DEFINING THE ROLES OF HIGH-DOSE-RATE ENDOBRONCHIAL BRACHYTHERAPY AND LASER RESECTION FOR RECURRENT BRONCHIAL MALIGNANCY

Endobronchial therapy is commonly used in the palliative management of malignant disease, but the optimal combinations of treatment modaliti es (laser, brachytherapy, external beam radiotherapy) have not been de fined. We have undertaken a prospective analysis of symptom response, duration of response, and prognostic factors for 117 patients treated with brachytherapy at a single centre, to identify hypotheses suitable for prospective randomised studies. All but one patient had received previous treatment. The percentage of patients with scores of 0 or 1 ( none or mild) for each symptom pre-treatment and at 3 months were as f ollows: cough 62% to 77% (43% improving by at least one grade, N.S.); dyspnoea 32% to 56% (50% improvement by al least one grade, P=0.0063); haemoptysis 78% to 97%; performance status 65% to 84% (54% by at leas t one grade, P = 0.0417). An actuarial risk of fatal haemoptysis al 2 years of 20% was associated with prior laser resection (P = 0.048). De ath before 2 months was associated with dyspnoea scores of 3 or 4. Sug gestions for randomised studies are made to address some of the uncert ainties revealed by the analysis. (C) 1997 Elsevier Science Ireland Lt d.