Photo Credit: sudok1

The following is a summary of “Brachytherapy Seed Placement by Robotic Bronchoscopy with Cone-Beam CT Guidance for Peripheral Lung Cancer: A Human Cadaveric Feasibility Pilot,” published in the January 2025 issue of Oncology by Latifi et al.

This study investigates the feasibility of using a robotic-assisted bronchoscopy and cone beam computed tomography (RB-CBCT) platform to perform low-dose-rate brachytherapy (LDR-BT) implants in a mechanically ventilated human cadaveric model, with dosimetric outcomes compared to standard stereotactic body radiation therapy (SBRT) plans. Using the RB-CBCT platform, inert LDR-BT seeds were placed into cadaveric pseudotumors created via percutaneous injection. Treatment plans were designed to deliver a prescription dose of 100 Gy to the pseudotumor plus a 3 mm margin, defining the planning target volume (PTV). Post-implant analysis evaluated dosimetry, seed placement accuracy, and implant quality.

Comparative analysis was performed between LDR-BT and SBRT for equivalent tumor volumes. Across eight pseudotumors, 41 LDR-BT seeds were successfully implanted, with a median of five seeds per tumor. Post-implant dosimetric analysis revealed an average V95% (volume of the PTV receiving at least 95% of the prescribed dose) of 99.4% ± 3.3% and D90% (dose delivered to 90% of the PTV) of 128 ± 23 Gy. Seed placement accuracy showed an average deviation of 3.8 ± 1.1 mm from planned positions. Compared to SBRT, LDR-BT demonstrated superior dose conformity, with a significantly lower ratio of V50% to PTV volume (2.3 vs. 4.0, p < 0.001) and reduced V25% (5.0 vs. 17.5, p < 0.001), indicating reduced radiation exposure to surrounding tissues. These results suggest that RB-CBCT enables precise LDR-BT seed implantation with accurate dosimetry and improved dose conformity relative to SBRT. Further clinical studies are warranted to validate the safety and efficacy of RB-CBCT-guided LDR-BT for early-stage lung cancer, potentially offering a minimally invasive alternative to existing treatment modalities.

Source: sciencedirect.com/science/article/abs/pii/S0360301625000781