Abstract
BackgroundEndobronchial metastasis is a very rare type of recurrence after lung cancer surgery. Surgical intervention may be difficult to perform due to the postoperative reduction in the activities of daily living (ADL) and the invasiveness associated with redo surgery. In such cases, endobronchial brachytherapy (EBBT) plays an important role not only as a palliative treatment, but also as a definitive treatment with curative intent.Case presentationThree men (64, 69, and 74 years old) underwent combination therapy of external beam radiation therapy (EBRT) and EBBT for endobronchial metastasis after lobectomy of stage I–II non-small cell lung cancer (NSCLC): 2 cases of squamous cell carcinoma and 1 of adenocarcinoma. We used a special source-centralizing applicator for EBBT to avoid eccentric distribution of the radiation dose. Follow-up was considered to start from the end of brachytherapy. None of our patients experienced severe adverse events, and none needed extensive outpatient treatment. Local control was achieved in all cases by a bronchoscopic evaluation. All patients were alive after 31, 38, and 92 months of follow-up, respectively. In the adenocarcinoma patient, two metastases to the lung were discovered 3 years after EBBT, and the patient underwent partial wedge resection.ConclusionsEBBT may be a promising treatment with curative intent for endobronchial metastasis after surgery of NSCLC.
Highlights
BackgroundDespite the advances in radiation therapy, chemotherapy, and newly developed molecular-targeted therapies, lung cancer remains a major health problem and a leading cause of cancer mortality worldwide
Endobronchial metastasis is a very rare type of recurrence after lung cancer surgery
Several studies have demonstrated that endobronchial brachytherapy (EBBT) plays a limited but specific role in definitive treatment with curative intent in select cases of early endobronchial disease, in select advanced inoperable tumors combined with external beam radiotherapy (EBRT), or in the postoperative treatment of small, residual peribronchial disease [3,4,5,6]
Summary
Despite the advances in radiation therapy, chemotherapy, and newly developed molecular-targeted therapies, lung cancer remains a major health problem and a leading cause of cancer mortality worldwide. Ltd., Yokohama, Japan) developed by Nomoto et al for EBBT to avoid eccentric distribution of the radiation dose (Fig. 1a) [7] This applicator can hold the source-delivering catheter because the two self-expandable wings open according to the bronchial diameter [5]. Case 3 A 74-year-old man underwent the left lower lobectomy for lung cancer of squamous cell carcinoma (5.7 cm, pT2bN0M0, pStage IIA). After a diagnosis of squamous cell carcinoma was made by a bronchoscopic biopsy (Fig. 4c), we performed a combination of EBRT and EBBT for the endobronchial metastasis as a definitive treatment. The patient has remained disease-free for 29 months since the irradiation
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