Endobronchial irradiation for malignant airway obstruction (original) (raw)
Related papers
High dose-rate endobronchial irradiation in malignant airway obstruction
CHEST Journal, 1993
Patients were admitted to ambulatory surgery, then transferred to the endoscopy room. Intravenous sedation was started (midazolain [Versed], 4 mg, and meperidine [Demerol], 50 to 100 mg). Topical anesthesia (lidocaine [Xylocaine] and/or cocaine) was used as local anesthetic. A 4.9-mm diameter bronchoscope (Olympus BF-P20 dual ports) was introduced and passed via the patient's CHEST I 104 I 3 I SEPTEMBER,
IR-192, low dose rate endobronchial brachytherapy in the treatment of malignant airway obstruction
International Journal of Radiation Oncology*Biology*Physics, 1993
To assess the value of low-dose-rate endobronchial brachytherapy in the treatment of malignant airway obstruction. Between September 1986 and April 1989, 39 patients with malignant airway obstruction had 49 catheter placements for an afterloading, low-dose-rate Ir-192 endobronchial brachytherapy. A flexible fiberoptic bronchoscope with fluoroscopic guidance was used for positioning. Thirty-eight of 39 (97%) patients completed the prescribed treatments. Ninety-seven percent had received previous external radiation in doses ranging from 36-60 Gy. One patient had metastatic renal cell carcinoma; the remainder had recurrent lung cancer. Endobronchial laser treatments were given to three patients 2-3 weeks prior to endobronchial brachytherapy. All patients were followed until death. The median dose delivered in 48 of the 49 placements was 20 Gy at 1 cm. Follow-up bronchoscopy was performed in 28 (72%) of 39 patients. Of these, 13 (46%) had a complete response, 12 (43%) had a partial response, and 3 (17%) had a minor response. Dyspnea improved in 30 of 37 patients (82%); hemoptysis in 17 of 19 patients (89%); cough in 31 of 39 patients (79%); and postobstructive pneumonia in 21 of 23 patients (92%). The median survival for the entire group was 5 months (range 1-31 months). This technique is simple, well-tolerated and offered significant palliation.
Cancer Biotherapy & Radiopharmaceuticals, 2010
The efficacy of high dose-rate endobronchial radiotherapy (HDERT) against proximal airway obstruction that results from lung cancer has not been thoroughly evaluated. This study retrospectively reviewed tumor= obstruction characteristics prior to therapy, interventions applied, symptoms before and after intervention, complications, and survival of all patients with proximal airway obstruction resulting from lung cancer who received HDERT between 1995 and 2003 in a tertiary teaching center. Thirty-four (34) patients received HDERT, while 28 had additional treatment (external radiotheraphy ¼ 23, neodymium yttrium aluminum garnet laser ablation ¼ 9, stenting ¼ 7, electrosurgery ¼ 5, cryosurgery ¼ 3, and photodynamic therapy ¼ 1). Sixteen (16) patients developed complications, the most frequent being respiratory failure and bronchial-wall necrosis, while 19 experienced symptomatic relief. The median (95% confidence interval) survival of these 34 patients was 7.8 (5.9-9.8) months, significantly longer (p ¼ 0.004) than a historic control of 3.9 (3.7-7.1) months from the Cleveland Clinic Foundation, in Cleveland, OH, and comparable to other previous reports. No single factor predicted complications or symptomatic relief. However, female gender, presence of only one symptom, absence of fatigue=weight loss, >1 HDERT sessions, and postprocedure symptom relief were associated with improved survival. Contemporary HDERT with or without additional treatment modalities is effective against central airway compromise resulting from lung cancer.
2018
One of the major role of EBBT is palliation of symptoms caused by endobronchial cancer ingrowth. Boost EBBT to endobronchial gross tumors combined with external beam radiotherapy (EBRT) provides not only palliative but curative possibilities2. In small endobronchial tumors EBBT is used as definitive curative treatment3.EBBT is also used for non-oncologic pathologies4,5. The majority of non-small cell lung cancer (NSCLC)found at loco-regionally advanced stage and frequently associated with bronchial obstruction Various endoscopic techniques available today are including cryotherapy, stent, laser, photodynamic, and EBBT6,7. Among these EBBT in the only one that provides biologically tumoricidal effect keeping the normal tissue structure as is.
Endobronchial radiation therapy (EBRT) in the management of lung cancer
International Journal of Radiation Oncology*Biology*Physics, 1990
,19 endobronchial Iridium-192 line source placements were attempted in 17 patients with advanced incurable lung cancer. Approximately 30 Gy was delivered to the endobronchus using a low dose rate (LDR) afterloading technique delivering a mean dose of 70 cGy/hr at 5 mm. Improvement in subjective symptoms was noted in 67% of evaluable patients whereas objective responses defined by chest X ray and bronchoscopy were noted in 26% and 60%, respectively. No significant morbidity was observed. The radiation exposure to health care workers was low ranging from 10 to 40 mRem per treatment course with most of the staff receiving less than 10 mRem per treatment course (minimal detectable level 10 mRem). The results of this series are compared with selected series using low dose rate as well as intermediate dose rate (IDR) and high dose rate (HDR) endobronchial radiation therapy (EBRT). Based on bronchoscopic responses from the selected series reviewed, both HDR low total dose per treatment (range 7.5-10 Gy) and LDR high total dose per treatment (range 30-50 Gy) are effective in palliating the vast majority of patients with endobronchial lesions. Intermediate dose rate is also effective using fractions similar to high dose rate but total dose similar to low dose rate. The efficacy of endobronchial radiation therapy in the palliative setting suggest a possible role for endobronchial radiation therapy combined with external beam irradiation with or without chemotherapy in the initial management of localized lung cancer. Defining the optimal total dose, dose rate, and the exact role of endobronchial radiation therapy in the management of lung cancer will require large cooperative trials with standardization of techniques and definitions.
Endobronchial Brachytherapy for Lung Cancer
Japanese Journal of Lung Cancer, 2006
High-dose rate endobronchial brachytherapy for endobronchial carcinomas became prevalent with the increasing use of afterloading brachytherapy machines: a tiny Iridium-192 seed is driven within the prepositioned catheter by remote afterloading. We performed the procedure more safely with an applicator which provides a space between the source and the bronchial wall than with only an intraluminal catheter. In patients presenting with superficial endobronchial tumors)often found by a regular health checkup with sputum cytology* , this treatment technique is more often used with curative intent than palliation. In order to reduce late complications, combining with external beam radiotherapy, using an applicator with two wings acting as spacers, evaluating point modifications depending on the airway diameter are performed. Combined treatment with endobronchial brachytherapy and external beam radiotherapy is effective)comparable to the treatment results of operating procedures*for endobronchial lesions with acceptable complications. In this paper, we described our techniques, results, and the indications for high-dose rate endobronchial brachytherapy, along with a review of literature.
The technique of endoscopic airway tumor treatment
Journal of Thoracic Disease
More than half of primary lung cancers are not resectable at diagnosis and 40% of deaths may be secondary to loco-regional disease. Many of these patients suffer from symptoms related to airways obstruction. Indications for therapeutic endoscopic treatment are palliation of dyspnea and other obstructive symptoms in advanced cancerous lesions and cure of early lung cancer. Bronchoscopic management is also indicated for all those patients suffering from benign or minimally invasive neoplasm who are not suitable for surgery due to their clinical conditions. Clinicians should select cases, evaluating tumor features (size, location) and patient characteristics (age, lung function impairment) to choose the most appropriate endoscopic technique. Laser therapy, electrocautery, cryotherapy and stenting are well-described techniques for the palliation of symptoms due to airway involvement and local treatment of endobronchial lesions. Newer technologies, with an established role in clinical practice, are endobronchial ultrasound (EBUS), autofluorescence bronchoscopy (AFB), and narrow band imaging (NBI). Other techniques, such as endobronchial intra-tumoral chemotherapy (EITC), EBUS-guided-transbronchial needle injection or bronchoscopy-guided radiofrequency ablation (RFA), are in development for the use within the airways. These endobronchial interventions are important adjuncts in the multimodality management of lung cancer and should become standard considerations in the management of patients with advanced lung cancer, benign or otherwise not approachable central airway lesions. We aimed at revising several endobronchial treatment modalities that can augment standard antitumor therapies for advanced lung cancer, including rigid and flexible bronchoscopy, laser therapy, endobronchial prosthesis, and photodynamic therapy (PDT).