P. Hernandez et al., HIGH-DOSE-RATE BRACHYTHERAPY FOR THE LOCAL-CONTROL OF ENDOBRONCHIAL CARCINOMA FOLLOWING EXTERNAL IRRADIATION, Thorax, 51(4), 1996, pp. 354-358
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.