Risk factors for massive hemoptysis after endobronchial brachytherapy in patients with tracheobronchial malignancies

BACKGROUND. Massive and mostly fatal hemoptysis is a frequently reported mo rbidity after endobronchial brachytherapy (EBB) for tracheobronchial malign ancies. However, to the authors' knowledge, it remains controversial whethe r this morbidity is related directly to EBB. To investigate whether massive hemoptysis is related to EBB, the authors retrospectively analyzed risk fa ctors for massive hemoptysis after EBB. METHODS. Thirty-six patients (30 men and 6 women) with a mean age of 70 yea rs underwent high-dose rate EBB for tracheobronchial malignancy using a cob olt-60 (Co-60) afterloading machine. EBB was performed as primary therapy i n 6 patients and as salvage treatment for recurrent disease in 30 patients. EBB was delivered to the tracheal lesions in 15 patients and to the main b ronchial lesions in 21 patients. EBB was combined with external beam radiat ion therapy (EBRT) in 24 patients, with laser photocoagulation in 3 patient s, and with EBRT plus laser photocoagulation in 5 patients. The dose of EBR T delivered with the EBB ranged from 16-69 grays (Gy), with a mean dose of 37 Gy. RESULTS. At a mean follow-up of 18 months, 33 of the 36 patients had died. Eight of the 33 patients had no evidence of local disease at the time of de ath. Seven patients died of massive hemoptysis. The cumulative rate of mass ive hemoptysis was 29.4% at 2 years. According to univariate analysis, no s tatistically significant correlation with massive hemoptysis was observed f or EBRT dose delivered in combination with EBB, EBB fractional and total do ses, EBB length, and the sum of all the EBRT doses including that used for the initial treatment. Local failure or persistent malignancy (P = 0.033) a nd delivery of laser photocoagulation (P = 0.032) were found to be statisti cally significantly associated with massive hemoptysis, Direct contact betw een the EBB applicator and the tracheobronchial walls at the vicinity of th e great vessels was observed in 16 patients and was found to be statistical ly significantly associated with massive hemoptysis (P = 0.003). In six pat ients, the applicator was in direct contact with two or more tracheobronchi al wails at the vicinity of the great vessels; all these patients died of m assive hemoptysis. CONCLUSIONS. Direct contact between the EBB applicator and the tracheobronc hial walls at the vicinity of the great vessels was one of the significant risk factors for massive hemoptysis. To prevent massive hemoptysis, a speci fic spacer should be employed to maintain a safe distance between the appli cator and the bronchial wall. (C) 2001 American Cancer Society.