Endobronchial Irradiation Research Articles

The role of brachytherapy in the treatment of tumors of the trachea and bronchi

The original methods of the radical and palliative endobronchial and combined radiation treatment of patients with primary and relapsing cancer of trachea and bronchi and the approaches to the calculation of dosimetric radiation plans are developed and suggested. The possibility of combining endobronchial radiation therapy, distance radiation therapy and laser destructionof the tumor, is studied. The indications to endobronchial radiation therapy are formulated. The suggested method of the endobronchial and combined radiation treatment significantly extended the possibilities of organsaving treatment of patients with primarily multiple metachronous and synchronous cancer and made it possible to formulate the new approaches to the radical treatment of patients with locally spread cancer of trachea.

Adenoid cystic carcinoma of the lung — a case report

Adenoid cystic carcinoma (ACC) is a malignant neoplasm that frequently originates from the salivary glands of the head and neck. The majority of pulmonary adenoid cystic carcinomas develop centrally in the trachea. Primary ACC of the lung arising from the bronchial glands is a rare disease and accounts for only 0.09‑0.2% of all primary lung neoplasms [1]. Although their growth rate is often indolent, they sometimes show aggressive biologic behaviour. Local invasion with perineural infiltrations, and lymph node and hematogenous metastases have been reported for some of these neoplasms [2]. Treatment options for advanced disease are limited. We herein report a case of a 56-year-old male patient with adenoid cystic carcinoma of the lung, who received conventional chemotherapy and endobronchial irradiation. This review focuses on the palliative therapy in the treatment of metastatic ACC.

Endobronchial radiotherapy in the treatment of patients with tracheal and lung cancer

Endobronchial radiotherapy in the treatment of patients with tracheal and lung cancer

7-5 気管支腔内照射の治療効果についての検討(シンポジウム7 Endobronchial/Endothoracic Treatment: Up-to-Date)

7-5 気管支腔内照射の治療効果についての検討(シンポジウム7 Endobronchial/Endothoracic Treatment: Up-to-Date)

The Clinical Utility of ^ Iridium Endobronchial Irradiation for Chest X-P Negative Lung Cancer(Present Status of Endoscopic Treatment of Lung Cancer)

The Clinical Utility of ^ Iridium Endobronchial Irradiation for Chest X-P Negative Lung Cancer(Present Status of Endoscopic Treatment of Lung Cancer)

High Dose-Rate Endobronchial Radiotherapy for Proximal Airway Obstruction Due to Lung Cancer: 8-Year Experience of a Referral Center

The efficacy of high dose-rate endobronchial radiotherapy (HDERT) against proximal airway obstruction that results from lung cancer has not been thoroughly evaluated. This study retrospectively reviewed tumor/obstruction characteristics prior to therapy, interventions applied, symptoms before and after intervention, complications, and survival of all patients with proximal airway obstruction resulting from lung cancer who received HDERT between 1995 and 2003 in a tertiary teaching center. Thirty-four (34) patients received HDERT, while 28 had additional treatment (external radiotherapy = 23, neodymium yttrium aluminum garnet laser ablation = 9, stenting = 7, electrosurgery = 5, cryosurgery = 3, and photodynamic therapy = 1). Sixteen (16) patients developed complications, the most frequent being respiratory failure and bronchial-wall necrosis, while 19 experienced symptomatic relief. The median (95% confidence interval) survival of these 34 patients was 7.8 (5.9-9.8) months, significantly longer (p = 0.004) than a historic control of 3.9 (3.7-7.1) months from the Cleveland Clinic Foundation, in Cleveland, OH, and comparable to other previous reports. No single factor predicted complications or symptomatic relief. However, female gender, presence of only one symptom, absence of fatigue/weight loss, >1 HDERT sessions, and postprocedure symptom relief were associated with improved survival. Contemporary HDERT with or without additional treatment modalities is effective against central airway compromise resulting from lung cancer.

Treatment of tumorous airway obstruction in patients with bronchial carcinoma by endobronchial radiotherapy following high-frequency electrocautery and net stenting

Treatment of tumorous airway obstruction in patients with bronchial carcinoma by endobronchial radiotherapy following high-frequency electrocautery and net stenting

Aortotracheal fistula secondary to bacterial aortitis.

Fistulas between the aorta and tracheobronchial tree are rare fatal complications that occur in patients treated with external and endobronchial radiation for carcinomas of the upper and lower respiratory tract. The etiopathogenesis can be multifactorial. We report the case of a patient with irradiated tracheal carcinoma who died of massive hemoptysis 25 months after completing therapy. Autopsy revealed a fistula between the trachea and arch of the aorta. Multiple colonies of cocci and bacilli were demonstrated within the media at the site of rupture and were absent in other areas of the aorta. The development of an aortotracheal fistula in this patient was most probably related to infection in an area of tracheal and vascular wall previously damaged by exposure to high doses of radiation.

Aortotracheal Fistula Secondary to Bacterial Aortitis

Fistulas between the aorta and tracheobronchial tree are rare fatal complications that occur in patients treated with external and endobronchial radiation for carcinomas of the upper and lower respiratory tract. The etiopathogenesis can be multifactorial. We report the case of a patient with irradiated tracheal carcinoma who died of massive hemoptysis 25 months after completing therapy. Autopsy revealed a fistula between the trachea and arch of the aorta. Multiple colonies of cocci and bacilli were demonstrated within the media at the site of rupture and were absent in other areas of the aorta. The development of an aortotracheal fistula in this patient was most probably related to infection in an area of tracheal and vascular wall previously damaged by exposure to high doses of radiation.

Neue Wege der Strahlentherapie des Bronchialkarzinoms: Die endobronchiale Kleinraumbestrahlung mit der Iridium-192-High-dose-After-loading-Technik in Kombination mit dem Neodym-YAG-Laser

106 patients with inoperable malignant tumours constricting the central bronchial tree underwent endobronchial small-field radiotherapy with iridium-192 at high dose between June 1983 and September 1985. Treatment was performed using the computer-guided after-loading technique and a flexible bronchoscope under local anaesthesia. In complete occlusion of a bronchus by the tumour, a neodymium YAG-laser was applied (57 patients) to allow insertion of the after-loading probe. Endoscopy showed tumour regression in 75% of the patients, accompanied by clinical improvement. Pulmonary function tests, arterial blood gas analyses and pulmonary perfusion scans yielded a highly significant improvement of data after treatment. The procedure also proved effective upon exhaustion of external radiation. Apart from its positive palliation, endobronchial small-field radiotherapy using high doses of iridium-192 also has a curative effect, thus opening up a new approach to the therapy of advanced bronchial carcinoma.

Clinical Relevance of Sputum Cytology and Chest X-Ray in Patients with Suspected Lung Tumors

To review diagnostic procedures, therapeutic modalities, and follow-up methods in patients with suspected lung tumors. We retrospectively examined 70 patients who underwent a complete medical checkup because they had been positive for sputum cytology and had presented no chest X-ray findings for the 10-year period between 1994 and 2004. To make a diagnosis, we conducted the first complete medical checkup that included chest X-ray, sputum cytology, chest computed tomography (CT), and bronchoscopy. In the case that no diagnosis could be made, we repeated the chest X-ray and sputum cytology every 3 to 6 months and additionally conducted chest CT and bronchoscopy according to abnormal findings. Among 70 patients, there were 36 and 13 who were diagnosed during the first complete medical checkup and follow-up, respectively, 13 who remained undiagnosed, and eight for whom follow-up was discontinued. Among the 49 diagnosed patients, 40, 8, and 1 patient had lung cancer, upper respiratory tract carcinoma (URTC), and esophageal carcinoma (EC), respectively. Among the 40 patients with lung cancer, 34 had a stage 0 or I tumor and 15 were radically treatable by photodynamic therapy and endobronchial irradiation. Nine among 11 patients whose lung cancer was detected during follow-up had a stage 0 or IA tumor. Not only lung cancer but also URTC and EC were successfully detected in patients who were positive for sputum cytology and presented negative chest X-ray. Radical treatment was possible in 38 (76%) of 50 diagnosed patients, thus indicating the importance of follow-up through these procedures.

Second Line Palliative Endobronchial Radiotherapy with HDR Ir 192 in Recurrent Lung Carcinoma

PurposeTo observe the efficiency of reirradiation with high dose rate intraluminal brachytherapy in symptomatic palliation of recurrent endobronchial tumors.Materials and MethodsBetween January 1994 and June 1998, 21 patients diagnosed with recurrent endobronchial tumors following external beam radiotherapy were treated palliatively with high dose rate intraluminal irradiation at Hacettepe University Oncology Institute. A single fraction of 10 Gy was prescribed to the specified area in 9 patients and 15 Gy to 12.ResultsEndobronchial treatment improved the performance and reduced symptomatology in 17 (81%) patients. Ten dyspneic patients (10/14, 71%) recovered clinically with an accompanying radiological downstaging. The median symptomatic palliation was 45 days (range, 0 - 9 months), and the overall median survival was 5.5 months (range, 4 - 12 months). The palliative intrabronchial brachytherapy was well tolerated, with the exception of in one patient with a fatal hemorrhage, and another with medically salvaged bronchospasm and intrabronchial edema.ConclusionRecurrent patients with a history of previous thoracic external beam irradiation can be effectively palliated with high dose rate endobronchial reirradiation if the symptoms are directly related to the endobronchial tumor.

Treatment of recurrent disease in lung cancer.

Recurrence is a common event after treatment of lung cancer. Retreatment options depend on previous therapies, location of recurrence, and physical condition of the patient. Locoregional relapse can be treated the same way as initial lung cancer, including surgery, radiotherapy (RT), and chemotherapy (CHT), or combined treatment. Approximately 1% to 2% of all recurrent lung cancer is treated with curative reoperation, with somewhat dismal results. RT has been used for either postsurgical or post-RT locoregional recurrences. In the former case, external beam RT was particularly effective in isolated bronchial stump recurrences, with median survival time of approximately 28.5 months and a 5-year survival of approximately 31.5%. In the latter case, reirradiation, generally with endobronchial brachytherapy, was successful in palliation of intrathoracic symptoms (in at least two-thirds of cases), carrying a low incidence of radiation pneumonitis (up to 5%) although cumulative doses went up to 120-150 Gy. Besides external beam RT, endobronchial RT was used to treat symptomatic intraluminal recurrences, with the vast majority of studies using high-dose rate brachytherapy. Finally, CHT has been used in relapsed/refractory advanced or metastatic non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) with the major emphasis on the third-generation drugs that show good response after previously used platinum-based CHT.

High Dose Rate Endobronchial Brachytherapy Effectively Palliates Symptoms Due to Inoperable Lung Cancer

Intraluminal brachytherapy has become an established treatment for major airway occlusion by relapsed or persistent inoperable endobronchial tumors. The aim of this study was to compare the palliation improvement pre- and post-radiotherapy. The study group was 95 patients with the diagnosis of inoperable lung cancer who were eligible for HDR brachytherapy. Fiber-optic bronchoscopy was performed and the level and degree of endobronchial obstruction were estimated in terms of bronchial obstruction index. Endobronchial irradiation was delivered using remote HDR afterloading brachytherapy with iridium-192. Brachytherapy was delivered at weeks 1, 2 and 3 at 7.5 Gy per fraction or at weeks 1 and 2 at 10 Gy per fraction. All patients were evaluated at the beginning and at the third month of therapy. Using Speiser's symptomatic scoring criteria, the severity of symptoms (dyspnea, cough, hemoptysis and postobstructive pneumonia) was weighted. Bronchoscopic findings at the initial evaluation and at the third month were also scored. Surviving patients were followed up for a minimum of 3 months with a mean of 7.5 +/- 5.35 months (median: 6 months). All the symptoms and bronchial obstruction improved significantly after brachytherapy (P < 0.05). The most responding symptoms were dyspnea and hemoptysis. The factors determining the complete response were evaluated; age, staging, histological type, lesion localization and previous history of radiotherapy did not seem to determine the complete response (P > 0.05). All the symptoms and bronchial obstruction index seemed to improve after brachytherapy. However, it is difficult to predict the response before the therapy.

High-dose endobronchial radiation therapy under fiberoptic bronchoscope for malignant airway obstruction.

To assess the effect of endobronchial radiation guided by fiberoptic bronchoscope for malignant airway obstruction. Sixty-five patients with lung cancer and malignant airway obstruction were investigated. After routine bronchoscopic examination , the brachytherapy catheter was inserted through biopsy channel and the tip was fixed onto the obstructing malignancies. Then radiotherapy was performed with 192 Ir at a dose of 628 Gy distributed among 225 points. The treatment was rendered weekly in a sequence of 3 weeks as one course. The chest X-ray and bronchoscopic assessment were made 1 and 4 week after finishing radiation therapy. X-ray assessment :CR ,PR and MR were 23. 08 %(15 cases) ,43. 08 %(28 cases) and 18. 46 %(12 cases) respectively , with 84. 62 %of total effective rate (CR + PR +MR) . Bronchoscopic assessment : CR , PR and MR were 38. 46 %(25 cases) , 43. 08 (28 cases) and 13. 85 %(9 cases) respectively , with 95. 38 % of total effective rate. The endobronchial radiation guided by fiberoptic bronchoscope has better reopening effect and less complications for malignant airway obstruction in the patients with lung cancer.

Transbronchial Palmaz Stent Placement for Tracheo-bronchial Stenosis

Evaluation of the efficacy of transbronchial Palmaz stent placement in the treatment of tracheo-bronchial narrowing. Twelve patients with stenoses of the tracheo-bronchial tree were treated with balloon-expandable Palmaz stents. Etiology was anastomotic stenosis after lung transplantation (n = 3), bronchogenic carcinoma (n = 2), external compression from thoracic aortic aneurysm (n = 2), Mycobacterium tuberculosis (n = 1), esophageal carcinoma (n = 1), after lobectomy (n = 1), after lobectomy and endobronchial radiation (n = 1), and lye ingestion (n = 1). All patients had respiratory symptoms, radiologic findings of persistent atelectasis, or worsening pulmonary function tests. Bronchoscopy was used to delineate the stenosis prior to intervention. With use of fluoroscopic guidance, stents were placed in the mainstem bronchus (n = 11), lower lobe bronchus (n = 5), bronchus intermedius (n = 5), trachea (n = 3), and middle lobe bronchus (n = 1). Initial technical success was achieved in all patients. Ten of the 12 patients (83%) had improvement of clinical pulmonary signs or symptoms. During follow-up, five patients died. One was lost to follow-up and was presumed dead. The 30-day mortality rate was 17% (two of 12 patients). The two complications were superficial laceration of the bronchial mucosa during balloon dilation in one patient and compression of stents by a thoracic aortic aneurysm in another patient. Initial results suggest that transbronchial Palmaz stent placement is a feasible and effective method of treating tracheo-bronchial stenosis.

479 A phase II study of combined endobronchial low-dose rate brachytherapy (EBT) and external beam radiotherapy (ER) for roentgenographically occult lung cancer

479 A phase II study of combined endobronchial low-dose rate brachytherapy (EBT) and external beam radiotherapy (ER) for roentgenographically occult lung cancer

506 Clinically relevant quality of life outcomes in the first UK randomised trial of endobronchial brachytherapy (EBT) versus external beam radiotherapy (XRT) in patients with inoperable non-small cell cancer (NSCLC)

506 Clinically relevant quality of life outcomes in the first UK randomised trial of endobronchial brachytherapy (EBT) versus external beam radiotherapy (XRT) in patients with inoperable non-small cell cancer (NSCLC)

Endoscopic Treatment of Malignant Airway Obstructions in 2,008 Patients

We report our 13-year experience with endoscopic treatment of malignant obstructions of the airway by Nd:YAG laser, stents, and intraluminal brachytherapy in 2,008 patients. We performed 2,610 laser resections in 1,838 patients, 66 high dose rate brachytherapies, and we placed 393 tracheobronchial silicone stents in 306 patients. We used the rigid bronchoscope in 96% of the laser procedures and in all cases requiring stent placement; general anesthesia was given to 90% of these patients. Endobronchial radiotherapy was performed under local, anesthesia. In 93% of patients undergoing laser resection, we obtained an immediate patency of the airway with consequent improvement of quality of life. The median time between the first and second laser treatment was 102 days, being longer in the case of stent placement (when required) or in association with brachytherapy. Even if endoscopic treatment should be considered only for palliation, laser vaporization could be curative in case of in situ carcinoma. Since 1983, we have treated 23 such lesions in 17 patients and up to now, none has recurred. Finally, endoscopic resection may allow a better assessment of the true extent of the tumor, shifting to surgery patients originally considered to have inoperable disease or allowing lung-sparing operations (21 and 18 patients of our series, respectively). The total mortality rate was 0.4% (12 patients over 2,798 treatments; 2,710 Nd:YAG laser + 151 stents without laser + 37 brachytherapies without laser) in the first week after the procedures, and was mainly related to cardiovascular problems and respiratory failure. In conclusion, endoscopic resection of lung malignancies is rapid, effective, repeatable, and complementary to other treatments; although it should be considered only palliative, laser resection could be curative in patients with in situ carcinomas and early cancers. Laser, stents, and endoluminal brachytherapy should be available in all centers with major experience; a well-trained team is mandatory to plan the most appropriate treatment and manage any possible complication.

Percutaneous and endobronchial high dose rate brachytherapy for lung cancer

Endobronchial and percutaneous high dose rate (HDR) brachytherapy was performed with a microSelectron HDR using iridium-192 as a radiation source. As spontaneous pain was uncontrollable by external beam radiation (EBR), chemotherapy, hyperthermia or a combination of these treatment methods, three patients with lung cancer infiltration into the chest wall underwent percutaneous HDR brachytherapy for palliation of severe pain. Selectron needles were inserted under CT guidance and the irradiation dose was set to 10 or 12 Gy at the point 1 cm from the center of the radiation source. A total of 2-4 selectron needles was introduced by means of a template. Irradiation was performed once a week for 1-2 weeks depending on the degree of alleviation of spontaneous pain. In all 3 cases, alleviation of spontaneous pain occured within 7 days after the completion of HDR brachytherapy, and the mean pain score decreased from a value of 2 to 1 within 2 weeks. After discharge from the hospital, the pain score remained between 1-4 in all 3 patients. One problem in percutaneous brachytherapy is the possible hindrance of multiple selectron needle insertion through the template by the ribs depending on the location of the lesion. Six patients aged 51-75 years were subjected to endobronchial HDR brachytherapy. Two of these patients had postoperative recurrence of lung cancer, and 3 patients received concomitant chemotherapy. Brachytherapy was performed 3.4 months (average) after the administartion of 40-70 Gy of EBR. Endobronchial irradiation was performed at a dose of 7 Gy, measured at 1 cm from the center of the radiation source, once a week over a 3 week period for a total of 21 Gy. With the exception of 2 patients who died due to systemic exacerbation, local control of the illness has been good. In endobronchial HDR brachytherapy, it is important to develop a system for altering radiation dose in response to changes in the caliber of the tracheobronchial tree and the degree of the tumor invasion under the bronchial mucosa.