International Journal of Radiation Oncology*Biology*Physics
Clinical investigation: lungHigh-dose-rate endobronchial brachytherapy effectively palliates symptoms due to airway tumors: The 10-year M. D. Anderson Cancer Center experience
Introduction
The potential to use radioactive sources in or near airway tumors has long been recognized. For example, reports from as early as 1922 describe the implantation of radon seeds in a pulmonary lesion via a rigid bronchoscope (1). Unfortunately, these initial attempts were limited by the fact that physicians and personnel were exposed to high levels of radiation, dosimetry was nonuniform, and tumor access was restricted. With the development of more advanced techniques, such as flexible fiberoptic bronchoscopy and the remote afterloading of high-activity sources, endobronchial brachytherapy (EBBT) has now emerged as a safe and effective treatment (2).
The majority of lung cancer patients are diagnosed with clinically advanced disease. These are tumors that have invaded local tissues or spread to regional lymph nodes, which makes them either inoperable or unlikely to be eradicated by surgical resection alone. The patients, who then undergo combined chemotherapy and radiotherapy or radiotherapy alone, are at substantial risk for intrathoracic relapse or metastasis. Indeed, clinical relapse rates of 30–50% have been noted in prospective trials (3). When local tumor control was defined by the pathological complete response, a rate of 17% has been reported (4). Retreatment options in these patients are often limited because the doses prescribed for definitive external-beam radiotherapy usually preclude the administration of additional external radiation due to the increased risk of severe toxicity to other organs such as the heart or to structures such as the esophagus and spinal cord.
An advantage of EBBT in patients with airway tumors is that it allows the delivery of a potentially tumoricidal radiation dose to the site of recurrent disease with less overall risk of substantial injury to the surrounding organs and tissues. An additional particular strength of EBBT lies in its ability to relieve debilitating symptoms, such as dyspnea and hemoptysis. EBBT may also alleviate postobstructive pneumonitis, thereby enabling patients to receive chemotherapy without increased risk of neutropenic sepsis.
At The University of Texas M. D. Anderson Cancer Center, high-dose-rate (HDR), remote-afterloaded, Iridium-192 EBBT has been applied over the past 10 years to palliate patients’ symptoms from recurrent or metastatic endobronchial tumors. In this review, we report on this therapy’s efficacy and toxicity in a series of 175 consecutive patients with lung carcinoma treated during this past decade at our institution.
Section snippets
Methods and materials
One hundred ninety-eight consecutive patients who underwent palliative (EBBT) HDR for endobronchial tumors at M.D. Anderson between November 1988 and December 1997 were identified from a Division of Radiation Oncology database. Twenty-three of these patients received treatment for nonpulmonary primary tumors and were excluded from the analysis. The remaining 175 patients included 74 patients who were included in a previous report (5). Patients’ hospital and radiotherapy charts were reviewed to
Results
The patients ranged in age from 28 to 79 years (median 60); 119 were men and 56 were women (Table 1). The median KPS before treatment was 70, with the score ranging from 50 to 100. One hundred forty-nine patients (85%) had dyspnea, while 133 (76%) had cough, and 60 (34%) had hemoptysis. Forty-seven patients (27%) reported wheezing prior to EBBT. Sixteen patients (9%) reported other symptoms, such as dysphagia, chest pain, and hoarseness. Non-small cell lung carcinoma was the prevalent
Discussion
HDR EBBT provides prompt relief of symptoms in patients with intraluminal airway tumors. Although external-beam radiation therapy could also be used for this purpose, often it cannot be used because patients have already received definitive irradiation, where additional dose to normal intrathoracic tissues and organs would risk severe and debilitating chronic complications. For patients who have not had prior thoracic radiation therapy, a combination of external-beam and endobronchial radiation
References (29)
- et al.
Induction cisplatin/vinblastine and irradiation in unresectable squamous cell lung cancerFailure patterns by cell type in RTOG 88-08/ECOG 4588
Int J Radiat Oncol Biol Phys
(1997) - et al.
Does additional brachytherapy improve the effect of external irradiation? A prospective, randomized study in central lung tumors
Int J Radiat Oncol Biol Phys
(1997) - et al.
Treatment of endotracheal or endobronchial obstruction by non-small cell lung cancerLack of patients in an MRC randomized trial leaves key questions unanswered. Medical Research Council Lung Cancer Working Party
Clin Oncol (R Coll Radiol)
(1999) - et al.
Prolonged survival after high-dose rate endobronchial radiation for malignant airway obstruction
Chest
(1994) - et al.
Ir-192 low dose rate endobronchial brachytherapy in the treatment of malignant airway obstruction
Int J Radiat Oncol Biol Phys
(1993) - et al.
Remote afterloading brachytherapy for the local control of endobronchial carcinoma
Int J Radiat Oncol Biol Phys
(1993) - et al.
High dose rate intraluminal irradiation in bronchogenic carcinoma
Chest
(1993) - et al.
Neodymium:YAG laser and brachytherapy in the management of inoperable bronchogenic carinoma
Ann Thorac Surg
(1990) - et al.
Sequential comparison of low dose rate and hyperfractionated high dose rate endobronchial radiation for malignant airway occlusion
Int J Radiat Oncol Biol Phys
(1992) - et al.
High dose rate brachytherapy in patients with local recurrences after radiotherapy of nonsmall cell lung cancer
Int J Radiat Oncol Biol Phys
(1992)
High dose rate afterloading intraluminal brachytherapy in malignant airway obstruction of lung cancer
Int J Radiat Oncol Biol Phys
Massive haemoptysis death and other morbidity associated with high dose rate intraluminal brchytherapy for carcinoma of the bronchus
Radiother Oncol
Predictive factors for late toxicity after endobronchial brachytherapyA multivariate analysis
Int J Radiat Oncol Biol Phys
Defining the roles of high dose rate endobronchial brachytherapy and laser resection for recurrent bronchial malignancy
Lung Cancer
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