HIGH-DOSE-RATE ENDOBRONCHIAL BRACHYTHERAPY - RESULTS AND COMPLICATIONS IN 189 PATIENTS

The purpose of this study was to determine the benefit of high dose ra te endobronchial brachytherapy in the treatment of obstructive lung ca ncer. Between September 1990 and March 1995, 189 patients with broncho genic carcinoma were treated with high dose rate endobronchial brachyt herapy. Most patients (69.3%) had received prior treatment and present ed with symptomatic bronchial obstruction due to either recurrent or r esidual endobronchial disease. A small group (12%) was medically unfit for either surgical resection or thoracic radiotherapy and benefited from endobronchial brachytherapy alone for small endobronchial rumours . The remainder of the patients had not been treated previously and en dobronchial brachytherapy was performed for life-threatening symptoms requiring emergency obstruction relief before other therapy. Treatment was performed weekly and consisted of three to four 8 to 10 Gy fracti ons at a radius of 10 mm from the centre of the source. Major symptoma tic relief was obtained for haemoptysis (74%), dyspnoea (54%), and cou gh (54%). Complete endoscopic response was observed in 54% of cases. M edian survival was 7 months for the entire group. For small, strictly endobronchial rumours, complete response rate was 96%, median survival 17 months, and 30 month survival 46%, with a plateau, starting at 18 months. Grade 3 to 4 toxicities occurred at a rate of 17% and included massive haemoptysis (n=13), bronchial stenosis (n=12), soft tissue ne crosis (n=8), and bronchial fistula (n=3). By univariate analysis, no factor was found to be predictive of late pulmonary toxicity. The pres ent study confirms the usefulness of endobronchial brachytherapy in al leviating symptoms caused by endobronchial recurrence of bronchogenic carcinoma. In addition, this therapy can be tried with curative intent in patients who present with small endobronchial rumours and are not candidates for other forms of therapy.