External irradiation versus external irradiation plus endobronchial brachytherapy in inoperable non-small cell lung cancer: a prospective randomized study

Purpose: No randomized studies are available on the additional value of end obronchial brachytherapy (EBB) to external irradiation (XRT) regarding pall iation of respiratory symptoms (RS). A prospective randomized study was ini tiated to test the hypothesis that the addition of EBB to XRT provides high er levels of palliation of dyspnea and other RS and improvement of quality of life (QoL) in patients with non-small cell lung cancer (NSCLC) with endo bronchial tumour. Materials and methods: Patients with previously untreated NSCLC, stages I-I IIb, WHO-performance status of 0-3 and with biopsy proven endobronchial tum our in the proximal airways were eligible. EBB consisted of two fractions o f 7.5 Gy at 1 cm on day 1 and 8. XRT started at day 2. The XRT dose was 30 Gy (2 weeks) or 60 Gy (6 weeks). The EORTC QLQ-C30 and QLQ-LC13 were assess ed before treatment and 2 weeks, 6 weeks, 3, 6 and 12 months after treatmen t. Re-expansion of collapsed lung was tested by the inspiratory vital capac ity (IVC) and CT scan of the chest. Results: Ninety-five patients were randomized between arm 1 (XRT alone) (n = 48) or arm 2 (XRT + EBB) (n = 47). The arms were well balanced regarding pre-treatment characteristics and QoL scores. The compliance for QoL-assess ment was >90% at all times. No significant difference between the trial arm s was observed with respect to response of dyspnea. However, a beneficial e ffect of EBB was noted concerning the mean scores of dyspnea over time (P = 0.02), which lasted for 3 months. This benefit was only observed among pat ients with an obstructing tumour of the main bronchus. A higher rate of re- expansion of collapsed lung was observed in arm 2 (57%) compared to arm 1 ( 35%) (P = 0.01). The inspiratory vital capacity (IVC) assessed 2 weeks afte r radiotherapy improved with 493 cm(3) in arm 2 and decreased 50 cm(3) in a rm 1 (P = 0.03). No difference was noted regarding the incidence of massive haemoptysis (13 vs. 15%). Conclusion: The addition of EBB to XRT in NSCLC is safe and provides higher rates of re-expansion of collapsed lung resulting in a transient lower lev els of dyspnea. This beneficial effect was only observed among patients wit h obstructing tumours in the main bronchus. (C) 2001 Elsevier Science Irela nd Ltd. All rights reserved.