Advertisement

American Brachytherapy Society consensus guidelines for thoracic brachytherapy for lung cancer

Published:November 07, 2015DOI:https://doi.org/10.1016/j.brachy.2015.09.006

      Abstract

      Purpose

      To update brachytherapy recommendations for pretreatment evaluation, treatment, and dosimetric issues for thoracic brachytherapy for lung cancer.

      Methods and Materials

      Members of the American Brachytherapy Society with expertise in thoracic brachytherapy updated recommendations for thoracic brachytherapy based on literature review and clinical experience.

      Results

      The American Brachytherapy Society consensus guidelines recommend the use of endobronchial brachytherapy for disease palliation in patients with central obstructing lesions, particularly in patients who have previously received external beam radiotherapy. The use of interstitial implants after incomplete resection may improve outcomes and provide enhanced palliation. Early reports support the use of CT-guided intratumoral volume implants within clinical studies. The use of brachytherapy routinely after sublobar resection is not generally recommended, unless within the confines of a clinical trial or a registry.

      Conclusions

      American Brachytherapy Society recommendations for thoracic brachytherapy are provided. Practitioners are encouraged to follow these guidelines and to develop further clinical trials to examine this treatment modality to increase the evidence base for its use.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Brachytherapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cancer Facts and Figures 2013. American Cancer Society
        (Available at:) (Accessed December 27, 2013)
        • Tscheikuna J.
        • Disayabutr S.
        • Kakanaporn C.
        • et al.
        High dose rate endobronchial brachytherapy (HDR-EB) in recurrent benign complex tracheobronchial stenosis: experience in two cases.
        J Med Assoc Thai. 2013; 96: S252-S256
        • Meyer A.
        • Warszawski-Baumann A.
        • Baumann R.
        • et al.
        HDR brachytherapy: an option for preventing nonmalignant obstruction in patients after lung transplantation.
        Strahlenther Onkol. 2012; 188: 1085-1090
        • Allen A.M.
        • Abdelrahman N.
        • Silvern D.
        • et al.
        Endobronchial brachytherapy provides excellent long-term control of recurrent granulation tissue after tracheal stenosis.
        Brachytherapy. 2012; 11: 322-326
        • Dagnault A.
        • Ebacher A.
        • Vigneault E.
        • et al.
        Retrospective study of 81 patients treated with brachytherapy for endobronchial primary tumor or metastasis.
        Brachytherapy. 2010; 9: 243-247
        • Mantz C.A.
        • Dosoretz D.E.
        • Rubenstein J.H.
        • et al.
        Endobronchial brachytherapy and optimization of local disease control in medically inoperable non-small cell lung carcinoma: a matched-pair analysis.
        Brachytherapy. 2004; 3: 183-190
        • Rochet N.
        • Hauswald H.
        • Stoiber E.M.
        • et al.
        Primary radiotherapy with endobronchial high-dose-rate brachytherapy boost for inoperable lung cancer: long-term results.
        Tumori. 2013; 99: 183-190
        • Lee W.
        • Daly B.D.
        • DiPetrillo T.A.
        • et al.
        Limited resection for non-small cell lung cancer: observed local control with implantation of I-125 brachytherapy seeds.
        Ann Thorac Surg. 2003; 75: 237-242
        • Hilaris B.S.
        • Martini N.
        Interstitial brachytherapy in cancer of the lung: a 20 year experience.
        Int J Radiat Oncol Biol Phys. 1979; 5: 1951-1956
        • Hilaris B.S.
        • Dattatreyudu N.
        • Beattie Jr., E.J.
        • et al.
        Value of perioperative brachytherapy in the management of non-oat cell carcinoma of the lung.
        Int J Radiat Oncol Biol Phys. 1983; 9: 1161-1166
        • Hilaris B.S.
        • Gomez J.
        • Nori D.
        • et al.
        Combined surgery, intraoperative brachytherapy and postoperative external radiation in stage III non-small cell lung cancer.
        Cancer. 1985; 55: 1226-1231
        • Aye R.W.
        • Mate T.P.
        • Anderson H.N.
        • et al.
        Extending the limits of lung cancer resection.
        Am J Surg. 1993; 165: 572-576
        • Chen A.
        • Galloway M.
        • Landreneau R.
        • et al.
        Intraoperative 125I brachytherapy for high-risk stage I non-small cell lung carcinoma.
        Int J Radiat Oncol Biol Phys. 1999; 44: 1057-1063
        • D'Amato T.A.
        • Galloway M.
        • Szydlowski G.
        • et al.
        Intraoperative brachytherapy following thoracoscopic wedge resection of stage I lung cancer.
        Chest. 1998; 114: 1112-1115
        • Fernando H.C.
        • Santos R.S.
        • Benfield J.R.
        • et al.
        Lobar and sublobar resection with and without brachytherapy for small stage IA non-small cell lung cancer.
        J Thorac Cardiovasc Surg. 2005; 129: 261-267
        • Fleischman E.H.
        • Kagan A.R.
        • Streeter O.E.
        • et al.
        Iodine 125 interstitial brachytherapy in the treatment of carcinoma of the lung.
        J Surg Oncol. 1992; 49: 25-28
        • Santos R.
        • Colonias A.
        • Parda D.
        • et al.
        Comparison between sublobar resection and 125Iodine brachytherapy after sublobar resection in high-risk patients with stage I non small cell lung cancer.
        Surgery. 2003; 134: 691-697
        • Voynov G.
        • Heron D.E.
        • Lin C.J.
        • et al.
        Intraoperative 125I vicryl mesh brachytherapy after sublobar resection for high-risk stage I non-small cell lung cancer.
        Brachytherapy. 2005; 4: 278-285
        • Rogers C.L.
        • Theodore N.
        • Dickman C.A.
        • et al.
        Surgery and permanent 125I seed paraspinal brachytherapy for malignant tumors with spinal cord compression.
        Int J Radiat Oncol Biol Phys. 2002; 54: 505-513
        • Armstrong J.G.
        • Fass D.F.
        • Bains M.
        • et al.
        Paraspinal tumors: techniques and results of brachytherapy.
        Int J Radiat Oncol Biol Phys. 1991; 20: 787-790
        • Stewart A.J.
        • O'Farrell D.
        • Mutyala S.
        • et al.
        Case reports to describe toxicity resulting from permanent radioactive seed implantation for mediastinal carcinoid tumor.
        Brachytherapy. 2007; 6: 58-61
        • Birdas T.J.
        • Koehler R.P.M.
        • Colonias A.
        • et al.
        Sublobar resection with brachytherapy versus lobectomy for stage IB nonsmall cell lung cancer.
        Ann Thorac Surg. 2006; 81: 434-439
        • Heelan R.T.
        • Hilaris B.S.
        • Anderson L.L.
        • et al.
        Lung tumors: percutaneous implantation of I-125 sources with CT treatment planning.
        Radiology. 1987; 164: 735-740
        • Parashar B.
        • Wernicke A.G.
        • Pavese A.
        • et al.
        Cesium-131 permanent seed brachytherapy: dosimetric evaluation and radiation exposure to surgeons, radiation oncologists, and staff.
        Brachytherapy. 2011; 10: 508-513
        • Parashar B.
        • Arora S.
        • Christos P.
        • et al.
        Comparison of wedge resection versus wedge resection plus Cesium-131 brachytherapy versus stereotactic body radiation therapy in management of early stage lung cancer patients that are not candidates for a standard lobectomy.
        Int J Radiat Oncol Biol Phys. 2013; 87: S203-S204
        • Nag S.
        • Abitbol A.A.
        • Anderson L.L.
        • et al.
        Consensus guidelines for high dose rate remote brachytherapy in cervical, endometrial, and endobronchial tumors. Clinical Research Committee, American Endocurietherapy Society.
        Int J Radiat Oncol Biol Phys. 1993; 27: 1241-1244
        • Nag S.
        • Kelly J.F.
        • Horton J.L.
        • et al.
        Brachytherapy for carcinoma of the lung.
        Oncology. 2001; 15: 371-381
        • Yankauer S.
        Two cases of lung tumor treated bronchoscopically.
        NY Med J. 1922; 21: 741
        • Rodrigues G.
        • Videtic G.M.
        • Sur R.
        • et al.
        Palliative thoracic radiotherapy in lung cancer: an American Society for Radiation Oncology evidence-based clinical practice guideline.
        Pract Radiat Oncol. 2011; 1: 60-71
        • Langendijk H.
        • de Jong J.
        • Tjwa M.
        • et al.
        External irradiation versus external irradiation plus endobronchial brachytherapy in inoperable non-small cell lung cancer: a prospective randomized study.
        Radiother Oncol. 2001; 58: 257-268
        • Kishi K.
        • Yoshimasu T.
        • Shirai S.
        • et al.
        Usefulness of mini-tracheostomy and torque controlled insertion of applicator in fractionated endobronchial brachytherapy.
        Br J Radiol. 2006; 79: 522-525
        • van Eijkeren M.
        • Thienpont M.
        • Boterberg T.
        • et al.
        Implementation, uptime, and safety of a pulsed dose rate afterloading machine.
        Int J Radiat Oncol Biol Phys. 1996; 36: 1233-1237
        • Liu L.
        • Bassano D.A.
        • Prasad S.C.
        • et al.
        On the use of C-arm fluoroscopy for treatment planning in high dose rate brachytherapy.
        Med Phys. 2003; 30: 2297-2302
        • Hara R.
        • Itami J.
        • Aruga T.
        • et al.
        Risk factors for massive haemoptysis after endobronchial brachytherapy in patients with tracheobronchial maliganacies.
        Cancer. 2001; 92: 2623-2627
        • Sawicki M.
        • Kazalski D.
        • Lyczek J.
        • et al.
        The evaluation of treatment plans in high-dose-rate endobronchial brachytherapy by utilizing 2D and 3D computed tomography imaging methods.
        J Contemp Brachytherapy. 2014; 6: 289-292
        • Kennedy M.P.
        • Jimenez C.A.
        • Chang J.
        • et al.
        Optimisation of bronchial brachytherapy catheter placement with a modified airway stent.
        Eur Respir J. 2008; 31: 902-903
        • Marsiglia H.
        • Baldeyrou P.
        • Lartigau E.
        • et al.
        High-dose-rate brachytherapy as sole modality for early-stage endobronchial carcinoma.
        Int J Radiat Oncol Biol Phys. 2000; 47: 665-672
        • Gay H.A.
        • Allison R.R.
        • Downie G.H.
        • et al.
        Toward endobronchial Ir-192 high-dose-rate brachytherapy therapeutic optimization.
        Phys Med Biol. 2007; 52: 2987-2999
        • Lyczek J.
        • Kazalski D.
        • Kowalik L.
        • et al.
        Comparison of the GTV coverage by PTV and isodose of 90% in 2D and 3D planning during endobronchial brachytherapy in the palliative treatment of patients with advanced lung cancer. Pilot study.
        J Contemp Brachytherapy. 2012; 4: 113-115
        • Oh M.
        • Wang Z.
        • Malhotra H.K.
        • et al.
        Impact of surface curvature on dose delivery in intraoperative high-dose-rate brachytherapy.
        Med Dosim. 2009; 34: 63-74
        • Li X.A.
        • Chibani O.
        • Greenwald B.
        • et al.
        Radiotherapy dose perturbation of metallic esophageal stents.
        Int J Radiat Oncol Biol Phys. 2002; 54: 1276-1285
        • Sutherland J.G.H.
        • Miksys N.
        • Furutani K.M.
        • et al.
        Metallic artefact mitigation and organ-constrained tissue assignment for Monte-Carlo calculations of permanent implant lung brachytherapy.
        Med Phys. 2014; 41: 011712
        • Skowronek J.
        • Kubaszewska M.
        • Kanikowski M.
        • et al.
        HDR endobronchial brachytherapy (HDRBT) in the management of advanced lung cancer—comparison of two different dose schedules.
        Radiother Oncol. 2009; 93: 436-440
        • Niemoeller O.M.
        • Pöllinger B.
        • Niyazi M.
        • et al.
        Mature results of a randomized trial comparing two fractionation schedules of high dose rate endoluminal brachytherapy for the treatment of endobronchial tumors.
        Radiat Oncol. 2013; 7: 8
        • Mallick I.
        • Sharma S.C.
        • Behera D.
        • et al.
        Optimization of dose and fractionation of endobronchial brachytherapy with or without external radiation in the palliative management of non-small cell lung cancer: a prospective randomized study.
        J Cancer Res Ther. 2006; 2: 119-125
        • Stout R.
        • Barber P.
        • Burt P.
        • et al.
        Clinical and quality of life outcomes in the first United Kingdom randomized trial of endobronchial brachytherapy (intraluminal radiotherapy) vs. external beam radiotherapy in the palliative treatment of inoperable non-small cell lung cancer.
        Radiother Oncol. 2000; 56: 323-327
        • Chella A.
        • Ambrogi M.C.
        • Ribechini A.
        • et al.
        Combined Nd-YAG laser/HDR brachytherapy versus Nd-YAG laser only in malignant central airway involvement: a prospective randomized study.
        Lung Cancer. 2000; 27: 169-175
        • Ferstl A.
        • Fischer R.
        • Hautmann H.
        • et al.
        Simultaneous chemotherapy and high dose rate brachytherapy (HDRBT) in the treatment of locally advanced non-small cell lung cancer.
        Eur Respir J. 1997; 10: 198
        • Reveiz L.
        • Rueda J.R.
        • Cardona A.F.
        Palliative endobronchial brachytherapy for non-small cell lung cancer.
        Cochrane Database Syst Rev. 2012; 12: CD004284
        • Skowronek J.
        • Piorunek T.
        • Kanikowski M.
        • et al.
        Definitive high-dose-rate endobronchial brachytherapy of bronchial stump for lung cancer after surgery.
        Brachytherapy. 2013; 12: 560-566
        • Rodrigues G.
        • Macbeth F.
        • Burmeister B.
        • et al.
        International practice survey on palliative lung radiotherapy: Third International Consensus Workshop on Palliative Radiotherapy and Symptom Control.
        Clin Lung Cancer. 2012; 13: 225-235
        • Pollinger B.
        • Huber R.M.
        • Fischer R.
        • et al.
        Prospective randomised trial on the role of HDR brachytherapy in addition to external beam radiotherapy for central bronchial carcinoma.
        Int J Radiat Oncol Biol Phys. 1996; 36: 208
        • Huber R.M.
        • Fischer R.
        • Hautmann H.
        • et al.
        Does additional brachytherapy improve the effect of external irradiation? A prospective, randomized study in central lung tumors?.
        Int J Radiat Oncol Biol Phys. 1997; 38: 533-540
        • Rosenzweig K.E.
        • Chang J.Y.
        • Chetty I.J.
        • et al.
        ACR appropriateness criteria nonsurgical treatment for non-small-cell lung cancer: poor performance status or palliative intent.
        J Am Coll Radiol. 2013; 10: 654-664
        • Moghissi K.
        • Bond M.G.
        • Sambrook R.J.
        • et al.
        Treatment of endotracheal or endobronchial obstruction by non-small cell lung cancer: lack of patients in an MRC randomized trial leaves key questions unanswered. Medical Research Council Lung Cancer Working Party.
        Clin Oncol. 1999; 11: 179-183
        • Dale R.G.
        • Jones B.
        The clinical radiobiology of brachytherapy.
        Br J Radiol. 1998; 71: 465-483
        • Shi S.
        • Yang J.
        • Sun D.
        CT-guided 125I brachytherapy on pulmonary metastases after resection of colorectal cancer: a report of six cases.
        Oncol Lett. 2015; 9: 375-380
        • Stewart A.J.
        • Mutyala S.
        • Holloway C.L.
        • et al.
        Intra-operative seed placement for thoracic malignancy-a review of technique, indications and published literature.
        Brachytherapy. 2009; 8: 63-69
        • Mutyala S.
        • Stewart A.
        • Khan A.J.
        • et al.
        Permanent iodine-125 interstitial planar seed brachytherapy for close or positive margins for thoracic malignancies.
        Int J Radiat Oncol Biol Phys. 2010; 76: 1114-1120
        • Wernicke A.G.
        • Parikh A.
        • Yondorf M.
        • et al.
        Lung-conserving treatment of a pulmonary oligometastasis with a wedge resection and (131)Cs brachytherapy.
        Brachytherapy. 2013; 12: 567-572
        • Fernando H.C.
        • Landreneau R.J.
        • Mandrekar S.J.
        • et al.
        Analysis of longitudinal quality-of-life data in high-risk operable patients with lung cancer: results from the ACOSOG Z4032 (Alliance) multicenter randomized trial.
        J Thorac Cardiovasc Surg. 2015; 149: 718-726
        • Fernando H.C.
        • Landreneau R.J.
        • Mandrekar S.J.
        • et al.
        Impact of brachytherapy on local recurrence rates after sublobar resection: results from ACOSOG Z4032 (Alliance), a phase III randomized trial for high-risk operable non-small-cell lung canceR.
        J Clin Oncol. 2014; 32: 2456-2462
        • Trombetta M.G.
        • Colonias A.
        • Makishi D.
        • et al.
        Tolerance of the proximal aorta using intraoperative iodine-125 intersitial brachytherapy in cancer of the lung.
        Brachytherapy. 2008; 7: 50-54
        • Martínez-Monge R.
        • Pagola M.
        • Vivas I.
        • et al.
        CT-guided permanent brachytherapy for patients with medically inoperable early-stage non-small cell lung cancer (NSCLC).
        Lung Cancer. 2008; 61: 209-213
        • Nori D.
        • Li X.
        • Pugkhem T.
        Intraoperative brachytherapy using Gelfoam radioactive plaque implants for resected stage III non-small cell lung cancer with positive margin: a pilot study.
        J Surg Oncol. 1995; 60: 257-261
        • Yang R.
        • Wang J.
        • Zhang H.
        Dosimetric study of 131Cs, I-125, and Pd-103 seeds for permanent prostate brachytherapy.
        Cancer Biother Radiopharm. 2009; 24: 701-705
        • Armpilia C.I.
        • Dale R.G.
        • Coles I.
        • et al.
        The determination of radiobiologically-optimised half-lives for radionuclides used in permanent brachytherapy implants.
        Int J Radiat Oncol Biol Phys. 2003; 55: 378-385
        • Parashar B.
        • Port J.
        • Arora S.
        • et al.
        Analysis of stereotactic radiation vs. wedge resection vs. wedge resection plus Cesium-131 brachytherapy in early-stage lung cancer.
        Brachytherapy. 2015; 14: 648-654
        • Thomadsen B.
        • Ayyangar K.
        • Anderson L.
        • et al.
        Chapter 8: brachytherapy treatment planning.
        in: Nag S. Principles and practice of brachytherapy. Wiley, Hoboken, NJ1997: 150-151
        • Johnson M.
        • Colonias A.
        • Parda D.
        • et al.
        Dosimetric and technical aspects of intraoperative I-125 brachytherapy for stage I non-small cell lung cancer.
        Phys Med Biol. 2007; 52: 1237-1245
        • Nath R.
        • Anderson L.L.
        • Luxton G.
        • et al.
        Dosimetry of interstitial brachytherapy sources: recommendations of the AAPM Radiation Therapy Committee Task Group No 43.
        Med Phys. 1995; 22: 209-234
        • Cormack R.A.
        • Holloway C.L.
        • O'Farrell D.
        • et al.
        Permanent planar iodine-125 implants: the dosimetric effect of geometric parameters for idealized source configurations.
        Int J Radiat Oncol Biol Phys. 2007; 69: 1310-1315
        • Smith R.P.
        • Schuchert M.
        • Komanduri K.
        • et al.
        Dosimetric evaluation of radiation exposure during I-125 vicryl mesh implants: implications for ACOSOG z4032.
        Ann Surg Oncol. 2007; 14: 3610-3613
        • Manchikanti L.
        • Cash K.A.
        • Moss T.L.
        • et al.
        Risk of whole body radiation exposure and protective measures in fluoroscopically guided interventional techniques: a prospective evaluation.
        BMC Anesthesiol. 2003; 3: 2
      1. National Council on Radiation Protection and Measurements, Limitation of exposure to ionising radiation, N.R.N. 116, Editor. Bethesda, MD: NCRP; 1993.

        • Smathers S.
        • Wallner K.
        • Korssjoen T.
        • et al.
        Radiation safety parameters following prostate brachytherapy.
        Int J Radiat Oncol Biol Phys. 1999; 45: 397-399
        • Michalski J.
        • Mutic S.
        • Eichling J.
        • et al.
        Radiation exposure to family and household members after prostate brachytherapy.
        Int J Radiat Oncol Biol Phys. 2003; 56: 764-768
        • Sharma D.N.
        • Rath G.K.
        • Thulkar S.
        • et al.
        Computerized tomography-guided percutaneous high-dose-rate interstitial brachytherapy for malignant lung lesions.
        J Cancer Res Ther. 2011; 7: 174-179
        • de Aquino Gorayeb M.M.
        • Gregorio M.G.
        • de Oliveira E.Q.
        • et al.
        High-dose-rate brachytherapy in symptom palliation due to malignant endobronchial obstruction: a quantitative asessment.
        Brachytherapy. 2013; 12: 471-478
        • Sur R.
        • Donde B.
        • Mohuiddin M.
        • et al.
        Randomized prospective study on the role of high dose rate intraluminal brachytherapy (HDRILBT) in palliation of symptoms in advanced non small cell lung cancer (NSCLC) treated with radiation alone.
        Int J Radiat Oncol Biol Phys. 2004; 60: S205
        • Kawamura H.
        • Ebara T.
        • Katoh H.
        • et al.
        Long-term results of curative intraluminal high dose rate brachytherapy for endobronchial carcinoma.
        Radiat Oncol. 2012; 7: 112