High dose rate endobronchial brachytherapy in the management of primary and recurrent bronchogenic malignancies

Gary Gustafson, Frank Vicini, Laura Freedman, Eric Johnston, Gregory Edmundson, Stanley Sherman, Stewart Pursel, Melanie Komic, Peter Chen, J. Carlos Borrego, Joel Seidman, Alvaro Martinez

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40 Scopus citations

Abstract

Background. The clinical, radiographic, and bronchoscopic records of patients treated with out-patient high dose rate (HDR) endobronchial brachytherapy were reviewed to determine its effectiveness in patients with malignant airway obstruction (with or without prior external beam radiation). In addition, quality of life and acute and chronic morbidity were evaluated. Methods. From January 1, 1989 to June 30, 1993, 46 patients received 128 HDR endobronchial treatments employing a high activity Ir-192 source with a remote afterloader. Patients treated had a total of 22 primary and 17 recurrent bronchogenic carcinomas, 7 of which were metastatic nonpulmonary tumors. Three separate fractions of 7.0 Gy were prescribed to a depth of 1.0 cm. and given 1 week apart. Twelve patients (36%) received prior external beam irradiation (median dose, 58 Gy). Results. Median follow-up for the entire group was 5 months (17.5 for surviving patients). Of the eight asymptomatic patients, five (62%) remained asymptomatic for the remainder of their lives. Of the 38 symptomatic patients, 28 (74%) had significant clinical improvement, and 12 of them remained improved for the duration of their lives. Of thirty-six (78%) patients examined for radiographic response, 25 (69%) had a partial or complete response to this treatment. In patients without prior irradiation, there was a tendency for a higher percentage of clinical and radiographic response. Two patients (4%) experienced mild, transient dysphagia, four patients developed self-limited radiation pneumonitis (9%), and three patients (7%) suffered fatal hemoptysis (all of these patients received prior or concurrent external beam radiotherapy). No factor (i.e., prior radiation therapy, number of catheters placed, surgery, or chemotherapy) predicted an increased risk of complications (P = NS). Conclusions. Outpatient HDR endobronchial brachytherapy is effective in both preventing and relieving endobronchial obstruction in patients with or without prior irradiation, recurrent lesions, or metastatic nonpulmonary disease. A significant proportion of patients can be rendered asymptomatic for the duration of their lives, hence were provided with improved quality of life. These treatments are well tolerated and safe, and result in minimal long term morbidity.

Original languageEnglish (US)
Pages (from-to)2345-2350
Number of pages6
JournalCancer
Volume75
Issue number9
DOIs
StatePublished - May 1 1995
Externally publishedYes

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Keywords

  • airway obstruction
  • endobronchial
  • high dose rate brachytherapy
  • lung cancer
  • recurrent

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Gustafson, G., Vicini, F., Freedman, L., Johnston, E., Edmundson, G., Sherman, S., Pursel, S., Komic, M., Chen, P., Borrego, J. C., Seidman, J., & Martinez, A. (1995). High dose rate endobronchial brachytherapy in the management of primary and recurrent bronchogenic malignancies. Cancer, 75(9), 2345-2350. https://doi.org/10.1002/1097-0142(19950501)75:9<2345::AID-CNCR2820750925>3.0.CO;2-M