title: Hemoptysis due to fungus ball after tuberculosis: A series of 21 cases treated with hemostatic radiotherapy.
abstract: BACKGROUND
  In patients who are not amenable to surgical resection (cavernostomy), it is difficult to achieve palliation of hemoptysis from pulmonary aspergilloma. There are only 9 cases with a short follow-up that have reported the use of radiotherapy for hemoptysis in this scenario.
  
  
  METHODS
  A retrospective series of 21 patients with chronic necrotizing pulmonary aspergillosis were treated with radiotherapy (20 Gray) from 1990 to 2002. The outcome measures were the period from tuberculosis treatment to the onset of hemoptysis, hemoptysis resolution rate, change in Zubrod performance status after 30 days of the completion of radiotherapy, local failure-free survival, and overall survival.
  
  
  RESULTS
  The median time between tuberculosis treatment and the onset of hemoptysis due to aspergilloma was 9 years. After radiotherapy, general status improved and the hemoptysis resolved in all patients. During the follow-up period, 4 failures occurred, with a 5-year local failure-free survival rate of 82 % and a 5-year overall survival rate of 59 %. Of these failures, 2 patients died due to recurrence of the hemoptysis, and 2 were rescued (using cavernostomy and reirradiation). The presence of chronic obstructive pulmonary disease (COPD) (p = 0.021) and female gender (p = 0.032) were negatively associated with overall survival. None of the variables was related to local control.
  
  
  CONCLUSIONS
  Based on these long-term data, radiotherapy is a potential option for controlling bleeding due to fungus balls. Female patients and COPD were associated with lower survival.
authors.affiliation: Radiation Oncology Department, Clínicas Oncológicas Integradas (COI-RJ), Rio de Janeiro, Brazil. lgsapienza@yahoo.com.br.|Radiation Oncology Department, A.C. Camargo Cancer Center, São Paulo, Brazil. lgsapienza@yahoo.com.br.
authors.forename: Lucas G
authors.initials: LG
authors.lastname: Sapienza
authors.affiliation: Radiation Oncology Department, Hospital Federal Servidores do Estado do Rio de Janeiro (HFSE-RJ), Rio de Janeiro, Brazil. mjlgomes52@gmail.com.
authors.forename: Maria José L
authors.initials: MJ
authors.lastname: Gomes
authors.affiliation: Nuclear Medicine Department, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil. carmelindomaliska@gmail.com.
authors.forename: Carmelindo
authors.initials: C
authors.lastname: Maliska
authors.affiliation: Infectology Department, Fundação Técnico-Educacional Souza Marques, Rio de Janeiro, Brazil. norberg@uol.com.br.
authors.forename: Antonio N
authors.initials: AN
authors.lastname: Norberg
mesh_terms: D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006469:Hemoptysis / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012189:Retrospective Studies; D012737:Sex Factors; D014057:Tomography, X-Ray Computed; D014376:Tuberculosis / Q000473:pathology*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents