Brachytherapy

Brachytherapy

Local determinants of response to endobronchial high-dose rate brachytherapy in bronchogenic carcinoma

https://www.ncbi.nlm.nih.gov/pubmed/9377957

Landmark Article

Reference: Ofiara L, Roman T, Schwartzman K, Levy RD. Local determinants of response to endobronchial high-dose rate brachytherapy in bronchogenic carcinoma. Chest. 1997;112(4):946-53.

Background: Use of High Dose Rate (HDR) brachytherapy (BT) for endobronchial disease treatment

PICO:

Populations:

  • Unresectable bronchogenic carcinoma patients treated with external beam radiation

Intervention:

  • Intraluminal radiation treatments 800 cGy each at 2 weeks intervals in two different groups who received external beam radiation.
  • Two groups based on whether the initial bronchoscopic appearance showed an endoluminal mass or submucosal infiltration/extrinsic compression. Furthermore, patients were also classified based on tumor location: central (trachea or mainstem bronchi) and peripheral (lobar or segmental bronchi).

Comparison:

  • Treatment response to intraluminal radiation between two groups

Outcome:

  • 15 of 24 patients who underwent follow-up bronchoscopy had reductions in the degree of endobronchial obstruction. 7 of 24 patients had radiographic improvement in the extent of atelectasis. Patients in either group with both tumor appearances (endoluminal and submucosal/extrinsic compression) had significant improvement following HDR-BT with regard to hemoptysis. Patients with submucosal disease also had improvement in cough. Patients with peripheral tumors had better rates of response for hemoptysis and cough than those with central tumors did.

Take Home: HDT-BT is an effective tool for palliation of symptoms in patients in unresectable bronchogenic carcinoma with various submucosal or endoscopic involvement of tumors.


 A prospective analysis of high-dose-rate endobronchial brachytherapy in the palliation of obstructive symptoms in lung cancer patients: A single-institution experience

https://www.ncbi.nlm.nih.gov/pubmed/25983031

Clinical Trial

Reference: Goldberg M, Timotin E, Farrell T, Puksa S, Donde B, Sur R. A prospective analysis of high-dose-rate endobronchial brachytherapy in the palliation of obstructive symptoms in lung cancer patients: A single-institution experience. Brachytherapy. 2015;14(5):655-61.

Background: Prospective single center institution trial evaluating HDR Endobronchial Brachytherapy (HDR EBBT) effectiveness for palliation of symptoms in lung cancer patients.

PICO:

Populations:

  • Lung cancer patients with locally advanced inoperable disease

Intervention:

  • Bronchoscopically placed catheters marked for endoscopic marking were treated with 5-10 Gy and were closely followed at 1-2 4 week intervals. They were not concurrently treated with external beam radiation or chemotherapy.

Comparison:

  • None

Outcome:

  • Overall survival was 13.4% at 12 months. Improvement in performance status after HDR EBBT was seen. Mean hemoptysis-free survival for all patients was 232.3 days, cough-free survival was 140.3 days, and dyspnea-free survival was 173.5 days. There was no impact of any treatment- or patient-related factors of these outcomes on multivariate analysis, including additional treatment modalities and HDR EBBT dose. At 1-year follow-up, no significant toxicities were seen.

Take Home: HDR EBBT is a safe and effective way to palliate endobronchial symptoms. Additional external-beam radiation therapy, chemotherapy, or chemoradiation after HDR EBBT improves survival, but does not affect QOL measures.


 Palliative endobronchial brachytherapy for central lung tumors. A prospective, randomized comparison of two fractionation schedules

https://www.ncbi.nlm.nih.gov/pubmed/7531132

Clinical Trial

Reference: Huber RM, Fischer R, Haŭtmann H, et al. Palliative endobronchial brachytherapy for central lung tumors. A prospective, randomized comparison of two fractionation schedules. Chest. 1995;107(2):463-70.

Background: Prospective, randomized study to compare 2 treatment doses and schedules for endobronchial HDR-BT in terms of survival time, local tumor control, and possible complications. 93 patients were divided into two treatment groups.

PICO:

Populations:

  • Non-operable lung cancer patients with endobronchial disease and no other treatment options

Intervention:

  • Apply HDR-BT in different doses in 2 different groups and evaluate their respective outcomes. A mean total irradiation dose of 13.4 ± 5.2 Gy for group 1 and 13.7 ± 4.4 for group 2 were applied.
  • Group 1 received 4 brachytherapies with a dose of 3.8 Gy (at a 10-mm depth) on a weekly basis, and group 2 received 2 treatments with 7.2 Gy (at a 10-mm depth) at a 3-week interval.

Comparison:

  • Treatment effects of the 2 different doses in each group

Outcome:

  • 1-year survival rate was 11.4% in group 1 and 20.4% in group 2. Mean survival time was longer in group 2. Local disease control after 3 months was comparable in both groups.
  • Fatal hemoptysis occurred at a similar rate in group 1 (22.2%) and group 2 (21.1%).

Take Home: HDR-BT with 2X7.2Gy at a 3-week interval is equivalent to a 4X3.8-Gy regimen on a weekly basis. These regimens were comparable in terms of side effects and provides equivalent local tumor control. The shorter treatment schedule is more convenient for patients.


 High-dose-rate endobronchial brachytherapy effectively palliates symptoms due to airway tumors: the 10-year M. D. Anderson cancer center experience

https://www.ncbi.nlm.nih.gov/pubmed/11020566

Review

Reference: Kelly JF, Delclos ME, Morice RC, Huaringa A, Allen PK, Komaki R. High-dose-rate endobronchial brachytherapy effectively palliates symptoms due to airway tumors: the 10-year M. D. Anderson cancer center experience. Int J Radiat Oncol Biol Phys. 2000;48(3):697-702.

Summary: HDR-EBBT effectively palliates most patients’ symptoms caused by endobronchial lesions. It also correlated to overall survival benefit in this retrospective study.