title: Endobronchial brachytherapy for metastasis from extrapulmonary malignancies as an effective treatment for palliation of symptoms.
abstract: Endobronchial metastasis (EBM) originating from primary cancers outside the lung is rare. External beam radiotherapy is often attempted for control of symptoms with variable effectiveness and retreatment is challenging if symptoms recur. There is limited documentation of high-dose-rate brachytherapy for EBM in the literature.
  
  
  
  A prospective database was created from 2006 to 2015. Patients with EBM who received high-dose-rate brachytherapy were included. Cough, dyspnea, chest pain, and hemoptysis were assessed and graded (0-4) at the time of initial consult and in followup. Symptom-free survival and re-expansion were assessed.
  
  
  
  Thirty-five patients with EBM were identified. Most patients received three fractions of 700 cGy, and 17 patients had prior external beam radiotherapy. Median symptom-free and overall survival were 67 and 117 days. After brachytherapy, improvement in cough was documented in 75.0%, hemoptysis in 76.4%, dyspnea in 60.0% for a median of 3-6 months. Of the 22 patients who had subsequent chest imaging, re-expansion was documented in 32%. There were no significant toxicities reported.
  
  
  
  Brachytherapy appears effective in achieving durable symptom control of cough hemoptysis, and dyspnea in patients with EBM and should be considered routinely for palliation where available. Further studies are required to better characterize expected symptom improvement, lung re-expansion rates, and efficacy in comparison with other local treatments.
authors.affiliation: Department of Radiation Oncology, McMaster University, Hamilton, Ontario, Canada. Electronic address: donovane@hhsc.ca.
authors.forename: E
authors.initials: E
authors.lastname: Donovan
authors.affiliation: Department of Radiation Oncology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Timotin
authors.affiliation: Department of Radiation Oncology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Farrell
authors.affiliation: Division of Oncology, Department of Radiation Oncology, Sandton Oncology Centre, Johannesburg, South Africa.
authors.forename: B
authors.initials: B
authors.lastname: Donde
authors.affiliation: Division of Respirology, Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Puksa
authors.affiliation: Department of Radiation Oncology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Sur
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D001984:Bronchial Neoplasms / Q000150:complications* / Q000532:radiotherapy* / Q000556:secondary; D002637:Chest Pain / Q000209:etiology; D003371:Cough / Q000209:etiology; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D015996:Survival Rate; D063189:Symptom Assessment; D016896:Treatment Outcome
keywords: Brachytherapy; Dyspnea; Endobronchial metastasis; Hemoptysis; Palliation