Efficacy and safety of chemotherapy combined with iodine-125 seed brachytherapy for intermediate and advanced oncogenic driver gene-negative non-small cell lung cancer.

Purpose: To compare the effectiveness and safety of CT-guided iodine-125 seed brachytherapy in conjunction with chemotherapy against chemotherapy alone for the management of intermediate and advanced non-small cell lung cancer (NSCLC) lacking oncogenic driving genes.

Methods and materials: Retrospective analysis was conducted on clinical data from 128 patients diagnosed with intermediate and advanced non-small cell lung cancer who received iodine-125 combined with chemotherapy or chemotherapy alone due to the absence of oncogenic driver gene mutations. The patients in two groups were compared at 6-month follow-up for objective remission rate (ORR), Disease control rate (DCR), local progression-free survival (LPFS), overall survival (OS), clinical symptom improvement, and adverse events.

Results: A median of 47 (range, 16-100) iodine-125 seeds were implanted. The median D90 was 139.4 Gy. In patients with stage III NSCLC, the 6-month ORR were 40.0% and 8.0% in two groups, while those with stage IV NSCLC had rates of 20.9% and 4.0%. No significant issues arose during the 5-58 months follow-up period. OS did not significantly differ between stage III and IV NSCLC patients. The LPFS for stage III patients was 14 months and 9 months, compared to 8 months and 7 months for stage IV patients. Symptom improvement rates, including cough, chest discomfort, hemoptysis, and chest constriction, were 87.2% versus 20.4%, 77.8% versus 33.3%, and 77.8% versus 26.1%, respectively.

Conclusions: CT-guided iodine-125 seed implantation with chemotherapy failed to improve OS in stages III and IV NSCLC. However, it did extend the LPFS of stage III NSCLC. Furthermore, the ORR was much higher than that of the chemotherapy-only group, and lung cancer clinical symptoms were significantly reduced, improving patient quality of life.