Braquiterapia endobronquial de alta tasa de dosis en pacientes con obstrucción de la vía aérea central: experiencia en el Instituto Nacional del Cáncer y revisión de la literatura / High dose rate endobronchial brachytherapy in patients with central airway obstruction

Introduction: The main indication of modern high dose rate end bronchial brachyherapy (HDR EBBT) is the palliation of symptoms related to the growth of the endobronchial lung cancer. Methods: EBBT was performed to 27 patients who suffered symptomatic tumoral endobronchial or tracheal pathology, due to primary bronchial disease or secondary metastasis cancer, evaluating the rate of clinical benefit. The tumors were located at tracheal, carinal or proximal bronchial level. Fibrobronchoscopy was performed to all the patients to measure the degree of airway obstruction and to install brachytherapy endobronchial catheters. Between 1 to 4 fractions of 7 to 7.5 Gy were administered. Dyspnea, cough and hemoptysis were subjectively registered before and after treatment, according to an international validated scale. Results: After treatment, all symptoms considerably decreased, disappearing all of the severe categories. Hemoptysis and dyspnea resolved in a 100 percent and 40 percent of patients, respectively; and cough disappeared or was reduced to a minimum grade in 90 percent of cases.

Introducción: La indicación principal de la braquiterapia endobronquial moderna (BTEB) de alta tasa de dosis (HDR), es la paliación de síntomas por crecimiento endobronquial de cánceres pulmonares. Métodos: Se realizó BTEB HDR a 27 pacientes sintomáticos de patología tumoral endobronquial o traqueal, debido a patologías primarias bronquiales o secundarias metastásicas. Los tumores se ubicaban en tráquea, carina o a nivel bronquialproximal. Para observar mejorías en la sintomatología clínica, a todos se les realizó una fibrobroncoscopía (FBC) para medir el grado de obstrucción bronquial e instalar catéteres endobronquiales de braquiterapia. Se administraron entre 1 y 4 fracciones de 7 a 7,5 Gy. Se registró subjetivamente la disnea, tos y hemoptisis antes y después del tratamiento, de acuerdo a una escala internacionalmente validada. Resultados: Tras el tratamiento todos los síntomas disminuyeron considerablemente, desapareciendo toda sintomatología severa. La hemoptisis y disnea desaparecieron en el 100 por ciento y 40 por ciento de los pacientes respectivamente, y la tos desapareció o disminuyó a grado leve en el 90 por ciento de los pacientes.

Braquiterapia endobrônquica de alta taxa de dose: estudo dosimétrico / High dose-rate endobronchial brachytherapy: a dosimetric study

OBJETIVO: Avaliar a distribuição de dose em diferentes situações de braquiterapia endobrônquica de alta taxa de dose, com foco principalmente nos volumes de altas doses, e tentar definir situações de melhor ou pior distribuição de dose que possam servir de guia na prática clínica. MATERIAIS E MÉTODOS: Estudo teórico, simulando braquiterapia endobrônquica de alta taxa de dose utilizando dois cateteres, com variação da extensão de carregamento, angulação entre os cateteres, profundidade de cálculo e o intervalo entre as paradas da fonte. Com prescrição de 7,5 Gy, foram calculados os volumes englobados pelas isodoses correspondentes a 100 por cento, 150 por cento e 200 por cento da dose prescrita (V100, V150 e V200, respectivamente) e as razões V150/V100 e V200/V100. RESULTADOS: Os volumes aumentaram com o aumento da extensão de carregamento dos cateteres, profundidade de cálculo e angulação, com tendência a um aumento proporcionalmente menor para angulações maiores. As relações V150/V100 e V200/V100 foram, em geral, homogêneas, ao redor de 0,50 e 0,30, respectivamente. CONCLUSÃO: A distribuição de dose na situação considerada padrão é em geral adequada. Nenhum parâmetro específico que pudesse ser relacionado à maior toxicidade foi identificado. Recomendamos uma avaliação rápida da qualidade do implante por meio da análise das relações V150/V100 e V200/V100.

OBJECTIVE: To evaluate the dose distribution in different situations of high dose-rate endobronchial brachytherapy, focusing especially on high-dose volumes, and try to identify better or worse situations in terms of dose distribution to aid as guidance in the clinical practice. MATERIALS AND METHODS: Theoretical study simulating high dose-rate endobronchial brachytherapy utilizing two catheters, varying the loading extent, angle between the catheters, prescription depth, and source step. With a prescription dose of 7.5 Gy, the volumes involved by the 100 percent, 150 percent and 200 percent isodoses (V100, V150 and V200, respectively) and V150/V100 and V200/V100 ratios were calculated. RESULTS: There was a volume enhancement with larger loaded lengths, increase in prescription depth and angles, with a tendency towards a proportionally smaller increase with larger angulations. In general, the V150/V100 and V200/V100 ratios were homogeneous, respectively around 0.50 and 0.30. CONCLUSION: Overall, the dose distribution in the standard situation was appropriate. No specific parameter that could be related to a higher toxicity was identified. The authors recommend a swift evaluation of the treatment quality through the analysis of the V150/V100 and V200/V100 ratios.

The Palliative Effect of Endobronchial Brachytherapy for Previously Irradiated Patients with Lung Cancer / 대한방사선종양학회지

PURPOSE: To evaluate the palliative effect of endobronchial brachytherapy (EBB) for patients with lung cancer that previously received external beam radiotherapy (EBRT). MATERIALS AND METHODS: From July 1992 to May 2003, 29 patients with a recurrent or persistent lung cancer were treated with palliative EBB at our institute. EBB consisted of three fractions (once a week) of a dose of 5 Gy using the high dose-rate remote afterloader. Symptomatic improvement was assessed subjectively, and patients were divided into two groups according to whether symptoms were improved or not. Factors such as age, performance status, duration from EBRT to EBB and the location of the tumor were compared between the improved and unimproved groups of patients. RESULTS: Overall symptomatic improvement was found in 27 out of 52 symptoms (52%). Improvement as to the type of symptoms was seen in 41%, 50%, 82% and 33% of patients with cough, dyspnea, hemoptysis, and obstructive pneumonia respectively. The rate of improvement of hemoptysis was more than that of cough (p<0.05). The median time to symptom relapse was 5 months. The improved patient group (n=17, 59%) had a better performance status and longer duration from EBRT to EBB than the unimproved patient group (p<0.05). Lesions located in the distal trachea and/or main bronchus were found more frequently in the improved group of patients than in the unimproved group of patients, but the difference was not statistically significant (p =0.06). Fatal complications developed in two patients (7%), which were a hemoptysis and bronchopleural fistula respectively. CONCLUSION: Symptom improvement was found in 60% of patients after EBB and improvement was maintained for 5 months. Palliative EBB, even when EBRT was given previously, can be effective for a patient that has an endobronchial symptom, such as hemoptysis, and for a patient with good performance and a long duration from previous EBRT to EBB.

Comparison of the therapeutic effects of HDR endobronchial brachytherapy and simple external irradiation on the treatment of lung cancer with atelectasis / 第三军医大学学报

Objective Objective To investigate the clinical application of high-dose-rate(HDR)endobronchial brachytherapy for the treatment of primary lung cancer with atelectasis. Methods A total of 142 cases of lung cancer with atelectasis treated with HDR endobronchial brachytherapy and 71 cases(contr01)treated with extemal irradiation only at onr center of cancer were comparatively studied.1n the treatment group,with the aid of bmnchoscope,brachytherapy was applied 2 or 3 times at the dose of 8 Gy each time to a tissue depth of 1 to 1.5 cm.Cases in the contmlgroup,treated with external irradiation,received 60-70 Gy in total.Results Complete recruitment of atelectasis was observed in 80.28%cases of the treatment group and 64.79%in the control,T11ere Was significant difference between the two groups.Survival rates after 1,2 and 3 years in cases with complete remission of atelectasis in treatment group were 60.68%,44.44%and 23.93%,but 36.00%,28.00%and 16.00%in cases with no remission of atelectasis.Significant difference of one-year survival Was found between the two groups(P

Endobronchial Brachytherapy of Advanced Non-small Cell Lung Carcinoma

PURPOSE: To evaluate the effect of high-dose-rate endobronchial brachytherapy for symptomatic relief, tumor response and overall survival of advanced non-small cell lung carcinoma (NSCLC). MATERIALS AND METHODS: Between July 1992 and July 2001, 37 patients with advanced NSCLC were analysed retrospectively. Group A patients (palliative aim, n=25) were treated using brachytherapy alone due to relapse after external beam radiation therapy (EBRT). Group B patients (curative aim, n=12) were treated using brachytherapy alone or combined EBRT due to untreated inoperable NSCLC or positive resection margin after radical resection. The dose per fraction was 3~6 Gy at a radius of 1cm from the center of the source and each patient received 2~3 fractions. The total dose of brachytherapy was 9~18 Gy (median 15 Gy). Each fraction separated by 1 week interval. RESULTS: Symptomatic relief was obtained for cough (58.3% & 72.7%), dyspnea (56.3% & 75%) and hemoptysis (86.7% & 100%) in group A and B, respectively. The tumor improvement on bronchoscopy was obtained for complete response (28% & 60%) and partial response (64% & 40%) in group A and B, respectively. Median overall survival was 7 and 17.2 months for Group A and B, respectively. In group A, mediastinal node metastasis (p=0.039) and Karnofsky performance scale (p=0.062) was independent prognostic factor by univariate analysis. After radical therapy, 7 symptomatic radiation pneumonitis, 4 hemoptysis and 1 pneumothorax were observed. CONCLUSION: Endobronchial brachytherapy was effective for symptomatic relief of hemoptysis. In curative aim, we think that survival improvement may be expected in some selected patients

Short-term Results of Endobronchial Brachytherapy for Malignant Airway Obstructions / 대한치료방사선과학회지

PURPOSE: Respiratory symptoms related with malignant airway disease have been the main causes of lowered quality of life and also sometimes may be life-threatening if not properly amanged. He authors report the short-term experiences of endobronchial brachytherapy for symptomatic malignant airway obstruction using high dose rate after-loading brachytherapy unit. MATERIALS AND METHODS: Twenty-five patients with symptomatic malignant airway obstruction were treated with endobronchial brachytherapy between the period of December 1994 and March 1996 at Department of Radiation Oncology of Samsung Medical Center. Twenty-one(84%) were patients with non-small cell lung cancer, three with tracheal malignancies, and one with recurrence of esophageal cancer. Twenty patients were given elective external beam radiation therapy, while six were given endobronchial laser evaporation therapy on emergency bases in addition to endobronchial brachytherapy. Three procedures for each patients were planned and total of 70 procedures were completed. RESULTS: Improvement rates of major respiratory symptoms after endobronchial brachytherapy procedures were 88%(22/25), 96%(22/23)m 100%(15/15), and 100%(9/9) for cough, dyspnea, hemoptysis and obstructive pneumonia, respectively. ECOG Performance scores were improved in 56% of total patients group, while there was no case with worsened ECOG score. Fifteen patients died and the median interval from the start of treatment to death was 4 months (range : 1~17 months), while that of ten survivors was 9 months (range:5~19 months). There were five patients with controlled intrathoracic disease, who have survived over one year. All deaths were associated with uncontrolled local and/or distant disease. Four patients died of massive fatal hemoptysis, three of who received emergency endobrronchial laser evaporation therapy before the start of endobronchial brachytherapy. CONCLUSION: Endobronchial brachytherapy has been confirmed as an excellent palliative treatment modality improving respiratory symptoms as well as patients' general performance status. Based on the current observations, use of endobronchial brachytherapy in curative setting as a boost technique may be warranted.

Endobronchial Brachytherapy for MalignantAirway Obstruction: Low Dose Rate Versus High Dose Rate / 대한치료방사선과학회지

PURPOSE: This is a retrospective study to compare the palliation rates, survival rates and complications of low dose rate and high dose rate endobronchial brachytherapy in the management of malignant airway obstruction. METHODS AND MATERIALS: Forty three consecutive patients with malignant airway compromise from primary or metastatic lung tumors were treated with low dose rate(LDR) endobronchial Iridium-192 insertion (21 patients) between October 1988 and June 1992, and high dose rate(HDR) endobronchial brachytherapy(22 patients) between August 1992 and April 1994 with palliative aim. Flexible fiberoptic bronchoscopy under fluoroscopic control was utilized in all 91 provedures. Twenty seven LDR provedures delivereda dose of 5-7.5 Gy to a 1.0 cm radius respectively. RESULTS: Subjective and objective responses to treatments were evaluated on follow-up examinations by clinical examination, chest x-rays and CT scan of the chest had been demonstrated on 8 LDR patients and 10 HDR patients. CONCLUSION: The technique of LDR and HDR endobronchial brachytherapy is simple and well tolerated procedure with minimal morbidity. It provides excellent palliation by keeping airway patent in these short life-spanned patients.