[High-dose brachytherapy in endobronchial neoplastic stenoses]. / La brachiterapia con alto rateo di dose nelle stenosi neoplastiche endobronchiali.

Form March, 1991, to September, 1995, twenty-nine patients with endobronchial neoplastic stenosis were treated with high dose rate (HDR) brachytherapy at the Casa Sollievo della Sofferenza Hospital in San Giovanni Rotondo (Foggia, Italy). Fifteen patients had hemoptysis, 10 dyspnea, 6 constant cough and 6 lung atelectasis. The total dose, specified at 1 cm from the source, ranged 5 to 21 Gy and the fraction doses 5 to 15 Gy. Fourteen of 29 patients (48%) died. The mean survival is 7 months, with the follow-up ranging 1 to 22 months. Subjective responses were achieved in 78.4% of cases, with 67.6% complete and 10.8% partial remission rates. Complete remission of hemoptysis was observed in 100% of patients. Dyspnea improved in 70%, cough in 46.4% and atelectasis in 83.2%. Endoscopic findings, 1 month after the end of brachytherapy, showed a response in 79.4% of patients. The complication rate was 13.8% (1 tracheoesophageal fistula, 2 pulmonary hemorrhages and 1 cavitary necrosis). Even though the number of treated patients is small, our experience confirms the efficacy of HDR endobronchial brachytherapy in the palliation of lung cancer-related symptoms. Literature data show that brachytherapy improves the quality of life in the patients with poor prognosis who are otherwise untreatable. The HDR technique is more accurate than the LDR technique and therapy is better tolerated also because execution time is shorter. Prospective clinical trials are needed to investigate the most effective total doses and fractionations and to better define the role of brachytherapy in the curative treatment of lung cancer.

[High-dose-rate brachytherapy in esophageal carcinoma: the Italian experience]. / Brachiterapia con alto rateo di dose del carcinoma esofageo: esperienza italiana.

The results are reported of HDR intracavitary brachytherapy in 134 esophageal carcinoma patients (110 men and 24 women) treated in 10 Italian centers. Forty-one patients received radical treatment and brachytherapy was often combined with external irradiation and/or chemotherapy. Clinical response rates follow: 56% complete remissions, 34% partial remissions, 10% no response/disease progression and not assessed. Ninety-three patients underwent palliative treatment: dysphagia was reduced in 80% of them and pain was reduced in 71% of them. Treatment-induced esophageal damage consisted in G3-G4 esophagitis (5% of patients), strictures (10%) and fistulas (3%). Complication rates were correlated with fraction dose (9.5% complications for fraction doses < 500 cGy, 20% with doses ranging 500-800 cGy and 38% with fraction doses > 800 cGy). Moreover, the esophagus was more severely injured when small tubes were used (24% with tubes phi < 2 mm, 19% with tubes phi 2-6 mm and 5% with tubes phi > 6 mm). When external irradiation was combined with brachytherapy, dysphagia was more relieved than with brachytherapy alone (89% vs. 71%), with no increase in complication rates. Also the chemotherapy-brachytherapy combination improved swallowing more than brachytherapy alone (88% vs. 79%) and once again complication rates did not increase. To conclude, in the radical treatment of esophageal carcinoma, HDR brachytherapy permits higher radiation doses to be delivered, with fair complication rates. As for palliative treatment, HDR brachytherapy is safe, has low morbidity and provides adequate relief of dysphagia in 80% of patients. We suggest the use of tubes phi > 6 mm and fraction doses ranging 5-6 Gy.