Incremental Value of Iodine-125 Seed Implantation After Bronchial Artery Chemoembolization in Immunotherapy-Treated Advanced Lung Squamous Cell Carcinoma with Hemoptysis: A Retrospective Cohort Study Using Inverse Probability of Treatment Weighting.
The incremental value of iodine-125 (I-125) seed implantation in advanced refractory lung squamous cell carcinoma (LUSC) with hemoptysis treated with bronchial artery chemoembolization (BACE) and immunotherapy remains unclear.
This retrospective cohort study included 90 patients treated between June 2023 and June 2025. Patients receiving BACE plus immunotherapy were classified according to whether I-125 seed implantation was performed within 7 days after BACE: G1, BACE plus immunotherapy (n = 42), and G2, BACE, I-125 seed implantation, and immunotherapy (n = 48). Inverse probability of treatment weighting (IPTW) served as the primary adjustment method.
After IPTW, baseline covariates were well balanced; propensity score matching yielded 26 patients per group. Compared with G1, G2 was associated with longer hemoptysis-free survival (not reached vs. 11 months; HR = 0.34, 95% CI 0.18-0.64, p < 0.05), overall survival (19 vs. 14 months; HR = 0.26, 95% CI 0.15-0.44, p < 0.05), and progression-free survival (12 vs. 9 months; HR = 0.34, 95% CI 0.21-0.56, p < 0.05). The 6-month objective response rate (ORR) and disease control rate (DCR) were higher in G2, whereas no significant difference in 24-h hemostasis or recorded grade 3 or higher adverse events was observed.
Adding I-125 seed implantation to BACE plus immunotherapy was associated with improved outcomes in selected patients, and prospective validation is warranted.
This retrospective cohort study included 90 patients treated between June 2023 and June 2025. Patients receiving BACE plus immunotherapy were classified according to whether I-125 seed implantation was performed within 7 days after BACE: G1, BACE plus immunotherapy (n = 42), and G2, BACE, I-125 seed implantation, and immunotherapy (n = 48). Inverse probability of treatment weighting (IPTW) served as the primary adjustment method.
After IPTW, baseline covariates were well balanced; propensity score matching yielded 26 patients per group. Compared with G1, G2 was associated with longer hemoptysis-free survival (not reached vs. 11 months; HR = 0.34, 95% CI 0.18-0.64, p < 0.05), overall survival (19 vs. 14 months; HR = 0.26, 95% CI 0.15-0.44, p < 0.05), and progression-free survival (12 vs. 9 months; HR = 0.34, 95% CI 0.21-0.56, p < 0.05). The 6-month objective response rate (ORR) and disease control rate (DCR) were higher in G2, whereas no significant difference in 24-h hemostasis or recorded grade 3 or higher adverse events was observed.
Adding I-125 seed implantation to BACE plus immunotherapy was associated with improved outcomes in selected patients, and prospective validation is warranted.
Authors
Ran Ran, Chen Chen, Liang Liang, Xie Xie, Fu Fu, Yang Yang, Li Li, Liu Liu, Jiang Jiang
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