Prolonged survival after high-dose rate endobronchial radiation for malignant airway obstruction.
OBJECTIVE
To show that prolonged survival can be observed after high-dose rate (HDR) endobronchial brachytherapy as the sole treatment for some selected patients presenting with an endobronchial malignant obstruction.


METHODS
Twenty-nine patients (group 1) who presented with an endoluminal localized tumor without metastatic extension were treated by HDR endobronchial brachytherapy and are compared with 22 subjects who presented with extraluminal dissemination and were palliatively treated (group 2).


METHODS
Treatment consisted of sessions of two exposures, delivering 7 Grays at a 10-mm radius from the center of the applicator each, and repeated every 15 days, to a maximum of six exposures. Endoscopic response and survival are the main criteria of assessment.


RESULTS
Follow-up bronchoscopies, performed 2 months after the end of the procedure, showed tumor regressions: macroscopic complete responses (CR) were observed in 21 of 25 patients evaluable in group 1, and 6 of 22 in group 2, with histologic CR in 18 and 2 patients, respectively. Median overall survival was not reached in group 1 after 23 months of follow-up; it was 5 months for group 2.


CONCLUSIONS
These results confirm that HDR brachytherapy can be used as a monotherapy for carefully selected patients who have small tumors to all appearances limited to the bronchial lumen and bronchial wall without adjacent parenchymal extension or metastatic disease.
Trédaniel
J
J
Service de Pneumologie, Hôpital Saint-Louis, Paris, France.
Hennequin
C
C
Zalcman
G
G
Walter
S
S
Homasson
J P
JP
Maylin
C
C
Hirsch
A
A
D000402:Airway Obstruction / Q000209:etiology*; D001918:Brachytherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010865:Pilot Projects; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors