title: Primary radiotherapy with endobronchial high-dose-rate brachytherapy boost for inoperable lung cancer: long-term results.
abstract: BACKGROUND
  To retrospectively evaluate the outcome of patients with inoperable non-small-cell lung cancer treated with primary external beam radiotherapy combined with high-dose-rate endobronchial brachytherapy boost.
  
  
  METHODS
  Between 1988 and 2005, 35 patients with non-small-cell lung cancer (stage I-III) ineligible for surgical resection and/or chemotherapy, were primarily treated with external beam radiotherapy with a median total dose of 50 Gy (range, 46-60). A median of 3 fractions high-dose-rate endobronchial brachytherapy was applied as a boost after external beam radiotherapy, the median total dose was 15 Gy (range, 8-20). High-dose-rate endobronchial brachytherapy was carried out with iridium-192 sources (370 GBq) and prescribed to 1 cm distance from the source axis.
  
  
  RESULTS
  With a median follow-up of 26 months from the first fraction of high-dose-rate endobronchial brachytherapy, the 1-, 2- and 5-year overall (local progression-free) survival rates were 76% (76%), 61% (57%) and 28% (42%), respectively. Complete or partial remission rates 6 to 8 weeks after treatment were 57% and 17%, respectively. Significant prognostic favorable factors were a complete remission 6-8 weeks after treatment and a negative nodal status. In patients without mediastinal node involvement, a long-term local control could be achieved with 56% 5-year local progression-free survival. Common Toxicity Criteria grade 3 toxicities were hemoptysis (n = 2) and necrosis (n = 1). One fatal hemoptysis occurred in combination with a local tumor recurrence.
  
  
  CONCLUSIONS
  The combination of external beam radiotherapy with high-dose-rate endobronchial brachytherapy boost is an effective primary treatment with acceptable toxicity in patients with non-small-cell lung cancer ineligible for surgical resection and/or chemotherapy.
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rochet
authors.forename: Henrik
authors.initials: H
authors.lastname: Hauswald
authors.forename: Eva Maria
authors.initials: EM
authors.lastname: Stoiber
authors.forename: Frank W
authors.initials: FW
authors.lastname: Hensley
authors.forename: Heinrich D
authors.initials: HD
authors.lastname: Becker
authors.forename: Juergen
authors.initials: J
authors.lastname: Debus
authors.forename: Katja
authors.initials: K
authors.lastname: Lindel
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D001980:Bronchi; D001991:Bronchitis / Q000209:etiology; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy* / Q000556:secondary; D003251:Constriction, Pathologic / Q000209:etiology; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D007496:Iridium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D014132:Trachea / Q000473:pathology / Q000528:radiation effects; D016896:Treatment Outcome
chemical_list: D007496:Iridium Radioisotopes