Brachytherapy for Lung Cancer

Abstract

Brachytherapy is the direct placement of a radioactive source inside or close to a tumor mass. The use of endobronchial brachytherapy for bronchogenic carcinoma is not new, being the initial use reported back in the early 1920s. Brachytherapy for lung cancer can be done either by implanting the source directly via the upper airway (endoluminal brachytherapy) or by placing the source interstitially during tumor resection (intraoperative interstitial brachytherapy) or using a percutaneous technique (interstitial brachytherapy). Endoluminal high dose rate brachytherapy is largely used for the curative and palliative treatment of endobronchial tumors. Endoluminal brachytherapy can be used to treat patients with respiratory symptoms which are predominantly due to the endobronchial component of their disease. Brachytherapy can obtain palliation with less morbidity than external irradiation. Endoluminal brachytherapy can be used in combination with external beam radiotherapy for dose escalation as a part of a more radical approach. Finally, brachytherapy may be given to patients who require further palliation having relapsed after previous treatments, including high dose external beam irradiation. Interstitial brachytherapy has been described for the treatment of malignant thoracic tumors. Intraoperative permanent radioactive 125-I seed implantation can be used in the treatment of lung cancer when resection margins are close or involved with tumor or for palliation of inoperable disease. Percutaneous implantation of radioactive seeds has also been reported for the management of stage T1N0M0 medically inoperable NSCLC with CT-guided brachytherapy. During the last two decades, technological advances helped the development of brachytherapy and now it is a safe and effective standard procedure in the treatment of lung cancer.