The repeated use of high dose rate brachytherapy for locally recurrent lung cancer

PurposeTo assess the effect of repeated palliative treatment with high dose rate brachytherapy in patients with advanced lung cancer.Material and MethodsFifty-six patients, 25.3% of a total of 221 patients treated for lung cancer with HDR brachytherapy were treated twice, using High Dose Rate Brachytherapy. All patients were qualified for repeated brachytherapy due to the recurrence of intrabronchial tumour and acceptable remissions after the first treatment. The survival times were compared with selected clinical data. Correlations between survival times and subjective breathing difficulties were analyzed separately.ResultsThe median survival time in the whole group of patients was 8.9 months. The period of obtaining a positive clinical response was correlated with a longer survival time (log-rank test, p=0.0009, F Cox test, p=0.007). In the multivariate analysis other statistically important prognostic factors were also included: the clinical stage of the primary tumour (F Cox test, p=0.04), and the interval between the first and second treatment (F Cox, p=0.004). None of the analyzed factors (dyspnoea, cough, haemoptysis and pain) had any influence on survival.ConclusionRepeated HDR brachytherapy in advanced lung cancer was an efficient method that in many patients led to regression of symptoms and improvement in life quality

Treatment of advanced lung cancer by external beam radiotherapy and high dose rate (HDR) brachytherapy

PurposeBrachytherapy is a highly valued and effective palliative treatment for lung cancer, especially as it reduces intensity of dyspnoea and other symptoms arising from tumours inside the respiratory tract. In some cases, due to the location of the lesion brachytherapy is a treatment of choice. However, its curative role is unclear. A combination treatment of brachytherapy and an external beam irradiaton may play a significant role when the mediastinal lymph nodes are involved.The paper presents the results of treatment of advanced lung cancer patients by external beam irradiation and brachytherapy, and the role of this palliative treatment is discussed.Material and methodsBetween May 1999 and March 2000 at the Greatpoland Cancer Centre fifteen patients with advanced lung cancer were treated by HDR brachytherapy and palliative external beam irradiation using the method of hypofractionation. The patients’ age ranged between 39 to 80 years, mean: 54.3 years. The treatment consisted of external beam irradiation (total dose of 20–30 Gy), and a weekly high dose rate (HDR) brachytherapy (three fractions of 7.5 or 10 Gy, at 1 cm from the source). In three cases the treatment was started with external irradiation, whereas in 12 cases the first stage was brachytherapy. During the patients’ clinical and endobronchial follow-up of 1, 3 and 6 months, local remission and regression of difficulties in breathing, cough, pain and haemoptysis were assessed.ResultsIn all our patients subjective improvement (regression of all symptoms) was found on the first check-up following treatment. In one case complete remission of the tumour lasted for over 6 months, in 9 cases partial remission and in two cases progression were found. Severe complications due to the high total local dose were not observed.ConclusionsCombined palliative treatment (intraluminal brachytherapy and external beam irradiation) in advanced lung cancer was an efficient method that led to regression of symptoms and improvement of well-being in many patients

High dose rate endobronchial brachytherapy in the management of advanced lung cancer – comparison of different doses – preliminary assessment

PurposeBrachytherapy is one of the most efficient methods of overcoming endobronchial obstruction in palliative treatment of lung cancer. In single cases, brachytherapy is performed as radical treatment, however in most of cases, due to advanced clinical stage it has a palliative aim. In the absence of clear consensus regarding the value of doses used in brachytherapy different fraction doses are used in clinical treatment. The aim of this work is to compare results of palliative high dose rate brachytherapy using various treatment protocols with the view to analysing differences in survival and diminishing breathing difficulties.Material and methodsBetween May 1999 and February 2000 at the Greatpoland Cancer Center, 69 patients with advanced lung cancer were treated by high dose rate brachytherapy. They were disqualified from radical treatment due to advanced clinical stage. The age of the patients ranged from 39 to 76 years (average 53,2 years). Fifty-one patients received a total dose of 22,5 Gy in 3 fractions once a week, 18 patients received one single fraction of 10 Gy. All the patients were divided into two groups according to their clinical stage and the Karnofsky score – those with the Karnofsky score lower than 50 were qualified for a single fraction treatment. They were under clinical and endobronchial observation as regards survival rates, local remission and subsiding dyspnoea, breathing, cough and haemoptysis in the first, third, sixth and twelveth month of observation.ResultsFour weeks after the end of treatment subjective improvement (subsidence of all symptoms) was ascertained in 61/69 (88,4%) patients. In 12 cases (17,4%) complete remission (CR), in 49 cases (71,0%) – partial remission (PR) of the tumor were found. During one year of observation 45 (65,2%) patients died, in 10 cases (14,5%) improvement of in dyspnoea was observed and in 14 cases (20,3%) recurrence and progression of the disease were noted. There was no statistical difference in the survival rates between the two groups of patients treated with different fractions protocols.Conclusions1.Brachytherapy in advanced lung cancer is an efficient method that led in most of patients to subcidence of symptoms and to improvement of the quality their lives.2.The two treatment protocols showed similar efficiency in overcoming difficulties in breathing.3.Survival rates were similar in both group of patients treated with different treatment protocols