Combined endobronchial brachytherapy, external beam radiotherapy, with or without concurrent chemotherapy for bronchial obstruction for renal cell carcinoma metastases

Abstract

4760 Background: To report safety and efficacy of endobronchial brachytherapy (EBT) combined with external beam radiation (ER) with or without concurrent chemotherapy in patients with bronchial obstruction by metastatic renal cell carcinoma (RCC). Methods: Between April 2003 and July 2004, 15 consecutive patients with metastatic RCC to the lung (female n = 5, male n = 10; age: median 56 years) underwent endobronchial LDR brachytherapy. Eight patients were treated with concurrent chemotherapy consisting of capecitabine (1200mg/m2 orally 2 weeks on, 1 off), Thalidomide (200mg escalating to 400mg orally), and Interferon alpha (1mIu subcutaneously twice daily). Tumor size varied from 1.4 to 15 cm (mean 4.92cm). The initial endobronchial obstruction ranged from 60 - 100% (mean 84%). ER of 17.5 to 50 Gy (mean 39.3 Gy) were given (2.5–3.0 Gy/fx) either prior to or after the EBT. Ir-192 EBT was dosed to 20.0Gy at 1cm. Two patients with complete obstruction were treated with Au-198 seeds implants and were dosed to 25 and 30 Gy at 1 cm. Patients were followed up with history and physical exams, bronchoscopy and chest CT. Results: There were no major complications during catheterization and no treatment related mortality. Two patients died during ER unrelated to the radiation treatments. Eleven of 11 patients with follow-up had partial response as measured by subjective improvement on endobronchial examination. Therapy regimen was found to be effective for the palliation of symptoms: 7/7 patients for dyspnea, 5/7 for cough, and 3/3 for hemoptysis. One patient who experienced an improvement in dyspnea had a post-treatment bronchoscopy which revealed a 70% improvement in the obstruction. Five patients have died at last follow-up. Conclusions: We have demonstrated that EBT resulted in no complications even in combination with chemotherapy and ER. Also, the procedure is well tolerated with no major discomforts. This combined approach appears to be effective in palliating obstructive symptoms of dyspnea, cough and hemoptysis. Further studies of LDR-EBT in the multidisciplinary management of metastatic lung disease from RCC for symptoms palliation are planned. No significant financial relationships to disclose.