title: HDR brachytherapy: an option for preventing nonmalignant obstruction in patients after lung transplantation.
abstract: OBJECTIVE
  Interventional bronchoscopy is the main treatment modality in managing benign airway obstructions following lung transplantation. We analyzed the effect of intraluminal brachytherapy on preventing recurrence of hyperplastic tissue.
  
  
  METHODS
  From September 2002 to September 2004, a total of 24 intraluminal brachytherapy applications were carried out on 12 lung transplant patients in 15 different locations. A single dose of 3 Gy was calculated at a 5-mm distance from the catheter surface; the target volume included a stenosis plus safety interval of 0.5-1.0 cm.
  
  
  RESULTS
  All patients had a mean 10.6 local interventions (Argon plasma coagulation, balloon dilatations, stenting) over 4.4 months before the first application of endobronchial brachytherapy, with a mean amount of 2.4 applications per month. The mean forced expiratory volume in 1 s (FEV1) was 2,219 ml in the 3 months before application of brachytherapy. After endobronchial brachytherapy, all patients experienced improvement in clinical status and respiratory function. The mean level of FEV1 in the 3 months after application was 2,435 ml (p = 0.02), and the number of invasive interventions dropped to a mean rate of 5.2 interventions in the 5.1 months after the first intervention, with an amount of 1 application per month. No treatment-related complications were seen. Four patients were treated twice, 1 patient three times, and 1 patient four times at the same localization.
  
  
  CONCLUSIONS
  Recurrent symptomatic benign airway obstruction from hyperplastic tissue in the bronchus after lung transplantation can be successfully treated with intraluminal high-dose-rate brachytherapy with a dose of 3 Gy at a 5-mm distance from the catheter surface and a longitudinal safety margin of 1 cm.
authors.affiliation: Department of Radiation Oncology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. Meyer.A@mh-hannover.de
authors.forename: A
authors.initials: A
authors.lastname: Meyer
authors.forename: A
authors.initials: A
authors.lastname: Warszawski-Baumann
authors.forename: R
authors.initials: R
authors.lastname: Baumann
authors.forename: J H
authors.initials: JH
authors.lastname: Karstens
authors.forename: H
authors.initials: H
authors.lastname: Christiansen
authors.forename: J
authors.initials: J
authors.lastname: Gottlieb
authors.forename: T
authors.initials: T
authors.lastname: Welte
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000517:prevention & control* / Q000532:radiotherapy; D001918:Brachytherapy / Q000379:methods*; D001999:Bronchoscopy; D003131:Combined Modality Therapy; D004106:Dilatation; D005260:Female; D005541:Forced Expiratory Volume / Q000528:radiation effects; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control* / Q000532:radiotherapy; D011879:Radiotherapy Dosage; D019233:Retreatment; D055502:Secondary Prevention; D055815:Young Adult