High dose rate brachytherapy for nonmalignant airway obstruction: new treatment option.
OBJECTIVE
High dose rate (HDR) endobronchial brachytherapy is widely used as a palliative treatment for symptomatic airway obstruction by primary or secondary malignant tumors. We report on a successful use of HDR brachytherapy in patients with nonmalignant airway obstruction.


METHODS
Case series


METHODS
Six patients received HDR brachytherapy for airway obstruction caused by granulation tissue around a metal stent placed for restoration of the airway patency for nonmalignant causes. In four patients, brachytherapy was performed following recurrent occlusion of the airway by granulation tissue formation; in two patients, it was done as a prophylactic procedure.


METHODS
HDR brachytherapy catheters were passed through the metal stents under direct fluoroscopic guidance. Simulation and computerized treatment planning were done, and a single dose of 10 Gy was administered using a brachytherapy remote afterloader with a (192)Ir source. The dose was prescribed to a distance of 1 cm from the center of the source, with a margin of 1 cm from the proximal and distal ends of the stent.


RESULTS
At a median follow-up of 15 months, moderate granulation tissue formation was observed in only one patient; in four others, it was categorized as minimal, 5 to 30 months from the procedure. Restoration of the lumen was complete in four patients, near complete in one patient, and partial in one patient. In one patient, previously treated by external radiotherapy, local tissue necrosis was evident.


CONCLUSIONS
HDR brachytherapy can be used safely for nonmalignant airway obstruction. Further studies including more patients and longer follow-up are needed.
Brenner
Baruch
B
Oncology Institute, Rabin Medical Center, Beilinson Campus, and Sackler Faculty of Medicine, Tel Aviv University, Petah Tiqva, Israel.
Kramer
Mordechai R
MR
Katz
Alan
A
Feinmesser
Rafael
R
Weissmann-Brenner
Alina
A
Sulkes
Aaron
A
Fenig
Eyal
E
Brenner-Weissman
Alina
A
D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000532:radiotherapy*; D001918:Brachytherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011879:Radiotherapy Dosage; D012074:Remission Induction