High Dose Rate Endobronchial Brachytherapy Research Articles

Effective Differences between 2D and 3D Planned Brachytherapy in Lung Cancer: An Institutional Retrospective Study.

Background and Objectives: Advanced lung cancer is usually manifested by endoluminal tumor propagation, resulting in central airway obstruction. The objective of this study is to compare the high dose rate brachytherapy treatment outcomes in non-small-cell lung cancer (NSCLC) depending on the treatment planning pattern-two-dimension (2D) or three-dimension (3D) treatment planning. Materials and Methods: The study was retrospective and two groups of patients were compared in it (a group of 101 patients who underwent 2D planned high-dose-rate endobronchial brachytherapy (HDR-EBBT) in 2017/18 and a group of 83 patients who underwent 3D planned HDR-EBBT between January 2021 and June 2023). Results: In the group of 3D planned brachytherapy patients, there was a significant improvement in terms of loss of symptoms of bronchial obstruction (p = 0.038), but no improvement in terms of ECOG PS (European Cooperative Oncology Group Performance Status) of the patient (p = 0.847) and loss of lung atelectasis (if there was any at the beginning of the disease) (p = 0.781). Two-year overall survival and time-to-progression periods were similar for both groups of patients (p = 0.110 and 0.154). Fewer treatment complications were observed, and 91.4% were in 3D planned brachytherapy (BT) patients. Conclusions: Three-dimensionally planned HDR-EBBT is a suggestive, effective palliative method for the disobstruction of large airways caused by endobronchial lung tumor growth. Independent or more often combined with other types of specific oncological treatment, it certainly leads to the loss of symptoms caused by bronchial obstruction and the improvement of the quality of life of patients with advanced NSCLC. Complications of the procedure with 3D planning are less compared to 2D planned HDR-EBBT.

EP07.02-03 High-Dose Rate Endobronchial Brachytherapy with Palliative and Definitive Intent at a Tertiary Care Hospital

EP07.02-03 High-Dose Rate Endobronchial Brachytherapy with Palliative and Definitive Intent at a Tertiary Care Hospital

High-dose-rate brachytherapy for airway malignancy a single institution experience

To evaluate clinical outcomes of endobronchial malignancy treated using high-dose-rate endobronchial brachytherapy (HDREB). A retrospective chart review was conducted for all patients treated with HDREB for malignant airway disease between 2010 and 2019 at a single institution. Most patients had a prescription of 14 Gy in two fractions given a week apart. The Wilcoxon signed rank test and paired samples t test were used to compare changes in mMRC dyspnea scale prior to and after brachytherapy at first followup appointment. Toxicity data were collected for dyspnea, hemoptysis, dysphagia, and cough. A total of 58 patients were identified. Most (84.5%) had primary lung cancer with advanced cancers, stage III or IV (86%). Eight were treated while admitted in the ICU. Previous external beam radiotherapy (EBRT) was received by 52%. An improvement in dyspnea was seen in 72%, with an mMRC dyspnoea scale score improvement of 1.13 points (p < 0.001). Most (22, 88%) had an improvement in hemoptysis and 18 out of 37 (48.6%) had an improvement in cough. Grade four to five events occurred in 8 (13%) at the median time of 2.5 months from brachytherapy. Twenty-two patients (38%) had complete obstruction of the airway treated. Median progression free survival was 6.5 months and median survival was 10 months. We report a significant symptomatic benefit among patients receiving brachytherapy with endobronchial malignancy, with rates of treatment related toxicities similar to prior studies. Our study identified new subgroups of patients, ICU patients & those with complete obstruction, who benefited from HDREB.

PO04: Clinical and Dosimetric Outcomes with Image-Guided High Dose Rate (HDR) Endoluminal Brachytherapy in Endobronchial Tumours: A Single Institute Experience

<h3>Purpose</h3> Endoluminal brachytherapy is an effective treatment modality for endobronchial tumours. With the advent of image-guidance, target coverage has improved and volume-based target delineation has helped in conformal treatment. In this study, we report our experience with high dose rate endobronchial brachytherapy (HDR-EBBT) and to assess its efficacy and tolerability. <h3>Materials and Methods</h3> Between January 2015 to February 2022, a retrospective review of patients with endobronchial tumours treated at our institution with HDR-EBBT was retrospectively assessed. Analysis of disease characteristics and thereafter, the subjective response and treatment related toxicities were extracted from patient records. The follow-up was undertaken as per the institutional protocol. Local control (LC) and overall survival (OS) were analysed. During each procedure of EBBT, a source-centralizing applicator was used which kept the source-dwelling catheter in the centre of bronchial lumen and reference dose point was placed 5 mm from source axis as per the bronchial diameter. <h3>Results</h3> With a median follow up of 18 months, a total of 8 patients with histopathologically proven endobronchial tumours were identified. The median external beam radiation dose was 45Gy in 25 fractions followed by brachytherapy dose of 14Gy in 2 fractions with treatment a week apart. The commonest symptoms to palliate included dyspnea (5/8), cough (3/8), and hemoptysis (4/8). The median disease-free survival and overall survival was 18 months and 21 months respectively. No grade 3-5 acute or late toxicities were reported and only one patient required further palliation measures to control the symptoms. On dosimetric analysis the PTV V95% and V98% were 95.12% and 93.45% respectively. On assessing the D20 and D5 for lungs, the median dose was 1.32Gy and 0.73Gy respectively. Similarly, the D2cc, 1cc and 0.1cc of oesophagus and heart were 1.63, 1.89 and 2.67Gy and 1.15, 1.37 and 1.69Gy respectively. <h3>Conclusion</h3> HDR-EBBT is a promising treatment with minimal complications and improved outcomes and thus provide curative options. If performed properly, desirable dosimetry can be achieved to improve target coverage and reduced normal tissue doses.

High-dose-rate endobronchial brachytherapy in the management of advanced lung cancer - comparison according to the presence of lung atelectasis

Introduction/Objective. Locally advanced lung cancer is often accompanied by atelectasis of either a part or the entire lung. The aim of this study was to establish the benefits of brachytherapy on the patients? quality of life, the length of the progression-free survival (PFS), and the overall survival (OS) as related to the presence or absence of atelectasis after the applied treatment. Methods. The total of 100 patients with locally advanced lung cancer or endobronchial metastasis of other malignancy were treated with the high-dose-rate endobronchial brachytherapy (HDR-EBB) in 2017. For observing the patients? clinical characteristics, the PFS and OS, the patients were classified into four groups according to the presence of atelectasis before and after HDR-EBB. Results. After HDR-EBB alone or combined with other treatment modalities, a statistically significant symptom alleviation was registered for all the symptoms except cough (p &lt; 0.05). The significantly highest PFS value was registered among the patients with atelectasis prior but not after HDR-EBB. The longest survival was registered in the patients who had atelectasis prior to, but not after HDR-EBB, as well as among the patients without atelectasis either before or after EBB. Conclusion. HDR-EBB is an efficient method that improved the quality of life of most patients. There were improved rates of re-aeration after HDR-EBB treatment alone and as a part of combined treatment. Reaeration after EBB is a positive prognostic factor with respect to PFS and OS of these patients.

Endobronchial HDR Brachytherapy for Post-Transplant or Wegener’s Granulomatosis Associated Bronchial Stenosis

Bronchial stenosis is a clinically challenging problem following lung transplant and in Wegener’s Granulomatosis. Despite laser, stenting, balloon dilation among other interventions, worsening of stenosis often occurs. Endobronchial brachytherapy has been implemented for treatment refractory stenotic areas based on limited data. We hypothesize that high dose rate (HDR) Brachytherapy using 3Gy x1 fraction is effective in alleviating treatment refractory stenosis of bronchus. Patients who underwent endobronchial HDR Ir-192 brachytherapy from January 2016 to January 2020 for bronchial stenosis were retrospectively reviewed. Patients were selected for HDR brachytherapy if they had treatment refractory symptomatic re-stenosis. On day of brachytherapy, a flexible bronchoscopy was performed and a brachytherapy catheter was inserted. Intraoperative fluoroscopic imaging confirmed catheter positioning. Treatment length ranged from 3-5cm. The dose of 3Gy in 1 fraction was prescribed 1cm from the catheter surface. Patients were followed with bronchoscopies and pulmonary function testing (PFTs). Four patients were included with median follow-up of 5.2m (range: 0.9-16.8). One patient received brachytherapy 12Gy in 4 fractions 12 years prior to re-treatment. The same patient received a second double lung transplant due to bronchiolitis obliterans. All patients had initial clinical & bronchoscopic improvement with brachytherapy. The one Wegener’s Granulomatosis patient required an additional two courses of brachytherapy due to residual granulation tissue found proximally outside of the prior radiation treatment fields. Median time to next endobronchial intervention after brachytherapy was 5.2m [0.9-18.8]. The median number of interventions pre and post brachytherapy are listed below (Table 1). FEV1 prior to brachytherapy was 33% predicted [27-65] and PFT after brachytherapy was 40% predicted [25-72]. The one Wegener granulomatosis patient had a balloon dilation procedure induced grade 4 bronchopulmonary hemorrhage three months after 3rd brachytherapy treatment, requiring bronchial artery embolization. They were subsequently discharged 36 hours after the initial bleed and remains free of stenosis. Table 1 Endobronchial HDR brachytherapy utilizing 3Gy x 1 fraction was safe and effective in resolving refractory re-stenotic areas of bronchus caused by granulation tissue. There were no toxicities associated with lung transplant patients. The Wegener’s Granulomatosis patient had a potential G4 toxicity after a third brachytherapy treatment. Caution needs to be applied in the setting of repeated endobronchial brachytherapy procedures. More robust follow up is needed to assess long term success.Abstract 2512; TablePatientNumber of Pre-Brachytherapy InterventionNumber of Post-Brachytherapy Intervention12-6 months6-0 months0-6 months6-12 months194191221311303442042900Median [range]6.5 [2-13]6.5 [4-11]2.5 [0-19]0 [0-12] Open table in a new tab

P2.18-13 Endobronchial Brachytherapy: A Single Institutional Experience

High Dose Rate Endobronchial Brachytherapy (HDR-EB) allows treatment of endobronchial lung cancer with minimal radiation of surrounding tissues. It can be both applied as radical intent in local disease or as palliation in metastatic or non-curative setting. The aim of this study is to describe clinical characteristics, complications and survival of a cohort patients treated with HDR-EB as radical intent. Retrospective analysis of consecutive patients undergoing radical HDR-EB in our centre since 2010. Clinical, functional and survival variables were recorded, as well as those related to radiation. HDR-EB was performed after placement of the afterloading catheter in the target bronchus with a flexible bronchoscope. All treatment was delivered weekly. Simulation CT and dosimetry was performed before each fraction. Dose was 5Gy/fr, prescribed at 100% of the implant. 16 patients were analysed, 15 (94%) males, age 69 (±8) years-old, 3 (19%) were active and 13 (81%) former smokers. Lung function was FEV1 62.3% (±21%), DLCO 60.5% (±13%). Pathological diagnose included in-situ carcinoma (n=1, 6%) and invasive squamous cell carcinoma (n=15, 94%). T staging was T1 in 10 (62.5%) patients, T2 in 3 (18.8%) patients and T4 in 1 (6.3%) patient. All patients had N0 staging. 2 patients had exclusive endobronchial disease. 6 patients received 3 (n=3, 18.6%) and 4 (n=3, 18.6%) fractions after external beam radiotherapy as a boost. 10 patients received 5 (n=2, 12.5%) or 6 (n=8, 50%) fractions as exclusive radical HDR-EB. 2 complications were reported: obstructive pneumonitis (n=1) and bronchial stenosis (n=1). Neither deaths nor haemoptysis occurred in relation with the technique. Mean follow-up was 29 (±21) months. Mean overall survival was 29.0 (±22) months. Mean disease free-survival was 24.9 (±21) months. 4 (25%) progressions were observed, of which 3 (19%) were local progression. Patients who received boost strategy HDR-EB showed an increased overall survival compared to radical intent (38.2 vs 24.8, p>0.05) and a increased median free-survival; which showed no statistical significance. HDR-EB is a safe technique applicable in radical intention. Longer survival has been described in patients who received boost strategy. Prospective studies are needed to determine long-term benefits.

Radiologically Occult Lung Cancer That Can Be Treated Curatively with High Dose Rate-Endo Bronchial Brachytherapy

Early stage non-small cell lung cancer (NSCLC) can be cured with surgery or Stereotactic Body Radiation Therapy (SBRT) in majority of cases. However, patients with early stage NSCLC not amenable to surgery or SBRT poses a challenge as modalities like cryotherapy, photodynamic, or laser therapy only offer short term palliation but not cure. We present a case of radiologically occult NSCLC that was not a candidate for surgery or SBRT, and treated with curative intent High Dose Rate-Endo bronchial brachytherapy (HDR-EBBT).

Multidisciplinary approach to endobronchial HDR brachytherapy as an alternative to external beam radiation for palliating malignant airway obstruction.

132 Background: Concerns over the safety of high-dose-rate (HDR) endobronchial brachytherapy (EBB) has limited its widespread use in palliating pulmonary airway obstruction. Morbidity following EBB is commonly attributed to fatal hemoptysis and fistula formation. We implemented a procedure to deliver EBB under general anesthesia to minimize procedure risks, while maintaining treatment effectiveness. We hereby report outcomes of consecutive patients treated using this approach to palliate airway obstruction. Methods: We retrospectively reviewed charts of consecutive patients treated with EBB. Treated patients had obstructive lesions &gt;2cm distal to the carina and central structures, who were deemed candidates for EBB by a multidisciplinary team of interventional pulmonologists (IP) and radiation oncologists (RO). All patients were treated under general anesthesia. Bronchoscopy and localization of target lesions was performed by IP. HDR catheters carrying a marker wire were advanced past obstructive lesion. CT simulation was performed to confirm catheter placement, and perform CT-based 3D treatment planning. A dose of 6 -7 Gy/fraction was prescribed at 1 cm from catheter surface. Results: 25 patients (ages 29 -71, mean 52 years) were treated with EPP. 5 had previously received external beam radiation (EBRT) and 3 had concurrent EBRT and EPP. Overall, a total of 76 EBB treatments were performed, with a median of 3 weekly fractions per patient (range 1-6) to total dose of 18Gy. There were no incidences of major bleeding (&gt;50 mL) or fatal hemoptysis in the 30 days following EPP. Moreover, there were no cases of severe (Grade 3 or higher) CTCAE toxicity reported. After a median follow up of 30 months (range 4-42) only 1 out of 17 patients treated with EPP alone required additional EBRT for airway obstruction, 12 months following EPP. Conclusions: Our data suggest the safety and efficacy of an expert multidisciplinary approach to palliating pulmonary airway obstruction using EPP. This approach provides effective palliation of airway obstruction and decreased the need for additional EBRT in majority of treated patients.

Clinical and endoscopic response to high dose rate endobronchial brachytherapy in malignant lung tumors: A single centre experience.

Purpose:The aim of the study was to evaluate the short-term clinical, endoscopic response, and acute toxicities in endobronchial cancer treated with high-dose-rate endobronchial brachytherapy (HDR-EB).Materials and Methods:Thirty patients of advanced endobronchial cancers were treated with HDR-EB. Brachytherapy was delivered at a depth of 1 cm from the source axis at weeks 1, 2, and 3 with 7 Gy per fraction. All patients were evaluated before treatment and at 1 month after completion of therapy. Using Speiser's scoring criteria, the severity of symptoms (dyspnea, cough, hemoptysis, and postobstructive pneumonia) and degree of obstruction were graded.Results:Symptomatic response for cough, dyspnea, and hemoptysis was seen in 88%, 75%, and 96%, respectively, with a significant P value (<0.05). Obstructive pneumonia was resolved in 94% of patients. Endoscopic response in terms of degree of obstruction was seen in 84% of patients. Acute toxicities in the form of radiation bronchitis were seen in 32% of patients, whereas 8% of patients experienced esophagitis. Bronchospasm was seen in one patient during treatment.Conclusion:HDR brachytherapy is a highly effective, safe, convenient therapy in alleviating symptoms of endobronchial obstruction with endoscopic response in the majority of cases. Thus, HDR-BT is a promising treatment for palliation of patients presenting with symptoms of endobronchial obstruction with an acceptable rate of complications.

High Dose Rate Endobronchial Brachytherapy: Our institutional experience as an Effective Palliative Treatment Modality in Bronchial Carcinoma

Background: Treatment of inoperable carcinoma lung poses a challenge both due to the magnitude and local symptoms with resultant worsening of performance status of the patients. Endobronchial brachytherapy is an established modality for palliation of symptoms, namely dyspnoea, haemoptysis and coughthat result from disease infiltration of the airways. This study was aimed at evaluating the role of HDR endobronchial brachytherapy with external radiotherapy for symptomatic improvement and compliance for such patients at our institution. Method: 50 patients of inoperable Ca Lung with significant bronchial component, includingnon-small cell and small cell, were assessed. Patients were evaluated with fibre optic bronchoscopy regarding degree of bronchial obstruction. They were randomized into two treatment arms, Arm A: Endobronchial brachytherapy(EBBT) followed by External RT. Arm B: External beam Radiotherapy followed by endobronchial brachytherapy. Endobronchial Brachytherapy was delivered using remote afterloading HDR brachytherapy with Ir192 source. Dosefor external RT was 30Gy/10#, on Linear Accelerator or Co-60 teletherapy unit.Endobronchial brachytherapy doserange was 6.5Gy-10Gy in single or two fractions, one week apart. Bronchoscopic assessment was done after one week of each fraction of endobronchial brachytherapy as well as after completion of treatment at every 1 month for 3 months. In some patients with good response, follow up bronchoscopy was performed after 6 months. Response to the therapy was also assessed with the Speiser scoring criteria. Results: Total 50 patients were randomised into two arms according to presenting symptoms and Bronchoscopic feasibility for the catheter insertion. There were 20 patients in arm A and 30 patients in arm B. In short follow up, complete response for haemoptysis was achieved in 98% of patients (n=14), 80% patients showed complete response to dyspnoea(n=46). Symptoms like chest pain and cough showed less improvement after endobronchial brachytherapy. Re-expansion of atelectasis was seen in 100% patients (n=29). Values in both the arms were compared using Pearson Chi-square test. The pre- and post-treatment symptomatic differences were comparable in both the arms and statistically significant for dyspnoea, chest pain, cough, haemoptysis while it was found to be insignificant in patients with change of voice. Conclusion: Endobronchial brachytherapy, as documented, is an important palliative modality to relieve the obstructive symptoms like dyspnoea and hemoptysis, in patients with intrabronchial malignant mass.

Template-based high dose rate endobronchial brachytherapy for palliation of previously irradiated obstructive lung lesions.

174 Background: Local progression after external beam radiation therapy (RT) for lung cancer may result in clinical compromise from bleeding and/or airway obstruction, and additional RT may be precluded by radiation tolerance. High-dose-rate (HDR) endobronchial brachytherapy (EBT) is an effective salvage treatment for airway obstruction and/or bleeding, but requires significant time and resources; planning and treatment are performed bronchoscopically under anesthesia. We sought to reduce procedure and anesthesia time for EBT through template-based planning. Methods: EBT templates were created using the Brachyvision version 11.0.47 treatment planning system for the Varisource iX Ir-192 afterloader. Plans were optimized for dose uniformity at distance from the source following planning criteria of published works. Nine endobronchial centering tube templates were created for treatment lengths from 2-10 cm (1cm intervals) prescribed to 0.5cm distance from the applicator surface. Results: Standard EBT treatment requires a median of 47 minutes (range 44-49 minutes); 5 minutes for applicator placement and fluoroscopic confirmation, 15-17 minutes for plan design and optimization, 20 minutes for quality assurance and plan check, 2-5 minutes for radiation delivery, and 2 minutes for room clearance and applicator removal. Pre-planned templates were evaluated for plan quality, and achieved &gt;90% of the prescription dose for the entire treatment length at the respective treatment depth. Changes to the prescription dose could be achieved through dwell time scaling. Changes to the prescription depth require re-optimization of the plan with the current templates as a base. Use of template-based planning was expected to reduce overall treatment time by 8-9 minutes (16-20% reduction in overall procedure time, 50-56% reduction in treatment planning time); median observed treatment time was 35 minutes (range 32-38 minutes). Conclusions: Template-based HDR EBT treatment plans were developed for the palliative lung cancer program at our institution. Implementation of template-based plans resulted in reduced procedure and operative time, and are now our standard technique.

High Dose Rate Brachytherapy as a Treatment Option in Endobronchial Tumors.

Purpose. To report our experience with high dose rate endobronchial brachytherapy (HDR-EBBT) and to assess its efficacy and tolerability with possibility of its use in selected cases with curative intent. Method. Retrospective review of patients with endobronchial tumors treated at our institution in 2007–2013 with HDR-EBBT. Subjective response and treatment related toxicity were extracted from patients' records. Clinical response was evaluated by chest CT +/− bronchoscopy 2-3 months after treatment. Local control (LC) and overall survival (OS) were analyzed. Results. Overall 23 patients were identified. Ten patients were treated with curative intent, in 8 of them HDR-EBBT was combined with external beam radiotherapy. Short term palliation was as follows: dyspnea (13/15), cough (12/14), and hemoptysis (3/3). Seventeen patients were evaluated, of whom 9 (53%) showed complete response. Four patients developed local failure (only 1 of them treated with curative intent) and were salvaged with HDR-EBBT (n = 1), chemotherapy (n = 2), and laser (n = 1). Among patients treated with curative intent, the 2-year LC and OS were 89% and 67%, respectively, and 2 out of 4 deaths were cancer-related. Late toxicity included bronchial stenosis (n = 1). Only 1 patient had fatal hemoptysis and postmortem examination indicated local recurrence. Conclusion. HDR-EBBT is promising treatment with tolerable complication if used in properly selected patients.

Out-patient high-dose-rate endobronchial brachytherapy for palliation of lung cancer: an observational study

Out-patient high-dose-rate endobronchial brachytherapy (HDREB) is a possible option in the palliation of symptoms in patients with advanced lung cancer, but literature data is limited and the technique is still under development in Italy. Our aim was to evaluate safety and effectiveness of out-patient HDREB for palliation of malignant endobronchial tumours in the context of a multidisciplinary approach. Out-patient HDREB sessions were scheduled at weekly intervals (500-1000 cGy per session) with prior Diodi-laser resection in some cases. Response was assessed bronchoscopically, clinically and functionally at the end of treatment and one month after the last HDREB session. Inclusion criteria was: histological evidence of malignant tumour not susceptible to surgical treatment for extension or co-morbidity. 150 outpatient HDREB sessions were carried out on consecutive 35 patients (mean age 69 yrs, M/F 29/6) with symptoms due to central airway obstruction. A shortterm endoscopic response was observed in 15/28 patients. After delivering 2000 cGy dyspnoea decreased significantly. After one month cough decreased and haemoptysis disappeared. Palliation was obtained in all patients except one during. Lung function tests did not significantly improve after HDREB. No fatal complication occurred. A temporary radiation bronchitis was observed in six patients. This non-comparative, prospective observational study showed a palliative response of HDREB in most of patients with advanced endoluminal lung cancer. The safety of the procedure was good and the rate of non-fatal serious complications was very low.

Dose reconstruction technique using non-rigid registration to evaluate spatial correspondence between high-dose region and late radiation toxicity: a case of tracheobronchial stenosis after external beam radiotherapy combined with endotracheal brachytherapy for tracheal cancer

PurposeSmall organ subvolume irradiated by a high-dose has been emphasized to be associated with late complication after radiotherapy. Here, we demonstrate a potential use of surface-based, non-rigid registration to investigate how high-dose volume topographically correlates with the location of late radiation morbidity in a case of tracheobronchial radiation stenosis.Material and methodsAn algorithm of point set registration was implemented to handle non-rigid registration between contour points on the organ surfaces. The framework estimated the global correspondence between the dose distribution and the varying anatomical structure. We applied it to an 80-year-old man who developed tracheobronchial stenosis 2 years after high-dose-rate endobronchial brachytherapy (HDR-EBT) (24 Gy in 6 Gy fractions) and external beam radiotherapy (EBRT) (40 Gy in 2 Gy fractions) for early-stage tracheal cancer.Results and conclusionsBased on the transformation function computed by the non-rigid registration, irradiated dose distribution was reconstructed on the surface of post-treatment tracheobronchial stenosis. For expressing the equivalent dose in a fractional dose of 2 Gy in HDR-EBT, α/β of linear quadratic model was assumed as 3 Gy for the tracheal bronchus. The tracheobronchial surface irradiated by more than 100 Gyαβ3 tended to develop severe stenosis, which attributed to a more than 50% decrease in the luminal area. The proposed dose reconstruction technique can be a powerful tool to predict late radiation toxicity with spatial consideration.

A prospective analysis of high-dose-rate endobronchial brachytherapy in the palliation of obstructive symptoms in lung cancer patients: A single-institution experience.

Obstructive symptoms that affect quality of life (QOL) are commonly caused by endobronchial disease in many patients with locally advanced, inoperable lung cancer. High-dose-rate endobronchial brachytherapy (HDREBBT) has been used to palliate these symptoms, yet its role is not well defined in the literature. Ninety-eight patients with locally advanced, inoperable lung cancer received HDREBBT. They were prospectively followed for survival, QOL, and toxicity endpoints. QOL measures were captured using the Quality of Life Questionnaire-Lung Cancer 30 and -Lung Cancer13. At 1-year follow-up, no significant toxicities were seen. Overall survival was 13.4% at 12months (mean 192days). Performance status, additional treatment after HDREBBT and treatment intent affected overall survival on univariate analysis (p < 0.05). Mean hemoptysis-free survival for all patients was 232.3days, cough-free survival was 140.3days, and dyspnea-free survival was 173.5days. There was no impact of any treatment- or patient-related factors of these outcomes on multivariate analysis, including additional treatment modalities and HDREBBT dose. HDREBBT is a safe and effective way to palliate endobronchial symptoms. Additional external-beam radiation therapy, chemotherapy, or chemoradiation after HDREBBT improves survival, but does not affect QOL measures.

Birth Defects and Disinfection By-Products (DBPS)

This study was performed to objectively evaluate the effect of high-dose-rate endobronchial brachytherapy (HDREB) in symptom palliation of patients with malignant airway obstruction and treatment-related toxicity.Seventy-eight patients were treated with palliative intent according to a prospective observational protocol. HDREB was delivered in three fractions of 7.5 Gy at weekly or fortnightly intervals, associated or not with external beam irradiation. Most patients presented with lung cancer primaries and were treated because of lesions located in the trachea and/or main bronchi. Performance status, degree of obstruction, and symptom palliation were graded according to an objective score index, defined before and after HDREB at the last followup visit. Survival was considered from the end of HDREB for at least 3 years or until death.Overall, there was a 70% improvement, with migration of patients from lower to higher performance status. Bronchial obstruction was improved in 73.4% of the patients. The symptom that presented the better response was hemoptysis (100% complete relief) followed by postobstructive pneumonia (80%), dyspnea (57.4%), and cough (33.9%). Median survival was 6 months and improved in patients with complete response at bronchoscopy (9 months). There were two (2.6%) cases of bronchial fistulae and eight cases (10.2%) of fatal hemoptysis.HDREB is an excellent modality for palliating malignant airway obstruction resulting in quality of life improvement, with a good tolerance, patient compliance, and low rate of complications.

Definitive high-dose-rate endobronchial brachytherapy of bronchial stump for lung cancer after surgery

The aim of this work was to evaluate outcomes after definitive high-dose-rate endobronchial brachytherapy (HDR-BT) for lung cancer. We treated 34 patients after surgery for lung cancer, without nodal or distant metastases, with HDR-BT. Two groups were analyzed, one with local recurrence in stump after prior surgery (n=13) and a second with nonradical primary lobar resection found in histopathologically positive margins (n= 21). There were 27 men and 7 women with a median age of 57.4years. Twenty-five patients received sole brachytherapy with 4 fractions of 7.5Gy and 9 received combined treatment consisting of 2 fractions of 6Gy (HDR-BT) and 50Gy from external beam radiotherapy. Overall survival time (OS) and overall disease-free survival time (OFS) were compared with prognostic factors. The complete local and radiologic response rate evaluated at the first month after HDR-BT was 73.5% (25/34). The partial response rate was 26.5%. OFS time in total group was 17.4months; OS was 18.8months. Differences were found in OS between both groups-primary tumor or recurrence (log-rank test, p= 0.048). Differences were not found according to gender (p= 0.36), clinical stage (p= 0.76), histopathology (p= 0.93), treatment dose (p= 0.45), sole or combined treatment (p=0.16), or grade of remission in week 4 (p= 0.15). HDR-BT of a stump recurrence or after nonradical resection leads to a long-term OS rate in patients with localized lung cancer and could be considered curative. We found no correlations between OS and chosen clinical data; adjuvant HDR-BT gave better results.

High-dose-rate brachytherapy in symptom palliation due to malignant endobronchial obstruction: A quantitative assessment

This study was performed to objectively evaluate the effect of high-dose-rate endobronchial brachytherapy (HDREB) in symptom palliation of patients with malignant airway obstruction and treatment-related toxicity. Seventy-eight patients were treated with palliative intent according to a prospective observational protocol. HDREB was delivered in three fractions of 7.5 Gy at weekly or fortnightly intervals, associated or not with external beam irradiation. Most patients presented with lung cancer primaries and were treated because of lesions located in the trachea and/or main bronchi. Performance status, degree of obstruction, and symptom palliation were graded according to an objective score index, defined before and after HDREB at the last followup visit. Survival was considered from the end of HDREB for at least 3 years or until death. Overall, there was a 70% improvement, with migration of patients from lower to higher performance status. Bronchial obstruction was improved in 73.4% of the patients. The symptom that presented the better response was hemoptysis (100% complete relief) followed by postobstructive pneumonia (80%), dyspnea (57.4%), and cough (33.9%). Median survival was 6 months and improved in patients with complete response at bronchoscopy (9 months). There were two (2.6%) cases of bronchial fistulae and eight cases (10.2%) of fatal hemoptysis. HDREB is an excellent modality for palliating malignant airway obstruction resulting in quality of life improvement, with a good tolerance, patient compliance, and low rate of complications.

Mature results of a randomized trial comparing two fractionation schedules of high dose rate endoluminal brachytherapy for the treatment of endobronchial tumors

PurposeTo determine the efficacy of high dose rate endobronchial brachytherapy (HDR-BT) for the treatment of centrally located lung tumors, two different fractionation schedules were compared regarding local tumor response, side effects and survival. Mature retrospective results with longer follow-up and more patients were analyzed. Initial results were published by Huber et al. in 1995.Methods and materials142 patients with advanced, centrally located malignant tumors with preferential endoluminal growth were randomized to receive 4 fractions of 3.8 Gy (time interval: 1 week, n = 60, group I) or 2 fractions of 7.2 Gy (time interval: 3 weeks, n = 82, group II) endobronchial HDR-BT.Age, gender, tumor stage, Karnofsky Performance Score and histology were equally distributed between both groups.ResultsLocal tumor response with 2 fractions of 7.2 Gy was significantly higher as compared to 4 fractions of 3.8 Gy (median 12 vs. 6 weeks; p ≤ 0.015). Median survival was similar in both groups (19 weeks in the 4 fractions group vs. 18 weeks in the 2 fractions group). Fatal hemoptysis was less frequent following irradiation with 2 × 7.2 Gy than with 4 × 3.8 Gy, although the difference did not achieve statistical significance (12.2% vs. 18.3%, respectively. p = 0,345). Patients presenting with squamous cell carcinoma were at higher risk of bleeding compared to other histology (21.9% vs. 9%, p = 0,035).Multivariate analysis with regard to overall survival, revealed histology (p = 0.02), Karnofsky Performance Score (p < 0.0001) and response to therapy (p < 0.0001) as significant prognostic factors. For patients showing complete response the median survival was 57 weeks, while for patients with progressive disease median survival time was 8 weeks, p < 0.0001.The KPS at the start of the treatment was significantly correlated with survival. Patients presenting with a KPS ≤ 60 at the start had a significantly (p = 0,032) shorter survival time (10 weeks) than patients with a KPS > 60 (29 weeks).Moreover, the Karnofsky Performance Score of most patients improved during therapy (p = 0,001), suggesting successful palliation of cancer associated symptoms.Multivariate analysis with regard to local tumor control found no significant factors.ConclusionEndobronchial HDR-BT is an effective local treatment for advanced centrally located malignant tumors with endoluminal tumor growth. Local tumor response was significantly higher after HDR-BT with 2 × 7.2 Gy.