HIGH-DOSE-RATE INTRALUMINAL RADIOTHERAPY FOR CARCINOMA OF THE BRONCHUS - OUTCOME OF TREATMENT OF 406 PATIENTS

In April 1988 the Christie Hospital started using the microSelectron-H DR machine to deliver intraluminal radiotherapy (ILT) to inoperable br onchial carcinomas causing symptoms due to endobronchial disease. Resu lts of treatment in the first 406 patients with primary non-small-cell carcinoma are presented. Three main categories of patient were define d. Category 1 consisted of 324 patients (79.8%) who were previously un irradiated and received a single fraction of ILT as their primary trea tment, mostly to a dose of 1500 cGy (76%) or 2000 cGy (23%) at 1 cm fr om the centre of the iridium-192 treatment source. The percentage of t hese patients whose symptoms or signs were improved at 6 weeks followi ng ILT were as follows: strider 92%, haemoptysis 88%, cough 62%, dyspn oea, 60%, pain, 50% and pulmonary collapse, 46%. Approximately two-thi rds of these patients (67.3%) derived long lasting palliation and requ ired no further treatment during their lifetime. The other third of pa tients needed subsequent treatment at some stage because of recurrence of their symptoms and in this situation external beam radiotherapy (E B) or a repeat ILT treatment was effectively utilised. Category 2 cons isted of 65 patients (16%) who had previously received EB but required ILT when their tumour recurred. At 6 weeks post-ILT levels of symptom palliation were broadly similar to those obtained if ILT was used in previously unirradiated individuals, although the improvement was not so well sustained with time and only 7% showed improvement in pulmonar y collapse at 6 weeks. Category 3 consisted of 17 patients (4.2%) in w hom ILT was used concurrently with EB as a combined initial treatment. Similar levels of palliation were seen when compared with patients wh o received a single ILT treatment only. Overall, ILT was well tolerate d in terms of early and late morbidity. In conclusion, the efficiency of a single ILT treatment in palliating symptoms due to endobronchial tumour in previously unirradiated individuals is comparable with that reported in series where treatment for advanced lung cancer combines a prolonged course of EB concurrently with several ILT treatments.