[Endoluminal HDR brachytherapy in the palliative treatment of patients with the recurrence of a non-small-cell bronchial carcinoma after prior radiotherapy].
OBJECTIVE
The preferred primary treatment in non-small cell lung cancer is surgical resection. In fact, only less than 25% of patients are resectable with curative intent. The remaining patients are primarily treated with radiation therapy or combined radiochemotherapy, achieving remission rates up to 60% but 5-year survival rates of only about 5%. Therefore an effective palliative treatment is important. The aim of our study was to show that using intraluminal HDR brachytherapy, tumor-induced bronchial obstruction and its symptoms can be relieved in the majority of cases.


METHODS
Sixteen patients with recurrent previously irradiated non-small cell lung cancer were treated with intraluminal high dose rate iridium-192 afterloading irradiation at the Department of Radiotherapy and Radiation Oncology of the University of Münster between 1989 and 1993. There were 15 men and 1 woman with a median age of 61 years. As a primary treatment, 50 to 60 Gy had been delivered percutaneously. The recurrences were treated with HDR brachytherapy using 2 to 4 applications of 5 Gy to 6 Gy each to a tissue depth of 0.5 cm.


RESULTS
In 13 of 16 patients dyspnoea could be improved and in 15 of 16 patients atelectasis could be dissolved. Nine of 16 patients achieved a partial or complete remission evaluated by bronchoscopic criteria. The median period of remission was 4 months. The median survival time, measured from the start of therapy and analysed using the Kaplan-Meier method, was only 9 months. As side effects, 1 pneumothorax and 1 tracheomediastinal fistula occurred, the latter presumably related to tumor progression.


CONCLUSIONS
Our results show the importance of intraluminal HDR brachytherapy in the palliative treatment of patients with recurrent non-small cell lung cancer.
Micke
O
O
Klinik und Poliklinik für Strahlentherapie-Radioonkologie, Westfälische Wilhelms-Universität Münster.
Prott
F J
FJ
Schäfer
U
U
Wagner
W
W
Pötter
R
R
Willich
N
N
D000230:Adenocarcinoma / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002283:Carcinoma, Bronchogenic / Q000532:radiotherapy*; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D010166:Palliative Care / Q000379:methods; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies
Endoluminale HDR-Brachytherapie in der Palliativ-behandlung von Patienten mit Rezidiv eines nicht-kleinzelligen Bronchialkarzinoms nach vorausgegangener Strahlentherapie.