title: High-dose-rate (HDR) brachytherapy for the treatment of benign obstructive endobronchial granulation tissue.
abstract: BACKGROUND
  Severe airway obstruction can occur in the setting of benign granulation tissue forming at bronchial anastomotic sites after lung transplantation in up to 20% of patients. Many of these benign lesions respond to stent placement, laser ablation, or balloon bronchoplasty. However, in certain cases, proliferation of granulation tissue may persist despite all therapeutic attempts. This study describes a series of refractory patients treated with high-dose-rate (HDR) brachytherapy for benign proliferation of granulation tissue, causing airway compromise.
  
  
  METHODS
  Between April 2002 and June 2005, 5 patients with significant airway compromise from recurrent granulation tissue were treated with HDR brachytherapy. All patients had previously failed to maintain a patent airway despite multiple bronchoscopic interventions. Treatment was delivered using an HDR brachytherapy afterloader with (192)Ir. Dose prescription was to a depth of 1 cm. All patients were treated weekly, with total doses ranging from 10 Gy to 21 Gy in two to three fractions.
  
  
  RESULTS
  The median follow-up was 12 months. All patients experienced a reduction in therapeutic bronchoscopic procedures after HDR brachytherapy compared with the pretreatment period. With the exception of possible radiation-induced bronchitis in 1 patient, there were no other treatment related complications. At the time of this report, 2 patients have died and the other 3 are alive with marked symptomatic improvement and reduced bronchoscopic procedures.
  
  
  CONCLUSIONS
  High-dose-rate brachytherapy is an effective treatment for benign proliferation of granulation tissue causing airway obstruction. The early response to therapy is encouraging and further follow-up is necessary to determine long-term durability and late effects.
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA. chikam@xrt.upenn.edu
authors.forename: Chika N
authors.initials: CN
authors.lastname: Madu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Machuzak
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Sterman
authors.forename: Ali
authors.initials: A
authors.lastname: Musani
authors.forename: Vivek
authors.initials: V
authors.lastname: Ahya
authors.forename: James
authors.initials: J
authors.lastname: McDonough
authors.forename: James M
authors.initials: JM
authors.lastname: Metz
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001918:Brachytherapy / Q000379:methods*; D001999:Bronchoscopy / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006097:Granulation Tissue / Q000528:radiation effects*; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D016040:Lung Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012008:Recurrence
chemical_list: D007496:Iridium Radioisotopes