{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T19:30:23Z","timestamp":1778355023730,"version":"3.51.4"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,9,15]],"date-time":"2021-09-15T00:00:00Z","timestamp":1631664000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To analyze the efficacy and safety of low dose rate stereotactic ablative brachytherapy (L-SABT) for treatment of unresectable early-stage non-small cell lung cancer (NSCLC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data of patients with early-stage NSCLC who received CT-guided L-SABT (radioactive I-125 seeds implantation) at eight different centers from December 2010 to August 2020 were retrospectively analyzed. Treatment efficacy and complications were evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 99 patients were included in this study. Median follow-up duration was 46.3 months (6.1-119.3 months). The 1-year, 3-year, and 5-year local control rates were 89.1%, 77.5%, and 75.7%, respectively. The 1-year, 3-year, and 5-year overall survival rates were 96.7%, 70.1%, and 54.4%, respectively. Treatment failure occurred in 38.4% of patients. Local\/regional recurrence, distant metastasis, and recurrence combined with metastasis accounted for 15.1%, 12.1%, and 11.1%, respectively. Pneumothorax occurred in 47 patients (47.5%) with 19 cases (19.2%) needing closed drainage. The only radiation-related adverse reaction was two cases of grade 2 radiation pneumonia. KPS 80\u2013100, T1, the lesion was located in the left lobe, GTV D90 \u2265150 Gy and the distance between the lesion and chest wall was &amp;lt; 1 cm, were associated with better local control (all <jats:italic>P<\/jats:italic> &amp;lt; 0.05); on multivariate analysis KPS, GTV D90, and the distance between the lesion and chest wall were independent prognostic factors for local control (all <jats:italic>P<\/jats:italic> &amp;lt; 0.05). KPS 80\u2013100, T1, GTV D90 \u2265150 Gy, and the distance between the lesion and chest wall was &amp;lt; 1 cm were also associated with better survival (all <jats:italic>P<\/jats:italic> &amp;lt; 0.05); on multivariate analysis KPS, T stage, and GTV D90 were independent prognostic factors for survival (all <jats:italic>P<\/jats:italic> &amp;lt; 0.05). The incidence of pneumothorax in patients with lesions &amp;lt;1 cm and \u22651cm from the chest wall was 33.3% and 56.7%, respectively, and the differences were statistically significant (<jats:italic>P<\/jats:italic> = 0.026).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>L-SABT showed acceptable efficacy in the treatment of unresectable early-stage NSCLC. But the incidence of pneumothorax is high. For patients with T1 stage and lesions &amp;lt;1 cm from the chest wall, it may have better efficacy. Prescription dose greater than 150 Gy may bring better results.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2021.706242","type":"journal-article","created":{"date-parts":[[2021,9,15]],"date-time":"2021-09-15T14:07:47Z","timestamp":1631714867000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Clinical Outcome of CT-Guided Stereotactic Ablative Brachytherapy for Unresectable Early Non-Small Cell Lung Cancer: A Retrospective, Multicenter Study"],"prefix":"10.3389","volume":"11","author":[{"given":"Zhe","family":"Ji","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bin","family":"Huo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shifeng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qinghua","family":"Liang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao","family":"Xing","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miaomiao","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanli","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhe","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinxin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuqing","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yufeng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongmei","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaixian","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruoyu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shude","family":"Chai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuequan","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaokun","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junjie","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,9,15]]},"reference":[{"key":"B1","unstructured":"Clinical Practice Guidelines in Oncology: non-Small Cell Lung Cancer, Version 22019"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.06-3096","article-title":"Natural History of Stage I Non-Small Cell Lung Cancer: Implications for Early Detection","volume":"132","author":"Raz","year":"2007","journal-title":"Chest"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/1759-7714.12912","article-title":"Chinese Expert Consensus Workshop Report: Guideline for Permanent Iodine-125 Seed Implantation of Primary and Metastatic Lung Tumors","volume":"1","author":"Zhang","year":"2018","journal-title":"Thorac Cancer"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.issn.0254-5098.2020.03.003","article-title":"The Concept of Stereotactic Ablation Brachytherapy and Practice","volume":"40","author":"Wand","year":"2020","journal-title":"Chin J Radiol Med Prot"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2018.10.034","article-title":"The Effectiveness and Prognostic Factors of CT-Guided Radioactive I-125 Seed Implantation for the Treatment of Recurrent Head and Neck Cancer After External Beam Radiation Therapy","volume":"103","author":"Ji","year":"2019","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.7785\/tcrt.2012.500402","article-title":"Computed Tomography (CT)-Guided Interstitial Permanent Implantation of (125)I Seeds for Refractory Chest Wall Metastasis or Recurrence","volume":"14","author":"Jiang","year":"2015","journal-title":"Technol Cancer Res Treat"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1186\/1756-9966-32-106","article-title":"The Investigation of 125I Seed Implantation as a Salvage Modality for Unresectable Pancreatic Carcinoma","volume":"32","author":"Wang","year":"2013","journal-title":"J Exp Clin Cancer Res"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-008-0628-4","article-title":"Interstitial Permanent Implantation of 125I Seeds as Salvage Therapy for Re-Recurrent Rectal Carcinoma","volume":"24","author":"Wang","year":"2009","journal-title":"Int J Colorectal Dis"},{"key":"B9","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.jtho.2015.09.009","article-title":"The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer","volume":"11","author":"Goldstraw","year":"2016","journal-title":"J Thorac Oncol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1118\/1.597458","article-title":"Dosimetry of Interstitial Brachytherapy Sources: Recommendations of the AAPM Radiation Therapy Committee Task Group No. 43. American Association of Physicists in Medicine","volume":"22","author":"Nath","year":"1995","journal-title":"Med Phys"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1118\/1.598721","article-title":"Permanent Prostate Seed Implant Brachytherapy: Report of the American Association of Physicists in Medicine Task Group No.64","volume":"26","author":"Yu","year":"1999","journal-title":"Med Phys"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1118\/1.1646040","article-title":"Update of AAPM Task Group No. 43 Report: A Revised AAPM Protocol for Brachytherapy Dose Calculations","volume":"31","author":"Rivard","year":"2004","journal-title":"Med Phys"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2008.10.026","article-title":"New Response Evaluation Criteria in Solid Tumours: Revised RECIST Guideline (Version 1.1)","volume":"45","author":"Eisenhauer","year":"2009","journal-title":"Eur J Cancer"},{"key":"B14","unstructured":"Common Terminology Criteria for Adverse Events (CTCAE) Version 5.02017"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1118\/1.596926","article-title":"Biological Effects of the Auger Emitter Iodine-125: A Review. Report No. 1 of AAPM Nuclear Medicine Task Group No. 6","volume":"19","author":"Sastry","year":"1992","journal-title":"Med Phys"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2007.12.016","article-title":"CT-Guided Permanent Brachytherapy for Patients With Medically Inoperable Early-Stage Non-Small Cell Lung Cancer (NSCLC)","volume":"61","author":"Martinez-Monge","year":"2008","journal-title":"Lung Cancer"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2015.07.2260","article-title":"A Randomized Phase 2 Study Comparing 2 Stereotactic Body Radiation Therapy Schedules for Medically Inoperable Patients With Stage I Peripheral Non-Small Cell Lung Cancer: NRG Oncology RTOG 0915 (NCCTG N0927)","volume":"93","author":"Videtic","year":"2015","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)70168-3","article-title":"Stereotactic Ablative Radiotherapy Versus Lobectomy for Operable Stage I Non-Small-Cell Lung Cancer: A Pooled Analysis of Two Randomised Trials","volume":"16","author":"Chang","year":"2015","journal-title":"Lancet Oncol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.261","article-title":"Stereotactic Body Radiation Therapy for Inoperable Early Stage Lung Cancer","volume":"303","author":"Timmerman","year":"2010","journal-title":"Jama"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0000000000000525","article-title":"Stereotactic Body Radiotherapy Using a Radiobiology-Based Regimen for Stage I Non\u2013Small-Cell Lung Cancer: Five-Year Mature Results","volume":"10","author":"Shibamoto","year":"2015","journal-title":"J Thorac Oncol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.3109\/0284186X.2015.1020966","article-title":"Long-Term Results of a Prospective Phase II Trial of Medically Inoperable Stage I NSCLC Treated With SBRT - the Nordic Experience","volume":"54","author":"Lindberg","year":"2015","journal-title":"Acta Oncol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"S30","DOI":"10.1016\/j.ijrobp.2014.05.135","article-title":"Long-Term Results of RTOG 0236: A Phase II Trial of Stereotactic Body Radiation Therapy (SBRT) in the Treatment of Patients With Medically Inoperable Stage I Non-Small Cell Lung Cancer","volume":"90","author":"Timmerman","year":"2014","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.brachy.2015.09.006","article-title":"American Brachytherapy Society Consensus Guidelines for Thoracic Brachytherapy for Lung Cancer","volume":"15","author":"Stewart","year":"2016","journal-title":"Brachytherapy"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2018.03.034","article-title":"Long-Term Results of CT-Guided Percutaneous Radiofrequency Ablation of Inoperable Patients With Stage Ia Non-Small Cell Lung Cancer: A Retrospective Cohort Study","volume":"53","author":"Huang","year":"2018","journal-title":"Int J Surg"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1002\/jso.23701","article-title":"Percutaneous Microwave Ablation of Stage I Medically Inoperable Non-Small Cell Lung Cancer: Clinical Evaluation of 47 Cases","volume":"110","author":"Yang","year":"2014","journal-title":"J Surg Oncol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0b013e31822d538d","article-title":"Long-Term Results of Radiofrequency Ablation Treatment of Stage I Non-Small Cell Lung Cancer: A Prospective Intention-to-Treat Study","volume":"6","author":"Ambrogi","year":"2011","journal-title":"J Thorac Oncol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(08)70155-4","article-title":"Response to Radiofrequency Ablation of Pulmonary Tumours: A Prospective, Intention-to-Treat, Multicentre Clinical Trial (the RAPTURE Study)","volume":"9","author":"Lencioni","year":"2008","journal-title":"Lancet Oncol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30693","article-title":"7-Year Follow-Up After Stereotactic Ablative Radiotherapy for Patients With Stage I Non-Small Cell Lung Cancer: Results of a Phase 2 Clinical Trial","volume":"123","author":"Sun","year":"2017","journal-title":"Cancer"},{"key":"B29","doi-asserted-by":"publisher","first-page":"S8","DOI":"10.1016\/j.ijrobp.2016.06.035","article-title":"Efficacy and Toxicity Analysis of NRG Oncology\/RTOG 0813 Trial of Stereotactic Body Radiation Therapy (SBRT) for Centrally Located non-Small Cell Lung Cancer (NSCLC)","volume":"96","author":"Bezjak","year":"2016","journal-title":"Int J Radiat Oncol Biol Physics"},{"key":"B30","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s13014-018-0959-4","article-title":"Side Effects of CT-Guided Implantation of (125)I Seeds for Recurrent Malignant Tumors of the Head and Neck Assisted by 3D Printing non Co-Planar Template","volume":"13","author":"Jiang","year":"2018","journal-title":"Radiat Oncol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.brachy.2006.08.009","article-title":"Severe Toxicity After Permanent Radioactive Seed Implantation for Mediastinal Carcinoid Tumors","volume":"6","author":"Stewart","year":"2007","journal-title":"Brachytherapy"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/S1051-0443(07)61556-5","article-title":"Risk Factors for Pneumothorax and Bleeding After CT-Guided Percutaneous Coaxial Cutting Needle Biopsy of Lung Lesions","volume":"12","author":"Yeow","year":"2001","journal-title":"J Vasc Interv Radiol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.ejrad.2008.01.006","article-title":"CT-Guided Cutting Needle Lung Biopsy Using Modified Coaxial Technique: Factors Effecting Risk of Complications","volume":"70","author":"Yildirim","year":"2009","journal-title":"Eur J Radiol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.4103\/0973-1482.162117","article-title":"Percutaneous Computed Tomography-Guided Lung Biopsy of Solitary Nodular Ground-Glass Opacity","volume":"11","author":"Zheng","year":"2015","journal-title":"J Cancer Res Ther"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.208.2.9680552","article-title":"Technical Aspects of Needle Aspiration Lung Biopsy: A Personal Perspective","volume":"208","author":"Moore","year":"1998","journal-title":"Radiology"},{"key":"B36","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/j.apradiso.2016.12.009","article-title":"Dosimetry Verification of Radioactive Seed Implantation for Malignant Tumors Assisted by 3D Printing Individual Templates and CT Guidance","volume":"124","author":"Ji","year":"2017","journal-title":"Appl Radiat Isotopes"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.2174\/1574892809666140130215156","article-title":"Experimental Research on a Novel Iodine-125 Seed Strand Connected Using Magnesium Alloy AZ31","volume":"9","author":"Li","year":"2014","journal-title":"Recent Pat Anticancer Drug Discov"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1080\/01691864.2017.1298465","article-title":"Modelling and Analysis of a Novel CT-Guided Puncture Robot for Lung Brachytherapy","volume":"31","author":"Jiang","year":"2017","journal-title":"Advanced Robotics"},{"key":"B39","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1007\/978-3-319-70990-1_78","article-title":"Development of NSCLC Precise Puncture Prototype Based on CT Images Using Augmented Reality Navigation","volume":"691","author":"Qin","year":"2017","journal-title":"ICMIR"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2021.706242\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,15]],"date-time":"2021-09-15T14:07:54Z","timestamp":1631714874000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2021.706242\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,15]]},"references-count":39,"alternative-id":["10.3389\/fonc.2021.706242"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2021.706242","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,15]]},"article-number":"706242"}}