Efficacy and safety of iodine-125 brachytherapy combined with chemotherapy in the treatment of advanced NSCLC in the elderly

Figures & data

Table 1 Clinical features of patients enrolled in this study

Characteristics	Group A (n=50)	Group B (n=50)	P-value
Age (average, scale)	68 (60–76)	68 (60–79)	0.986
Gender
Male	38	35	0.653
Female	12	15
Pathology
Adenocarcinomas	23	26	0.689
Squamous cell carcinomas	27	24
Stage
III	17	14	0.666
IV	33	36
Pain score
0	6	8	0.78
1–3	18	19
4–6	26	23
7–10	0	0
ECOG score
0–1	16	14	0.828
2	34	36

Notes: Group A, 50 elderly patients with stage III or IV NSCLC treated with the chemotherapy regimens (paclitaxel/cisplatin) and CT-guided iodine-125 brachytherapy. Group B, 50 patients who received chemotherapy consisting of paclitaxel and cisplatin only.

Abbreviations: CT, computer tomography; ECOG, Eastern Cooperative Oncology Group; NSCLC, non-small-cell lung cancer.

Table 2 Analysis of pain in patients after treatments

Group	Pain score				P-value
	0	1–3	4–6	7–10
A	19	18	11	2
B	10	13	19	8	0.025

Notes: Group A, 50 elderly patients with stage III or IV NSCLC treated with the chemotherapy regimens (paclitaxel/cisplatin) and CT-guided iodine-125 brachytherapy. Group B, 50 patients who received chemotherapy consisting of paclitaxel and cisplatin only.

Abbreviations: CT, computer tomography; NSCLC, non-small-cell lung cancer.

Table 3 Analysis of physical status score in patients after treatments

Group	ECOG score				P-value
	0–1	2	3	4
A	25	21	4	0
B	18	17	12	3	0.036

Notes: Group A, 50 elderly patients with stage III or IV NSCLC treated with the chemotherapy regimens (paclitaxel/cisplatin) and CT-guided iodine-125 brachytherapy. Group B, 50 patients who received chemotherapy consisting of paclitaxel and cisplatin only.

Abbreviations: CT, computer tomography; Eastern Cooperative Oncology Group; NSCLC, non-small-cell lung cancer.

Table 4 Comparison of treatment effect in both groups

Group	CR	PR	SD	PD	RR = CR+PR(%)	P-value
A	4	32	12	2	36 (72%)	0.032
B	0	25	18	7	25 (50%)

Notes: Group A, 50 elderly patients with stage III or IV NSCLC treated with the chemotherapy regimens (paclitaxel/cisplatin) and CT-guided iodine-125 brachytherapy. Group B, 50 patients who received chemotherapy consisting of paclitaxel and cisplatin only.

Abbreviations: CT, computer tomography; NSCLC, non-small-cell lung cancer; RR, response rate; CR, complete response ; SD, stable disease; PR, partial response; PD, progressive disease.

Figure 1 CT scan images of typical patients in group A.

Notes: (A1, A2) CT scan of a 62-year-old male patient with adenocarcinoma. (A1) The pre-treatment CT image shows a mass in the left upper lobe (October 14, 2013). (A2) The target lesion completely disappeared after the combination of iodine-125 seed implantation and chemotherapy regimen. The chest pain symptoms were relieved considerably (March 12, 2014). (B1, B2). CT scan of a 60-year-old male patient with adenocarcinoma. (B1) The pre-treatment lung CT image shows a mass near the trachea in the right upper lobe (October 8, 2016). (B2) Six months after treatment, the CT scan indicated a complete response (April 17, 2017). (C1, C2) CT scan of a 67-year-old male patient with squamous cell carcinoma. (C1) The pre-treatment CT image shows an irregular mass in the left lower lobe (June 1, 2016). (C2) The lesion is significantly decreased in size and partially cavitated 6 months after treatment. Difficult breathing was relieved obviously (December 5, 2016). Group A, 50 elderly patients with stage III or IV NSCLC treated with the chemotherapy regimens (paclitaxel/cisplatin) and CT-guided iodine-125 brachytherapy.
Abbreviations: CT, computer tomography; NSCLC, non-small-cell lung cancer.

Figure 2 Kaplan–Meier curve of progression-free survival of patients in groups A and B.

Notes: Group A, 50 elderly patients with stage III or IV NSCLC treated with the chemotherapy regimens (paclitaxel/cisplatin) and CT-guided iodine-125 brachytherapy. Group B, 50 patients who received chemotherapy consisting of paclitaxel and cisplatin only.
Abbreviations: CT, computer tomography; cum, cumulative; NSCLC, non-small-cell lung cancer.

Figure 3 Kaplan–Meier curve of overall survival of patients in groups A and B.

Notes: Group A, 50 elderly patients with stage III or IV NSCLC treated with the chemotherapy regimens (paclitaxel/cisplatin) and CT-guided iodine-125 brachytherapy. Group B, 50 patients who received chemotherapy consisting of paclitaxel and cisplatin only.
Abbreviations: CT, computer tomography; cum, cumulative; NSCLC, non-small-cell lung cancer.

Table 5 Complications after brachytherapy with iodine-125 seed

Complications	Group A	Group B
Mild pneumothorax	4	0
Radiation pneumonitis	0	0
Seed migration	2	0
Local skin erythema	0	0

Notes: Group A, 50 elderly patients with stage III or IV NSCLC treated with the chemotherapy regimens (paclitaxel/cisplatin) and CT-guided iodine-125 brachytherapy. Group B, 50 patients who received chemotherapy consisting of paclitaxel and cisplatin only.

Abbreviations: CT, computer tomography; NSCLC, non-small-cell lung cancer.

Table 6 Adverse events observed in both groups upon follow–up

Grade	Group A						Group B						P-value
	0	1	2	3	4	5	0	1	2	3	4	5
Hematology toxicity
Leukocyte decrease	19	18	9	4	0	0	20	17	8	5	0	0	0.974
Anemia	17	26	6	1	0	0	15	25	7	3	0	0	0.748
Platelet decrease	18	25	4	3	0	0	20	22	6	2	0	0	0.825
Liver function lesion	42	6	2	0	0	0	44	5	1	0	0	0	0.790

Notes: Group A, 50 elderly patients with stage III or IV NSCLC treated with the chemotherapy regimens (paclitaxel/cisplatin) and CT-guided iodine-125 brachytherapy. Group B, 50 patients who received chemotherapy consisting of paclitaxel and cisplatin only.

Abbreviations: CT, computer tomography; NSCLC, non-small-cell lung cancer.