CT-Guided Interstitial HDR Brachytherapy for Malignant Lung Lesions: Experience from University of California Los Angeles

Abstract

The management of malignant lung lesions is complex and requires a multidisciplinary approach. Patients who are medically inoperable owing to comorbidities and/or poor pulmonary function have limited therapeutic options. Many factors are considered in choosing the appropriate therapy for maximum benefit to the patient while minimizing adverse effects. Important factors include goal of treatment, tumor location, tumor proximity to nearby vasculature or critical organs, and prior therapies. Careful consideration of these factors guides the multidisciplinary team into choosing one of several minimally invasive treatment options available for medically inoperable patients. Brachytherapy is an option that has the ability to overcome several limitations posed by other treatment alternatives, and it has been shown to be safe and effective. Specifically, interest in interstitial brachytherapy for treating malignant lung lesions is growing, and the University of California Los Angeles (UCLA) is the first institution in the United States to perform CT-guided interstitial HDR brachytherapy in this setting. In this chapter, we describe our institutional experience with this treatment technique for patients with either primary or metastatic pulmonary malignancies. The benefits and potential pitfalls to consider with interstitial HDR brachytherapy, clinical outcomes, and future directions are highlighted.