Adjuvant brachytherapy of non-small-cell lung cancer (NSCLC) with I-125 seeds

Learning Objectives 1. Highlight the complementary role of nuclear medicine techniques to surgical treatment of lung cancer.2. Describe the use of permanently implanted radiation sources, their properties, and techniques used in administration.3. Highlight the major challenges in this field and discuss the clinical and radiation safety issues in the provision of such service.4. Gain an understanding of the therapeutic effect of this technique in treating disease.

Summary: The combination of surgery and radionuclide techniques plays an important role in the treatment of some malignancies. We describe its use in NSCLC. Silver seeds filled with I-125 are used. I-125 emits X and gamma rays of energy around 30 keV, most of which is deposited within 1 cm around the seed. Seeds are sewn into a vicryl mesh. The resection field is covered with the seeds; the mesh provides a uniform distribution of the seeds. I-125 seeds are mainly used for interstitial therapy of prostate cancer in the form of single seeds. In the treatment of NSCLC, the seeds must be sewn into a mesh. All work must be done in a laminar flow hood under sterile conditions. The highest radiation burden is to the hands during sewing. The radiation exposure outside the patient is acceptable. Therapeutic effect is achieved by interaction of the emitted ionizing radiation with the tissue. The dose delivered by this technique is approximately 120 Gy over one year. Our goal is to improve the survival and quality of life of patients with advanced lung cancer.

Research Support Supported by a grant No NR 8528-5/2005 from the Czech Ministry of Health