HIGH-DOSE-RATE BRACHYTHERAPY FOR THE LOCAL-CONTROL OF ENDOBRONCHIAL CARCINOMA FOLLOWING EXTERNAL IRRADIATION

Background - External irradiation is an established palliative treatme nt for patients with inoperable lung cancer. However, persistent or re current symptoms due to local disease are common following external ir radiation. The impact of high dose rate (HDR) brachytherapy in the pal liative management of patients with local sequelae of residual or recu rrent endobronchial lung carcinoma following external irradiation was investigated. Methods - A prospective cohort of 29 patients (19 men, m ean age 65 years) underwent HDR brachytherapy for inoperable lung canc er. All patients had completed external irradiation at least one month before entry into the study (mean (SD) dose 4400 (1481) cGy, complete d 12.9 (21.3) months previously). Patients underwent outpatient bronch oscopic placement of 1-3 HDR brachytherapy catheters for delivery of 7 50-1000 cGy of intraluminal irradiation every two weeks on 1-3 occasio ns. Prospective evaluation before and four weeks after completion of H DR brachytherapy included assessment of indices of level of function, symptoms, extent of atelectasis (chest radiography), and bronchoscopic determination of degree of endobronchial obstruction. Results - One h undred and eighteen catheters were placed in 81 treatments. Eleven of the 26 patients who underwent repeat bronchoscopy showed a reduction i n the degree of endobronchial obstruction; five of 18 patients had rad iographic improvement in the extent of atelectasis. Positive response rates ranged from 25% for signs and symptoms related to pneumonitis to 69% for haemoptysis. Performance status improved in 24% of patients. Two patients died before completion of the study protocol. Short term complications included one episode of non-fatal, massive haemoptysis, five of minor haemoptysis, and one pneumothorax. Conclusions - HDR bra chytherapy may improve the degree of endobronchial ob-of function with minimal short term complications in patients with recurrent or residu al symptomatic disease following external irradiation.