Braquiterapia endobronquial con dosis elevada en tumores malignos del pulmón

Abstract

To assess clinical and bronchoscopic evolution as well as outcome in patients treated with high dose rate (HDR) endobronchial brachytherapy in order to determine its effectiveness for treating malignant airway obstruction. From May 1993 to January 1996, 10 patients (9 men and 1 woman) with bronchogenic carcinoma received 24 HDR endobronchial treatments. The mean age was 61.9 years (range 34 to 78 years). Inclusion criteria were, for palliative treatment, incurable endobronchial cancer, and, for curative treatment, residual tumor in the margins after resection, or endobronchial tumor that could not be treated surgically. Exclusion criteria were site of lesion unsuitable for placement of the brachytherapy catheter, life expectancy less than two months, Karnofsky index less than 60 or absence of signed consent from the patient. Response criteria was either complete or partial for symptoms and endobronchial tumor. Ten patients received 24 HDR endobronchial treatment from and HDR source of I192 radiation with remote afterloading. A flexible bronchoscope was passed down the bronchial tree toward the area affected by the tumor. At intervals of one week, four separate fractions between 5 and 10 Gy were delivered to a depth of 0.5 to 1 cm and a length of 1 to 5 cm. One month after the last session, each patient underwent endoscopic examination with removal of a histology specimen. Response was considered complete based on clinical signs in 66%; response was complete based on endoscopy in 50%. Three patients died within the first year after treatment and one patient did not return for a follow-up examination. Five patients who had been followed for less than one year were still living. The remaining patient was living 18 months after treatment. All tolerated the treatments well, showing neither early nor late complications. HDR endobronchial brachytherapy is effective both for preventing and relieving malignant endobronchial obstruction. Response to therapy is good, as shown by clinical symptoms and endobronchial examination. HDR endobronchial brachytherapy can cure in carefully selected patients.