1050 Endobronchial brachytherapy could be curative

Abstract

Brachytherapy is now a widely accepted palliative method for desob-structing the bronchial lumen. However, its place as a curative treatment is still debated. We have tried to distinguish between patients who can be cured with endobrachytherapy and palliative treatments. We report here the results of such a distinction. <h3>Definition of therapeutic groups</h3> (1) Curative group (CG), treated with brachytherapy alone: patients who have a small tumor without extrabronchial extension. Surgery or external irradiation (RT) were not possible, because of chronic respiratory failure or previous treatment (previous RT=87%). (2) Brachytherapy as a local boost after RT (EBRT + BT): initial treatment of lung cancer patients, stages I–IIIB, who have a large endobronchial component at diagnosis. (3) Palliative group (PG): patients with a large obstructing tumor or with metastases. <h3>Population</h3> 148 pts have been treated. CG=69; EBRT + BT=48; PG=31. Mean endobronchial tumor length: CG=2cm; EBRT + BT=2.6cm;PG=4.5cm. Protocol: CG;=6 fractions of 7 Gy in 1 month; EBRT + BT: 2 fractions of 5 or 7 Gy, 15 days after external irradiation; PG; 2 to 6 fractions of 7 Gy. <h3>Results</h3> PG: Objective endoscopic response: 71%; Symptomatic improvement: 62% CG; 78% of complete histologic disappearance of the tumor (CHR). 33%of the pts relapse in the treated areas. EBRT + BT: 83% of CHR. <h3>Survival</h3> 3-year survivals were: PG: 0%; CG: 51%; EBRT + BT: 69%. Most of the pts in the CG died of local disease. <h3>Conclusion</h3> It seems to exist a subgroup of patients, with a low metastatic potential, which can be cured by brachytherapy alone.