Short-term Results of Endobronchial Brachytherapy for Malignant Airway Obstructions

Chung, Man Pyo; Kwon, O Jung; Choi, Dong Rak; Huh, Seung Jae; Lim, Do Hoon; Kim, Moon Kyung; Kim, Dne Yong; Kim, Ho Joong; Ahn, Yong Chang

Abstract

PURPOSE: Respiratory symptoms related with malignant airway disease have been the main causes of lowered quality of life and also sometimes may be life-threatening if not properly amanged. He authors report the short-term experiences of endobronchial brachytherapy for symptomatic malignant airway obstruction using high dose rate after-loading brachytherapy unit.
MATERIALS AND METHODS
Twenty-five patients with symptomatic malignant airway obstruction were treated with endobronchial brachytherapy between the period of December 1994 and March 1996 at Department of Radiation Oncology of Samsung Medical Center. Twenty-one(84%) were patients with non-small cell lung cancer, three with tracheal malignancies, and one with recurrence of esophageal cancer. Twenty patients were given elective external beam radiation therapy, while six were given endobronchial laser evaporation therapy on emergency bases in addition to endobronchial brachytherapy. Three procedures for each patients were planned and total of 70 procedures were completed.
RESULTS
Improvement rates of major respiratory symptoms after endobronchial brachytherapy procedures were 88%(22/25), 96%(22/23)m 100%(15/15), and 100%(9/9) for cough, dyspnea, hemoptysis and obstructive pneumonia, respectively. ECOG Performance scores were improved in 56% of total patients group, while there was no case with worsened ECOG score. Fifteen patients died and the median interval from the start of treatment to death was 4 months (range : 1~17 months), while that of ten survivors was 9 months (range:5~19 months). There were five patients with controlled intrathoracic disease, who have survived over one year. All deaths were associated with uncontrolled local and/or distant disease. Four patients died of massive fatal hemoptysis, three of who received emergency endobrronchial laser evaporation therapy before the start of endobronchial brachytherapy.
CONCLUSION
Endobronchial brachytherapy has been confirmed as an excellent palliative treatment modality improving respiratory symptoms as well as patients' general performance status. Based on the current observations, use of endobronchial brachytherapy in curative setting as a boost technique may be warranted.