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AbstractAbstract
[en] With an annual incidence of more than 160,000 cases and a local failure rate between 30-50%, endobronchial occlusion seen with lung cancer is a common and potentially life-threatening complication. Several methods of managing this exist and recently endobronchial brachytherapy has been used extensively as a consequence of the development of fiberoptic bronchoscopy and high dose rate remote afterloading technology. Procedurally, one or more afterloading catheters are inserted in the involved portions of the tracheobronchial tree through fiberoptic guidance. Treatment techniques range from 1-4 applications fractionated over several weeks or given over 2 days with a single insertion procedure. Almost all procedures are currently performed in the outpatient setting. The major application of this technology is in the palliation of occlusive symptomatology. Clinical improvement ranges from 50-100%, radiographic reaeration ranges from 46-88% and bronchoscopic responses ranges from 59-100%. Symptomatic relief is usually quite durable with more than 70% of the patients' remaining life-time rendered symptom-free and symptom-improved. Recently, this modality has been explored for its curative potential as a boost following external beam radiotherapy. It is clear from these series, that in selected patients, endobronchial boost produces significant reaeration and sparing of lung volume from subsequent external radiation, and a few cases may even become resectable. Demonstration of the survival advantage will, however, require larger clinical trials with adequate controls. Some reports have suggested an unacceptably high rate of fatal hemoptysis following HDR endobronchial brachytherapy. Review of the world literature suggests that fatal hemoptysis rates range from 0-50% with an average of about 8%, comparable to an average of 5% with low dose rate brachytherapy. Other recognized complications include fistulae and radiation bronchitis. Because the majority of patients with cancer of the esophagus die with local recurrence and esophageal obstruction, preliminary brachytherapy efforts were limited to the recurrent disease setting. These data suggest that brief symptomatic relief results in two-thirds to three-quarters of patients. Subsequent trials in Vancouver and Japan established that in patients with advanced disease, a combination of external beam and endoesophageal brachytherapy was feasible with acceptable morbidity and no mortality. Quality of life analysis suggested improved swallowing ability and reduction in dysphagia in these patients. In a series of almost 300 patients, a small subset were treated with curative intent with planned resection after brachytherapy and external beam radiotherapy, resulting in a median survival of 43 months. Such data led to the incorporation of brachytherapy boost, into RTOG 9207, a Phase I/II trial for localized cancer of the esophagus combining external beam radiation and esophageal brachytherapy in combination with chemotherapy. Complete response to therapy was seen at the primary site in 73% of patients, suggesting that endoesophageal boost could be incorporated in the current standard of care which utilizes combination chemoradiotherapy. Two prospective trials from China and India have validated survival benefit with this approach
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Source
S0360301697805172; Copyright (c) 1997 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Record Type
Journal Article
Journal
International Journal of Radiation Oncology, Biology and Physics; ISSN 0360-3016;
; CODEN IOBPD3; v. 39(2,suppl.1); p. 123

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