Endobronchial High Dose Rate Brachytherapy for Control of Nsclc

الملخص EN

Purpose : to review the role of HDR remotes after-loading brachytherapy in the management of NSCLC as well as to evaluate its effectiveness for palliation of distressing malignant endobronchial obstruction.

Patients and methods : From 1986 to 1995, 88 patients (53 males and 35 females) with obstructive endobronchial malignancies received 215 HDR endobronchial treatments using a high activity Iridium-192 source with remote after-loading.

In 60 patients the objective was palliative to treat either symptomatic recurrence (n = 48) or metastatic non-pulmonary disease (n = 12).

The main presenting symptoms were : dyspnea (61 %), intractable cough (58 %) and hemoptysis (33 %).

In 28 patients with primary endobronchial carcinoma, the objective was curative using a combination of full course external irradiation (4500-6000 cGy) and HDR with an average dose of 600 cGy at 1 cm from the surface of the source and delivered in one fraction in 41 % of cases, 2 fractions in (20 %) and 3 fractions in (35 %), with 1-2 weeks interval.

Results : at a median follow-up period of 15 months range (3-95), the overall response rate was 641 % (CR = 23 % and PR = 41 %).

For the curative group, CR was achieved in 19 / 28 (68 %) patients with median duration of 12 months (range 3-55 m), while a good response was reported in 28 / 60 (47 %) patients in the palliative group, with median response duration of 7 months (range 3-34 m).

The median overall survival time was 15.5 months for the entire group, 17 months and 11 months for the palliative and the curative respectively.

The 1 and 2-year survival rates were 72 % and 39 % for the palliative group compared with 45% and 35% for the cure group (p .3906).

There was statistically a significant difference in survival in favor of stage 2 of the disease (p = 0.0446), as well as with adeno-carcinoma histological subtype (p = 0.0497).

All patients tolerated treatment well without any acute or late complications.

Conclusion : outpatient HDR endobronchial brachy-therapy is a very convenient treatment modality for the patients, being well tolerated, safe and a short-term schedule.

It is a valuable treatment alternative for local palliation in patients with local recurrent or metastatic disease suffering endobronchial obstructive symptoms and signs.

Also, this from of treatment may yield high local control rates in earlier stages of end bronchial carcinoma.