The purpose of this study was to determine the benefit of high dose rate endobronchial
brachytherapy in the treatment of obstructive
lung cancer. Between September 1990 and March 1995, 189 patients with
bronchogenic carcinoma were treated with high dose rate endobronchial
brachytherapy. Most patients (69.3%) had received prior treatment and presented with symptomatic bronchial obstruction due to either recurrent or residual endobronchial disease. A small group (12%) was medically unfit for either surgical resection or thoracic
radiotherapy and benefited from endobronchial
brachytherapy alone for small endobronchial tumours. The remainder of the patients had not been treated previously and endobronchial
brachytherapy was performed for life-threatening symptoms requiring emergency obstruction relief before other
therapy. Treatment was performed weekly and consisted of three to four 8 to 10 Gy fractions at a radius of 10 mm from the centre of the source. Major symptomatic relief was obtained for haemoptysis (74%), dyspnoea (54%), and
cough (54%). Complete endoscopic response was observed in 54% of cases. Median survival was 7 months for the entire group. For small, strictly endobronchial tumours, complete response rate was 96%, median survival 17 months, and 30 month survival 46%, with a plateau starting at 18 months. Grade 3 to 4 toxicities occurred at a rate of 17% and included massive haemoptysis (n=13), bronchial
stenosis (n=12), soft tissue
necrosis (n=8), and
bronchial fistula (n=3). By univariate analysis, no factor was found to be predictive of late pulmonary toxicity. The present study confirms the usefulness of endobronchial
brachytherapy in alleviating symptoms caused by endobronchial recurrence of
bronchogenic carcinoma. In addition, this
therapy can be tried with curative intent in patients who present with small endobronchial tumours and are not candidates for other forms of
therapy.