Achy brachy heart.

Top Line: A safe treatment strategy for central lung tumors remains an enigma.

The Study: Here is a look at safety outcomes for the first consecutive 25 patients receiving Iridium-192 high-dose rate brachytherapy for (mostly metastatic) lung tumors at Cedars-Sinai. Across 37 tumors, 9 were central (within 2 cm of central structures) and 20 were ultracentral (abutment of central structures). Under local anesthesia +/- conscious sedation (patient preference), patients underwent image-guided percutaneous insertion of a 17-gauge needle into the deep aspect of the tumor, through which a brachy catheter was inserted (more than one needle/catheter if tumor >3 cm or irregularly-shaped).  Most patients (n=23) received a single fraction to a median dose of 21.5 Gy (range 15–27.5) prescribed to gross tumor with a goal of 95% coverage with 100% of prescription. First of all, at a median follow-up of 19 months, only one treated tumor progressed—granted, only 5 patients had data out to 2 years. This last part may also contribute to now documented long term toxicities. What we can feel confident about, though, is periprocedural toxicity is low. Pneumothorax requiring chest tube occurred in 4 (10%) patients, and all resolved within 24 hours.

TBL: Add a single day of outpatient percutaneous brachyablation to radio-, microwave- and cryoabltation options at multidisciplinary tumor boards discussing the best approach to ultracentral lung tumors. | Yoon, Radiat Oncol 2021