L. Ofiara et al., LOCAL DETERMINANTS OF RESPONSE TO ENDOBRONCHIAL HIGH-DOSE-RATE BRACHYTHERAPY IN BRONCHOGENIC-CARCINOMA, Chest, 112(4), 1997, pp. 946-953
Study objective: We evaluated bronchoscopic tumor appearance and tumor
location as determinants of response to high-dose rate brachytherapy
(HDR-BT) in patients with symptomatic unresectable bronchogenic carcin
oma previously treated with external-beam irradiation. Patients and me
thods: Thirty patients with symptomatic endobronchial bronchogenic car
cinoma who had previously completed external irradiation were divided
into two groups based on whether the initial bronchoscopic appearance
showed an endoluminal mass or submucosal infiltration/extrinsic compre
ssion. Furthermore, patients were also classified based on tumor locat
ion: central (trachea or mainstem bronchi) and peripheral (lobar or se
gmental bronchi). Patients underwent three treatments of 800 cGy intra
luminal irradiation at 2-week intervals, with follow-up evaluation 4 w
eeks later. We evaluated response in tumor extent based on bronchoscop
ic and chest radiograph appearance, as well as symptoms with standardi
zed scales. Results: Fifteen of 24 patients who underwent follow-up br
onchoscopy had reductions in the degree of endobronchial obstruction.
Seven of 24 patients had radiographic improvement in the extent of ate
lectasis. Patients with both tumor appearances (endoluminal and submuc
osal/extrinsic compression) had significant improvements following HDR
-BT with regard to hemoptysis. Patients with submucosal disease also h
ad improvement in cough. Patients with peripheral tumors had better ra
tes of response for hemoptysis and cough than did those with central t
umors. Conclusion: HDR-BT may result in symptomatic improvement in pat
ients with bronchogenic carcinoma, whether characterized endoscopicall
y as endoluminal projection or submucosal infiltration/extrinsic compr
ession. Peripheral tumors have better rates of response than central t
umors, possibly on the basis of less extensive disease.