title: Definitive high-dose-rate endobronchial brachytherapy of bronchial stump for lung cancer after surgery.
abstract: OBJECTIVE
  The aim of this work was to evaluate outcomes after definitive high-dose-rate endobronchial brachytherapy (HDR-BT) for lung cancer.
  
  
  METHODS
  We treated 34 patients after surgery for lung cancer, without nodal or distant metastases, with HDR-BT. Two groups were analyzed, one with local recurrence in stump after prior surgery (n = 13) and a second with nonradical primary lobar resection found in histopathologically positive margins (n = 21). There were 27 men and 7 women with a median age of 57.4 years. Twenty-five patients received sole brachytherapy with 4 fractions of 7.5 Gy and 9 received combined treatment consisting of 2 fractions of 6 Gy (HDR-BT) and 50 Gy from external beam radiotherapy. Overall survival time (OS) and overall disease-free survival time (OFS) were compared with prognostic factors.
  
  
  RESULTS
  The complete local and radiologic response rate evaluated at the first month after HDR-BT was 73.5% (25/34). The partial response rate was 26.5%. OFS time in total group was 17.4 months; OS was 18.8 months. Differences were found in OS between both groups-primary tumor or recurrence (log-rank test, p = 0.048). Differences were not found according to gender (p = 0.36), clinical stage (p = 0.76), histopathology (p = 0.93), treatment dose (p = 0.45), sole or combined treatment (p = 0.16), or grade of remission in week 4 (p = 0.15).
  
  
  CONCLUSIONS
  HDR-BT of a stump recurrence or after nonradical resection leads to a long-term OS rate in patients with localized lung cancer and could be considered curative. We found no correlations between OS and chosen clinical data; adjuvant HDR-BT gave better results.
authors.affiliation: Brachytherapy Department, Greater Poland Cancer Center, Poznań, Poland; Electroradiology Department, Poznan University of Medical Sciences, Poznań, Poland. Electronic address: janusz.skowronek1@gmail.com.
authors.forename: Janusz
authors.initials: J
authors.lastname: Skowronek
authors.forename: Tomasz
authors.initials: T
authors.lastname: Piorunek
authors.forename: Marek
authors.initials: M
authors.lastname: Kanikowski
authors.forename: Adam
authors.initials: A
authors.lastname: Chicheł
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Bielęda
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D001980:Bronchi / Q000528:radiation effects* / Q000601:surgery; D001999:Bronchoscopy / Q000379:methods*; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011013:Pneumonectomy / Q000379:methods*; D011044:Poland / Q000453:epidemiology; D011184:Postoperative Period; D011882:Radiotherapy, High-Energy; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Definitive brachytherapy; Lung cancer; Radical brachytherapy; Recurrence; Stump