Treatment of recurrent bronchial carcinoma: the role of high-dose-rate endoluminal brachytherapy.
OBJECTIVE
This study's aim was to assess outcome and toxicity of high-dose-rate endoluminal brachytherapy (HDREB) for recurrent bronchial carcinoma.


METHODS
From 1987 to 2005, 41 patients were treated with HDREB for symptomatic recurrent bronchial carcinoma. All patients had previously undergone external beam radiotherapy (EBRT) with a median dose of 56 Gy (range, 30-70 Gy). The median HDREB dose applied was 15 Gy (range, 5-29 Gy). The median time interval between primary EBRT and reirradiation was 9 months (range, 2-54 months).


RESULTS
After a median follow-up of 6.7 months, the 6-, 12-, and 24-month overall survival rates were 58%, 18%, and 7%, respectively. The median overall survival time was 6.7 months. Local remission was achieved in 73% of patients (n = 30). A total of 24% of patients (n = 10) showed no response or progressive disease within 8 weeks after treatment. In 1 patient, treatment response was not documented. The 6-, 12-, and 24-month local control rates were 38%, 17%, and 3%, respectively. The median local progression-free survival time was 4 months (range, 1-23 months). Prognostic factors were a total dose of >or=15 Gy of HDREB (p = 0.029) and a Karnofsky performance score of >or=80% (p = 0.0012). The cause of death was locoregional progression in 27% of patients (n = 11), distant metastases in 24% of patients (n = 10), fatal hemorrhage in 15% of patients (n = 6), and other causes in 29% of patients (n = 12). None of the patients with locally controlled disease showed grade 3 or 4 late effects.


CONCLUSIONS
Palliative treatment of symptomatic, locally recurrent bronchial carcinoma with HDREB can effectively relieve symptoms in the majority of patients while causing only few complications. Still, time to progression is short.
Hauswald
Henrik
H
Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany. Henrik.Hauswald@med.uni-heidelberg.de
Stoiber
Eva
E
Rochet
Nathalie
N
Lindel
Katja
K
Grehn
Christian
C
Becker
Heinrich D
HD
Debus
Juergen
J
Harms
Wolfgang
W
D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002283:Carcinoma, Bronchogenic / Q000401:mortality / Q000532:radiotherapy*; D002423:Cause of Death; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy*; D010166:Palliative Care; D011832:Radiation Injuries / Q000150:complications / Q000473:pathology; D011879:Radiotherapy Dosage; D019233:Retreatment; D012189:Retrospective Studies; D016896:Treatment Outcome