Efficacy and Safety Aiming at the Combined-Modality Therapy of External Beam Radiotherapy (40Gy) and Iodine-125 Seed Implantation for Locally Advanced NSCLC in the Elderly

Figures & data

Figure 1 The Dose Volume Histogram of lung receiving a total radiotherapy dose of 60Gy. Blue line stands for the volume of lung receiving at different dose of radiotherapy; Yellow line stands for the volume of spinal cord at different dose of radiotherapy; Green line stands for the volume of heart at different dose of radiotherapy.

Figure 2 The treatment procedure. (A) Design of the preoperative plan, lines of different colors stand for different dose which was delivered to the primary tumor. (B) Course puncturing (C) The practical distribution of iodine −125 seed. (D) postoperative dose volume histography of tumor.

Table 1 General Information of All Patients

Characteristics	Patients	Percentage
Sex
Male	14	66.7
Female	7	33.3
Age (years)	Median 68 (60–79)
ECOG score	Median 2 (0–3)
Primary tumor stage
Stage IIIA	3	14.3
Stage IIIB	18	85.7
Diameter of tumors (cm)
<5.0	4	19.0
5.0–7.0	17	81.0
Seed radioactivity	Median 0.64 (0.47–0.82)
Seed number	Median 76.4 (30–135)
Prescription dose
<140Gy	10	47.6
≥140Gy	11	52.3
Short-term efficacy
CR	2	9.5
PR	14	52.4
SD	5	33.3

Abbreviations: ECOG, Eastern Cooperative Oncology Group; Short-term efficacy, evaluate at 6 months after the implantation; CR, complete response; PR, partial response; SD, stable disease.

Table 2 CT Scan Measurement Showing the Efficacy of Combined-Modality Therapy in Locally Advanced NSCLC Invading the Chest Wall Among the Elderly

Groups	Measurement of Tumors Through CT Scan (Mean ± SD, cm)
	Maximum Diameter	Maximum Vertical Diameter	cSum of the Two
Before treatment	4.42±1.28	3.42±0.97	7.84±1.20
After treatment	2.81±1.26	1.89±0.87	4.69±1.90
Degree of free	20	20	20
T value	4.118	5.340	5.230
P-value	P <0.001	P <0.0001	P <0.0001

Abbreviations: NSCLC, non-small-cell lung cancer; CT, computed tomography; SD, standard deviation; cm, centimeter; Sum of the two, the maximum diameter +the maximum vertical diameter.

Table 3 Analysis of Cancer-Pain Relief

Group	Pain Score				P-value
	0	1–3	4–6	7–10	P <0.05
Before treatment	0	3	14	4
After treatment	15	1	5	0

Table 4 Analysis of Physical Status Score

Group	ECOG Score				P-value
	0–1	2	3	4	P <0.05
Before treatment	3	15	3	0
After treatment	18	2	1	0

Table 5 Adverse Effects

Adverse Effects	Cases	Percentage
Radiation pneumonitis (grade 1)	1	4.7
Radiation esophagitis (grade 1)	2	9.5
Pneumothorax	2	9.5
Bloody sputum	2	9.5
Radiation myelosuppression (grade 1)	3	14.3
Radiation myelosuppression (grade 2)	1	4.7
Esophageal or tracheal fistulae	0	0
Late radiation toxicity	0	0

Figure 3 Efficacy of combined-therapy aiming at elderly patients with locally advanced NSCLC diagnosed as tumor invading the chest wall. (A) Compared with baseline, after six months combined-therapy, the maximum diameter of tumor showed a distinct decrease (4.42±1.28 vs 2.81±1.26cm) (P <0.001). (B) Compared with baseline, after six months combined-therapy, the maximum vertical diameter of tumor showed a distinct decrease (3.42±0.97 vs 1.89±0.87cm) (P <0.0001). (C) Compared with baseline, after six months combined-therapy, the sum of the two of tumor showed a distinct decrease (7.84±1.20 vs 4.69±1.90 cm) (P <0.0001).