High Dose Rate brachytherapy to prevent recurrent benign hyperplasia in lung transplant bronchi: Theoretical and clinical considerations

Background: Significant anastomotic stenosis and malacia is reported to aff ect 7% to 15% of lung transplant recipients. Laser debridement, dilation an d stenting can be used effectively to treat the majority of these patients. However, persistent, as well as reactive hyperplastic tissue reaction, wil l occur in some of these patients, requiring multiple bronchoscopic interve ntions. The experience of 2 patients who received intraluminal brachytherap y irradiation to prevent recurrence of hyperplastic tissue causing airway o bstruction is reported. Both had failed multiple attempts of local control, including wall stent, laser ablation and balloon dilation. They suffered f rom shortness of breath and progressive decrease in quality of life because of airway obstruction. Methods: Two patients received intraluminal irradiation immediately followi ng removal of severe post-lung transplant obstruction. Both patients' devel oped airway obstruction 3 to 4 months after left lung transplantation. High :Dose Rate (HDR) brachytherapy (Ir-192). Afterloader was used to treat Pati ent 1 on two occasions, Patient 2 required a single treatment. The radiatio n dose of 3Gy/fraction was calculated at 1 cm from the catheter for all app lications. Results: Follow up for both patients included bronchoscopy at 3 weeks, 3 mo nths and 6 months after radiation therapy. Follow up for Patient 1 is 7 mon ths, and patient 2 is 6 months. Each patient had an initial complete respon se after radiation. There were no treatment-related complications, and both patients experienced significant improvement in respiratory function. Conclusions: Symptomatic benign airway obstruction:from hyperplastic tissue in the bronchus after lung transplantation can be successfully treated wit h intraluminal radiation therapy. Patients who develop recurrent benign gra nulation tissue after stent and laser therapy may be considered for this ty pe of treatment.