¹²⁵I Seed Brachytherapy Combined with Single-Agent Chemotherapy in the Treatment of Non-Small-Cell Lung Cancer in the Elderly: A Valuable Solution

Figures & data

Table 1 Summary of Patient and Tumor Characteristics

Factor	Group A (n=50)	Group B (n=60)	P-value
Age (average±SD)	71.38±6.98	71.13±7.32	0.85 (t-test)
Gender			0.67 (x^2 test)
Male	28	36
Female	22	24
ECOG score			0.86 (x^2 test)
0–1	20	25
2	30	35
Pathology			0.75 (x^2 test)
Adenocarcinomas	21	27
Squamous cell carcinomas	29	33
Stage (AJCC 8)			0.94 (x^2 test)
II	32	38
III	18	22
Tumor diameter			0.58 (x^2 test)
≤2 cm	15	22
2–3 cm	25	30
≥3 cm	10	8
No. of lesions	50	60
Classification of tumor			0.28 (x^2 test)
The center type	15	24
The peripheral type	35	36
Carcinoembryonic antigen			0.23 (x^2 test)
Elevated	39	52
Normal range	11	8
Prior treatment	None	None

Notes: Group A, elderly patients with NSCLC treated with ¹²⁵I seed brachytherapy and single-agent chemotherapy. Group B, patients with NSCLC received combined chemotherapy only.

Abbreviations: NSCLC, non-small-cell lung cancer; ECOG, Eastern Cooperative Oncology Group; SD, standard deviation.

Table 2 Comparison of Treatment Effect in Groups A and B (Wilcoxon Test)

Group	CR	PR	SD	PD	RR=CR+PR(%)	P-value
A	14	25	8	3	39 (78.0%)	<0.0001
B	0	28	22	10	28(46.7%)

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

Figure 1 CT scan images of typical patients in group A.(A1, A2) CT scan of a 82-year-old male patient with Squamous cell carcinoma. (A1) The pre-treatment CT image shows a mass in the right upper lobe (September 19, 2016). (A2) The target lesion significantly decreased in size after the combination of iodine-125 seed implantation and single-agent chemotherapy regimen. The chest pain symptoms were relieved considerably (March 15, 2017). (B1–B4). CT scan of a 64-year-old female patient with adenocarcinoma. (B1) The pre-treatment CT image shows a lesion in middle lobe of right lung (March 10, 2016). (B2) Five months after treatment, the CT scan indicated a complete response (October 23, 2016). (B3, B4) After continuous follow-up, the lesion disappeared and remained in a slight high-density area in the middle lobe of the right lung (April 29, 2020).

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

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

Table 3 Relief of Clinical Symptoms and Laboratory Indicators Associated with NSCLC in Both Groups (Wilcoxon Test)

Symptoms	Group A				Group B				P-value
	SR	PR	NR	AG	SR	PR	NR	AG
Cough	14	28	8	0	5	28	22	5	0.0001
Chest pain	16	25	9	0	6	25	24	5	0.0001
Bloody sputum	15	28	6	1	12	30	16	2	0.0524
Chest tightness	16	26	8	0	14	27	15	4	0.0653
carcinoembryonic antigen/squamous cell carcinoma antigen	15	28	7	0	3	26	25	6	<0.0001
D-dimer	13	26	11	0	4	26	26	4	0.0003

Abbreviations: AG, aggravation; NR, no remission; PR, partial response; SR, significant remission.

Table 4 Adverse Reactions of Chemotherapy Observed in Both Groups Upon Follow-Up (X² Test)

Group	Myelosuppression	Gastrointestinal Response	Fever	Allergy	Alopecia
A	6	4	5	6	6
B	25	20	7	8	10
p value	0.0006	0.0014	0.78	0.83	0.49

Notes: Group A, elderly patients with NSCLC treated with ¹²⁵I seed brachytherapy and single-agent chemotherapy. Group B, patients with NSCLC received combined chemotherapy only.

Abbreviation: NSCLC, non-small-cell lung cancer.