ENDOBRONCHIAL RADIATION-THERAPY WITH OR WITHOUT NEODYMIUM YTTRIUM-ALUMINUM-GARNET LASER RESECTION FOR MANAGING MALIGNANT AIRWAY-OBSTRUCTION

Background. Previous reports have shown low-dose-rate (LDR) afterloadi ng Ir-192 endobronchial radiation therapy (EnBRT) to effectively palli ate symptoms in patients with malignant airway obstruction. The author s retrospectively assessed the consequences of LDR EnBRT with or witho ut neodymium yttrium aluminum garnet (Nd:YAG) laser resection in 37 pa tients. Methods. Between February 1986 and June 1991, 37 patients with malignant airway obstruction were treated with LDR EnBRT at The Cleve land Clinic Foundation. Inclusion criteria for LDR EnBRT with or witho ut Nd:YAG laser resection were patients with recurrent, symptomatic en dobronchial lesions treated previously with external beam irradiation. Of the 37 patients, 21 patients with endobronchial lesions underwent Nd:YAG laser resection; 16 patients with mainly extrinsic lesions rece ived EnBRT only. Before EnBRT, selected patients (7 of 16 in the nonla ser-treatment group and 14 of 21 in the laser-treatment group) receive d additional external beam treatments of 2000 cGy/10 fractions. The LD R afterloading Ir-192 technique was used to deliver approximately 30 G y to a 1.0-cm radius target. Results. All patients had one or more of the following symptoms: 1) dyspnea, 2) fever, 3) cough, and 4) hemopty sis. Good-to-excellent symptom relief was apparent in 16 of 21 (76.2%) laser-treated patients and in 12 of 16 (75%) nonlaser-treated patient s. Follow-up bronchoscopy in 28 patients revealed tumor regression in 22 (79%). Median survival time was 16.3 weeks in the laser group and 1 1.7 weeks in the nonlaser group (P = 0.36). Longer median survival tim es were noted in laser-treated (22.8 weeks) and nonlaser-treated (16.4 weeks) patients receiving additional external beam treatments. Exsang uination occurred in 7 of 21 (33.3%) laser-treated patients and in 4 o f 16 (25%) nonlaser-treated patients. The only factor affecting the ex sanguination rate was implant location: 6 of 11 (54.5%) patients had l esions in the right or left upper lobe. Conclusions. EnBRT alone or wi th Nd:YAG laser resection provided good-to-excellent symptom palliatio n in these patients although a high rate of exsanguination occurred in both groups.