ENDOBRONCHIAL RADIATION-THERAPY FOR OBSTRUCTING MALIGNANCIES - 10 YEARS EXPERIENCE WITH IR-192 HIGH-DOSE RADIATION BRACHYTHERAPY AFTERLOADING TECHNIQUE IN 365 PATIENTS

From 1983 to 1993, 365 patients with obstructing endobronchial maligna ncies were treated by endobronchial high-dose radiation (HDR) iridium- 192 afterloading. In 346 patients, the objective was palliation, and i n 19, the objective was curative. A dose of 5 Gy at 10 mm from the sou rce axis was administered on three (palliation) and four (cure) occasi ons, at intervals of 14 days. The majority of patients were treated af ter exhaustion of external beam radiation therapy (EBRT), often in con junction with other interventional bronchologic modalities such as end obronchial laser resection. Of the patients, 65% had a squamous cell c arcinoma. Endobronchial HDR brachytherapy results in few acute complic ations and can be performed with no major discomfort on an outpatient basis. In approximately 66% of patients, a palliative effect is achiev ed, even after the exhaustion of conventional treatment. Life may be p rolonged for a few months, but the enhancement of survival is difficul t to assess for several reasons. Mean survival is 9 months for limited disease and 5 months for extensive disease. Endobronchial HDR brachyt herapy influences the pattern of failure: a 21% rate of fatal hemorrha ges is probably the result of the selection of patients for this treat ment rather than a treatment-related complication. There is sufficient evidence to suggest the rational use of HDR brachytherapy in combinat ion with EBRT to effect a cure, or even on its own when tumor growth i s strictly limited. However, the standardization of radiotherapy and e ndoscopic indications is an urgent priority. Prospective, controlled, and cooperative studies are mandatory. Endobronchial iridium-192 HDR b rachytherapy complements endobronchial laser resection and is currentl y an established technique in the treatment of advanced malignant airw ay obstructions.