The use of high dose rate endobronchial brachytherapy to palliate symptomatic recurrence of previously irriadiated lung cancer

Abstract

Endobronchial obstruction associated with lung cancer represents a common and potentially life threatening complication of newly diagnosed or recurrent disease. The vast majority of patients with obstructive lesions are not curable so it is desirable to palliate these patients as quickly as possible without compromising quality of life. High dose rate brachytherapy (HDR-BT) represents a therapeutic option with several advantages over external beam radiotherapy (EBRT), particularly in previous irradiated patients. The primary objective of this retrospective analysis was to assess palliation efficacy and complication rate of repeated brachytherapy treatment in previously irradiated patients. Between July 2000 and December 2005, 270 patients with endobronchial recurrence after prior given HDR-BT and / or another treatment modality were again treated with HDR-BT. It makes 270 of 1036 patients (26 %) treated on lung cancer with HDR-BT at all in this period. Brachytherapy was delivered with a dose per fraction 8 or 10 Gy specified from the center of the source at 0,5 or 1,0 cm. The symptomatic response rate were as follows: dyspnea had a 76 % response rate, cough 77 % response rate, hemoptysis 92 % response rate, and post-obstructive pneumonia 82 % response rate, respectively. Among 270 of the patients 218 had follow up endoscopic examination (1 â 3 months after brachytherapy completion). Total response rate in this group was 80 %. Of 200 patients whose chest x-ray showed evidence of collapse or atelectasis caused by endobronchial recurrence obstruction, 146 (73 %) had evidence of re-aeration. The median duration of palliation, marked by symptoms or a chest x-ray that worsened was five months, the range varying from 2 to 14 months. We have noticed superficial mucosal necrosis in 166 of patients (61,5 %) and broncho-esophageal fistula in 6 of patients (2,2 %). Repeated HDR-BT effectively relieves the symptoms of endobronchial obstruction due to recurrent lung cancer and can be given safely as an outpatient procedure. Future studies should aim to determine the maximum tolerated dose and appropriate patient selection.