Main Session
Sep 29
PQA 07 - Head and Neck Cancer, Lung Cancer/Thoracic Malignancies, and Nursing and Supportive Care

3460 - Ten-Year Experience with Percutaneous HDR Brachyablation for Primary and Metastatic Lung Tumors

03:45pm - 05:00pm ET
Poster Hall - Exhibit Hall A
Screen: 20
POSTER

Presenter(s)

Michelle Ann Eala, MD, MBA - UCLA David Geffen School of Medicine/UCLA Medical Center, Los Angeles, CA

M. A. Eala1, D. Moghanaki1, J. Phan1, J. Wu1, E. Wang1, T. Oughourlian2, Y. Mezgueldi1, R. Suh3, F. Abtin3, A. Lee1, and A. J. Chang1; 1Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, 2Servier Pharmaceuticals, Boston, MA, United States, 3Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, CA

Purpose/Objective(s): Our institution offers percutaneous high-dose-rate (HDR) brachyablation as an alternative local treatment for primary and metastatic lung malignancies when surgery, external beam radiation, or percutaneous thermal ablation is considered less safe. In 2021, we published our initial experience in 25 patients with 37 lung tumors and a median follow-up of 19 months, reporting a single local failure. Here we present an updated analysis with a substantially larger cohort and longer follow-up.

Materials/Methods: We identified 83 patients who underwent CT-guided percutaneous HDR brachyablation for 135 primary and metastatic lung malignancies from September 2015 to December 2024. Treatments were delivered by an interdisciplinary team of interventional radiologists and radiation oncologists at a single institution. Clinical endpoints included local control (LC) via RECIST 1.1, progression-free survival (PFS), and overall survival (OS). Acute and late adverse events (AE) were graded according to CTCAE v5.0.

Results: The median age was 67.8 years (range: 26.5–95.7), with 53% male and 47% female. Most patients (85.5%) had good performance status (ECOG 0–1). Tumors were primarily located in the lung parenchyma (86.7%), while 7.4% involved lymph nodes (4.4% hilar, 3.0% mediastinal). Parenchymal lesions were distributed as peripheral (53.8%), central (23.1%), and ultra-central (22.2%). Median tumor size was 3.1 cm (range: 0.6–37 cm), with a median volume of 8.5 cc (range: 0.05–185.9 cc). At a median follow-up of 34.6 months, no additional local failures were observed. The Kaplan-Meier two-year LC, PFS, and OS rates were 98.3% (95% CI: 95.1–100%), 16.3% (95% CI: 9.21–28.7%), and 62.4% (95% CI: 50.9–76.5%), respectively. Procedural complications were uncommon: trace pneumothorax not requiring intervention occurred in 20% of procedures, while major pneumothorax requiring chest tube insertion occurred in one (0.7%); two additional patients experienced delayed pneumothorax within 30 days. Minor pulmonary hemorrhage was noted in 4 procedures (2.9%), with no hemorrhagic events beyond 24 hours. The acute and late grade 3 and 4 AE rates were 2.4% and 0%, respectively.

Conclusion: Percutaneous HDR brachyablation is a safe and durable treatment for challenging primary and metastatic lung malignancies, achieving a two-year LC rate of 98.3% with uncommon severe adverse events. These results, drawn from one of the largest and most mature institutional experiences reported to date, support its role as a compelling alternative to surgery, external beam radiation therapy, and thermal ablation in selected cases.