High Dose-Rate Intraluminal Irradiation in Bronchogenic Carcinoma
With the escalation of new cases of lung carcinoma in this decade, new approaches to the management of this disease are of utmost importance. In those patients who have previously been treated with external-beam irradiation, repeat treatment is of some value, but palliation is modest and of short duration. Laser debulking has also been used, with limited duration of palliation.2 It is necessary therefore, to use and combine other therapeutic options in the management of these patients. High dose-rate endobronchial irradiation (HDR) has been employed in the treatment of patients presenting with primary bronchogenic carcinoma, as well as in patients who present with a recurrent endobronchial lesion following definitive surgery or irradiation (or both). Reports studying the use of HDR for both populations have been published. canadian pharmacy mall
The results of treatment with HDR for endobronchial disease have revealed good to excellent response rates. Speiser and Spratling treated over 250 patients with various protocols of fractionated irradiation. The overall response rates were between 60 and 90 percent. Populations that were studied included those having had previous high-dose external-beam irradiation. Complications included a 13 percent incidence of radiation-induced bronchitis and a 6 percent incidence of fatal pulmonary hemorrhage. In a study of 188 patients, Macha et al reported an overall response rate of 67 percent, with a complication rate of 15 percent. In this series, the major morbidity was formation of fistulae. Similarly, Kohek et al observed a 70 percent response rate and an 8 percent complication rate in 81 patients treated with HDR for endobronchial disease.
On the other hand, Seagren et al reported the findings in patients who received a single fraction dose of 1,000 cGy and found a 94 percent symptomatic response and a 33 percent objective complete response. The incidence of fatal pulmonary hemorrhage in that series was 25 percent. A recent study of 38 patients by Bedwinek et al revealed a 66 percent incidence of complete or partial symptomatic relief in patients treated for endobronchial lesions. An objective complete response of 41 percent was noted. All patients in this analysis were treated for an endobronchial recurrence after previous treatment with high-dose external-beam irradiation and laser debulldng. An alarming 32 percent incidence of fatal pulmonary hemorrhage was reported. This is clearly an excessive rate of complications for a technique which is used largely for symptomatic palliation.
We herein report our experience with HDR brachy-therapy in both populations of patients. We evaluated both symptomatic and objective responses to treatment. In addition, we addressed complications of treatment and attempted to compare our results and incidence of complications to those of other published data.