Endobronchial metallic clips to guide high-dose external-beam radiotherapy in radio-occult lung cancer

Abstract

To the Editors: As a result of the increased sensitivity of videobronchoscopy (including narrow-band and video autofluorescence imaging) and a specific interest in surveillance of pre-invasive lesions, an increase in diagnosis of radiographically occult lung carcinoma (ROLC) can be anticipated. Described for the first time in the late 1970s by Martini and Melamed 1 and in the early 1980s by Cortese et al. 2, surgery still remains the treatment of choice for ROLC 3. However, patients can be functionally inoperable due to comorbidity, advanced age, multiple primary lesions or irresectable, centrally localised tumours, or because they refuse surgery 2. Therefore, varieties of endoscopic techniques, such as photodynamic therapy, cryotherapy, laser therapy, electrocautery and brachytherapy, were developed as alternatives to surgery 3–5. The combination of high-dose external-beam radiotherapy (EBRT) with intraluminal radiotherapy (IR) using low 6–8, middle 9 and high dose-rate 10 iridium-192, has been investigated in ROLC with promising results. EBRT has obvious advantages to surgery, as it is less invasive and better tolerated by the patient. A major issue is, however, the localisation of the tumour for the guidance of EBRT, since these tumours are radiologically occult. Previously, in those studies combining EBRT with IR 6–10 …