HIGH-DOSE-RATE ENDOBRONCHIAL IRRADIATION IN MALIGNANT AIRWAY-OBSTRUCTION

We evaluated the effectiveness of high dose rate (HDR) endobronchial i rradiation for palliation of malignant airway obstruction. Between May 1989 and February 1992, 39 patients were treated in our department. T hirty-two patients (82 percent) had primary lung neoplasms and 7 (18 p ercent) had metastatic disease. Thirty-three patients (85 percent) had prior external irradiation (either alone or in combination with chemo therapy), and 9 patients (23 percent) received laser excision before t reatment. Of the 39 patients, 14 (36 percent) presented with hemoptysi s, 20 (51 percent) with cough, 15 (38.5 percent) had dyspnea, and 15 p atients (38.5 percent) had pneumonia or atelectasis. There were 57 app lications performed in the 39 patients. Patients with hemoptysis had 9 3 percent complete response (CR), 20 percent with cough had CR; 60 per cent improved (partial response [PR]); no response was seen in 20 perc ent. Atelectasis and pneumonia resolved in 20 percent of patients. Eig hteen patients (46 percent) underwent a second procedure and were eval uated for objective response; 34 percent had CR, 44 percent had PR, an d 22 percent did not respond. There were two acute (one bronchospasm, one pneumothorax) and three late (two strictures, and one exsanguinati on) complications. In our experience, HDR was highly effective in the palliation of airway symptoms caused by malignant tumors with acceptab le toxicity.