Massive haemoptysis after radiotherapy in inoperable non-small cell lung carcinoma: is endobronchial brachytherapy really a risk factor?

Background and purpose: This retrospective study was conducted to investiga te whether endobronchial brachytherapy (EBB) is a risk factor for massive h aemoptysis in patients primarily treated by a combination of EBB and extern al irradiation (XRT) for NSCLC. Materials and methods: The records of 938 patients with inoperable NSCLC wh o were treated with XRT and/or EBB were reviewed. The patients were divided into five groups as follows: group XRT, treated by XRT alone (n = 421); gr oup XRTelig, treated by XRT but eligible for EBB (n = 419); group XRTEBB, p rimarily treated with EBB+XRT (n = 62); group EBBrec, treated by EBB for re currence after XRT (n = 23); and group EBB, treated by EBB alone (n = 13). EBB was delivered using HDR. Patients with bronchoscopy-proven endobronchia l tumour in the proximal airways, i.e. the trachea, the main bronchus or lo bar bronchus were considered eligible for EBB. Results: One hundred one out of 938 patients (10.8%) died from massive haem optysis. The incidence was 4.3% in group XRT, 13.1% in group XRTelig and 25 .4% in group XRTEBB. The differences between groups XRT and XRTelig as well as between groups XRTelig and XRTEBB were statistically significant (P < 0 .01). The incidence of massive haemoptysis depended significantly on the fr action size of brachytherapy. When two fractions of 7.5 Gy or a single frac tion of IO Gy were used, 11.1% of the patients died from massive haemoptysi s. However, when a single dose of 15 Gy was used, 47.8% died from massive h aemoptysis. In the multivariate analysis, a single dose of 15 Gy EBB was th e most important prognostic factor for massive haemoptysis. Conclusion: XRT+EBB as primary treatment for NSCLC does not lead to a highe r risk of massive haemoptysis as compared to XRT alone when fraction sizes for EBB of 7.5 or 10 Gy are used. However, the risk of massive haemoptysis increases dramatically when a fraction size of 15 Gy is used. (C) 1998 Else vier Science Ireland Ltd. All rights reserved.