Salvage treatment of NSCLC recurrence after first-line chemotherapy failure: Iodine-125 seed brachytherapy or microwave ablation?

BACKGROUND

Salvage treatments for recurrent NSCLC after first-line chemotherapy remain challenging. This study was conducted to evaluate the clinical value of microwave ablation (MWA) and iodine-125 brachytherapy, including overall survival (OS), disease free survival (DFS), local control, hospital stay, and health economics.

METHODS

The data of 51 and 32 patients who were treated with MWA and brachytherapy was retrospectively analyzed. The number of lesions was limited up to two, with a diameter <4 cm and patients diagnosed with unilateral lung disease. Peripheral tumors were treated with MWA, while lesions close to the hilum were treated with brachytherapy. Contrast-enhanced CT, blood cell count, coagulation function, liver & kidney function and tumor markers were performed for two years, with complications calculated. OS, DFS, local control rate, toxicity, hospital stay and expense were recorded.

RESULTS

The one and two-year OS rates were 96.08% and 92.16% versus 96.88% and 90.62% in the MWA and brachytherapy groups, respectively. The one and two-year DFS rates were 92.16% and 76.47% versus 93.75% and 78.13%, respectively. No significant differences were observed in log-rank analysis between the groups. Local control rates at six and 12 months were 100% and 96.08% versus 100% and 96.88%, while incidences of pleural effusion were 3.92% and 3.13%, respectively (P < 0.05). Medical cost was 3356.73 ± 206.87 and 6714.28 ± 35.43 U.S. dollars (P = 0.014).

CONCLUSION

MWA and brachytherapy are effective and safe options for the treatment of NSCLC recurrence after first-line chemotherapy. Which modality should be considered is dependent upon tumor location, tumor size and experience of specialists.