High dose rate endobronchial brachytherapy in combination with external beam radiotherapy for stage III non-small cell lung cancer.
BACKGROUND
A phase-II study was planned to test the effect of external beam radiotherapy in combination with endobronchial brachytherapy on the local control and survival of stage-III non-small cell lung cancer patients.


METHODS
Thirty patients with stage-III non-small cell lung cancer have been treated with 60 Gy external beam radiotherapy and 3 x 5 Gy HDR endobronchial brachytherapy to control tumor and to prolong survival.


RESULTS
Therapy regimen was found to be very effective for the palliation of major symptoms, palliation rates were 42.8% for cough, 95.2% for hemoptysis, 88.2% for chest pain and 80.0% for dyspnea. There was a 76.7% tumor response (53.3% complete, 23.3% partial) verified by chest CT scans and bronchoscopy. However, median locoregional disease free survival was 9+/-4 months (95% CI: 1-17) and it was only 9.6% at 5 years. Major side effects were radiation bronchitis (70.0%), esophagitis (6.6%) in the acute period and bronchial fibrosis (25%), esophagial fibrosis (12.5%) and fatal hemoptysis (10.5%) in the late period. Median survival was 11+/-4 months (95% CI: 4-18),and 5-year actuarial survival was 10%. Locoregional disease free survival (P=0.008) and the overall survival was longer (P<0.001) in the patients younger than 60, survival was also improved in the patients with complete response (P=0.019). There were no major complications during catheterisation; early side effects were quite tolerable but severe late complications were around 10%.


CONCLUSIONS
It is concluded that endobronchial brachytherapy in combination with external irradiation provides a good rate of response, however does not eradicate locoregional disease and does not prolong survival except for some subgroups such as younger patients.
Anacak
Y
Y
Department of Radiation Oncology, Ege University Faculty of Medicine, 35100 Izmir, Turkey. yanacak@hotmail.com
Mogulkoc
N
N
Ozkok
S
S
Goksel
T
T
Haydaroglu
A
A
Bayindir
U
U
D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy*; D002404:Catheterization; D002637:Chest Pain / Q000209:etiology; D003371:Cough / Q000209:etiology; D004307:Dose-Response Relationship, Radiation; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D016019:Survival Analysis; D016896:Treatment Outcome