchus and causing either cough or breathing difficulty.

    Generally speaking it is difficult to try to use brachytherapy to treat a large tumor or a tumor with multiple sites because you would need a large number of seeds to cover the entire area at risk.

    The idea of using brachytherapy as a supplment to external beam radiation and chemotherapy has been discussed and attempted. One of the advantages to brachytherapy is that the radiation is delivered from the “inside out” and since the radiation dose weakens as it proceeds — this approach may have less adverse effect on normal tissues than beams that are being aimed from the “outside in” that are traversing a large amount of normal tissues on their way to the target. Sometimes a patient will be discovered to be unresectable in the operating room, and we occasionally will try to implant the tumor directly at that time. This represents one case where we try to further shrink an unresectable tumor.

    I hope this answers your question.

    Vivek

  • foxy says:

    Yes sir, it does answer my question. Thank you very much. My RUL tumor is indeed blocking the bronchus and I keep having chronic consolidated infections in that area. That plus radiation damage to that lung, e.g. possible fistula to the pleural space are holding me back as far as making great progress is concerned.And it is hard to be on continuous antibiotics and steroids to combat infection/inflammation. Brachy therapy has been mentioned as a possible avenue. I am very willing to try it. Would you reccommend it?
    Thank you,
    Foxy

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