Sole
brachytherapy for
carcinoma of the lung is most often performed using high-dose-rate (HDR) remote afterloading equipment, which delivers the treatment within the tracheobronchial tree in an outpatient setting. It provides excellent, rapid palliation in advanced stages, and can also be used selectively for curative intent in early stages. In better-performance patients, fractionated external beam
radiation therapy (EBRT) is preferred to
brachytherapy as an initial treatment because it appears to provide a modest gain in survival, and more sustained palliation. In patients with centrally located
tumors and limited extent of disease, the combination of external and endoluminal irradiation enables curative treatment options. Intraoperative
brachytherapy may
complement standard adjuvant treatment in incompletely resected, unresectable, or medically inoperable patients, and has the potential to improve local control in selected cases. Due to the rarity of the disease, the role of endoluminal
brachytherapy in the treatment regimen of
tracheal neoplasms is not yet clearly defined. The risk of fatal
bleeding after endoluminal
brachytherapy appears to be correlated with
tumor localization and fraction size, but in the majority of cases fatal bleeds are caused by progression of local disease. The use of a distanceable applicator provides a central positioning of the source, prevents the delivery of high-contact doses to the mucosa, and may reduce toxicity. The standard technique for interstitial
brachytherapy after
breast-conserving surgery and adjuvant EBRT is the use of low-dose-rate (LDR)
brachytherapy, but it may also be applied by means of pulsed-dose-rate (PDR) or HDR techniques. Prospective trials comparing different boost techniques and indications are needed to define more precisely the subgroup of patients who are most suitable for interstitial
brachytherapy.
Reirradiation of chest wall local recurrences using
brachytherapy molds is effective and provides a high local control rate with acceptable toxicity.