Advertisement

Brachytherapy

  • Maher TabbaEmail author
Chapter

Abstract

The majority of newly diagnosed lung cancers are nonresectable and usually treated with chemotherapy, radiotherapy, or both. Malignant and recurrent endobronchial lesions are responsible for the majority of mortality from postobstructive pneumonia, respiratory failure, and sepsis in patients with lung cancer. Endobronchial brachytherapy (EBB) is a form of localized palliative radiation therapy that aims to control the growth of tumors and to achieve reductions in their sizes. Significant improvement in the clinical symptoms such as dyspnea, cough, hemoptysis, lung reaeration, and postobstructive pneumonia has been achieved with this treatment modality. EBB has been used to treat lung malignancy in the following clinical situations: (a) symptomatic endobronchial lesions, (b) early stage malignancy in patients who are not surgical candidates, (c) locally advanced disease with involvement of the nearby anatomic organs (bones or major vessels) and inability to achieve free margins, (d) carcinoma in situ, and (e) mesothelioma. There are three types of radiotherapy: low-dose rate (LDR), high-dose rate (HDL), and pulse dose rate (PDR). HDR has significantly shortened the treatment time, minimized the need for hospitalization and associated costs, as well as decreased catheter dislodgment. It is becoming the most frequently used brachytherapy treatment option.

Keywords

External Beam Radiation Therapy Radioactive Source Flexible Bronchoscopy Nonoperable Patient Sublobar Resection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The author thanks Dr. Carla Lamb and Dr. Sara Shadchehr from the Lahey Clinic, Burlington, Massachusetts, for providing the images used in this chapter.

Suggested Reading

  1. 1.
    Jemal A, Siegel R, Ward E, Hao Y, Xu J, et al. Cancer statistics 2008. CA Cancer J Clin. 2008;58:71–96.PubMedCrossRefGoogle Scholar
  2. 2.
    Strand TE, Rostad H, Moller B, Norstein J. Survival after resection for primary lung cancer: a population-based study of 3211 resected patients. Thorax. 2006;61:710–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Yang P, Allen M, Aubry M, et al. Clinical features of 5628 primary lung cancer patients: experience at Mayo Clinic from 1997 to 2003. Chest. 2005;128:452–62.PubMedCrossRefGoogle Scholar
  4. 4.
    Allison R, Sibata C, Sarma K, et al. High-dose-rate brachytherapy in combination with stenting offers a rapid and statistically significant improvement in quality of life for patients with endobronchial recurrence. Cancer J. 2004;10:368–73.PubMedCrossRefGoogle Scholar
  5. 5.
    Hauswald H, Stoiber E, Rochet N, et al. Treatment of recurrent bronchial carcinoma: the role of high-dose-rate endoluminal brachytherapy. Int J Radiat Oncol Biol Phys. 2010;77:373–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Lo TC, Beamis JF, Villanueva AG, Gray AW, et al. Intraluminal brachytherapy for malignant endobronchial tumors: an update on low-dose rate versus high-dose rate radiation therapy. Clin Lung Cancer. 2001;3:65–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Skowronek J, Kubaszewska M, Kanikowski M, et al. HDR endobronchial brachytherapy (HDRBT) in the management of advanced lung cancer: comparison of two different dose schedules. Radiother Oncol. 2009;93:436–40.PubMedCrossRefGoogle Scholar
  8. 8.
    Kubaszewska M, Skowronek J, Chichel A, Kanikowski M. The use of high dose rate endobronchial brachytherapy to palliate symptomatic recurrence of previously irradiated lung cancer. Neoplasma. 2008;55:239–45.PubMedGoogle Scholar
  9. 9.
    Barber P, Stout R. High dose rate endobronchial brachytherapy for the treatment of lung cancer: current status and indications. Thorax. 1996;51:345–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Kelly JF, Delclos ME, Morice RC, et al. 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;48:697–702.PubMedCrossRefGoogle Scholar
  11. 11.
    Delclos ME, Komaki R, Morice RC, et al. Endobronchial brachytherapy with high-dose-rate remote afterloading for recurrent endobronchial lesions. Radiology. 1996;201:279–82.PubMedGoogle Scholar
  12. 12.
    Hennequin C, Bleichner O, Tredaniel J, et al. Long-term results of endobronchial brachytherapy: a curative treatment? Int J Radiat Oncol Biol Phys. 2007;67:425–30.PubMedCrossRefGoogle Scholar
  13. 13.
    Celebioglu B, Gurkan OU, Erdogan S, et al. High dose rate endobronchial brachytherapy effectively palliates symptoms due to inoperable lung cancer. Jpn J Clin Oncol. 2002;32:443–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Perol M, Caliandro R, Pommier P, et al. Curative irradiation of limited endobronchial carcinomas with high-dose rate brachytherapy. Chest. 1997;111:1417–23.PubMedCrossRefGoogle Scholar
  15. 15.
    Sutedja G, Baris G, van Zandwijk N, et al. High-dose rate brachytherapy has a curative potential in patients with intraluminal squamous cell lung cancer. Respiration. 1994;61:167–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Stout R, Barber P, Burt P, et al. Clinical and quality of life outcomes in the first United Kingdom randomized trial of endobronchial brachytherapy (intraluminal radiotherapy) vs. external beam radiotherapy in the palliative treatment of inoperable non-small cell lung cancer. Radiother Oncol. 2000;56:323–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Huber RM, Fischer R, Hautmann H, et al. Does additional brachytherapy improve the effect of external irradiation? A prospective, randomized study in central lung tumors. Int J Radiat Oncol Biol Phys. 1997;38:533–40.PubMedCrossRefGoogle Scholar
  18. 18.
    Langendijk H, de Jong J, Tjwa M, et al. External irradiation versus external irradiation plus endobronchial brachytherapy in inoperable non-small cell lung cancer: a prospective randomized study. Radiother Oncol. 2001;58:257–68.PubMedCrossRefGoogle Scholar
  19. 19.
    Fuwa N, Kodaira T, Tachibana H, et al. Long-term observation of 64 patients with roentgenographically occult lung cancer treated with external irradiation and intraluminal irradiation using low-dose-rate iridium. Jpn J Clin Oncol. 2008;38:581–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Mathur PN, Edell E, Sutedja T, et al. Treatment of early stage non-small cell lung cancer. Chest. 2003;123:176S–80.PubMedCrossRefGoogle Scholar
  21. 21.
    Corti L, Toniolo L, Boso C, et al. Long-term survival of patients treated with photodynamic therapy for carcinoma in situ and early non-small-cell lung carcinoma. Lasers Surg Med. 2007;39:394–402.PubMedCrossRefGoogle Scholar
  22. 22.
    Weinberg BD, Allison RR, Sibata C, et al. Results of combined photodynamic therapy (PDT) and high dose rate brachytherapy (HDR) in treatment of obstructive endobronchial non-small cell lung cancer (NSCLC). Photodiagnosis Photodyn Ther. 2010;7:50–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Imamura F, Ueno K, Kusonoki Y, et al. High-dose-rate brachytherapy for small-sized peripherally located lung cancer. Strahlenther Onkol. 2006;182:703–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Marsiglia H, Baldeyrou P, Lartigau E, et al. High-dose-rate brachytherapy as sole modality for early-stage endobronchial carcinoma. Int J Radiat Oncol Biol Phys. 2000;47:665–72.PubMedCrossRefGoogle Scholar
  25. 25.
    Hara R, Itami J, Aruga T, et al. Risk factors for massive hemoptysis after endobronchial brachytherapy in patients with tracheobronchial malignancies. Cancer. 2001;92:2623–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Matsumoto I, Oda M, Imagawa T, et al. Management of tracheobronchial ulceration induced by high-dose brachytherapy. Ann Thorac Surg. 2009;87:1301–3.PubMedCrossRefGoogle Scholar
  27. 27.
    Chawla M, Getzen T, Simoff MJ. Medical pneumonectomy: interventional bronchoscopic and endovascular management of massive hemoptysis due to pulmonary artery pseudoaneurysm, a consequence of endobronchial brachytherapy. Chest. 2009;135:1355–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Hauswald H, Stoiber E, Rochet N, et al. Treatment of recurrent bronchial carcinoma: the role of high-dose-rate endoluminal brachytherapy. Int J Radiat Oncol Biol Phys. 2001;77:373–7.CrossRefGoogle Scholar
  29. 29.
    Nag S, Kelly JF, Horton JL, et al. Brachytherapy for carcinoma of the lung. Oncology. 2001;15:371–81.PubMedGoogle Scholar
  30. 30.
    Ginsberg RJ, Rubenstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995;60:615–23.PubMedCrossRefGoogle Scholar
  31. 31.
    Martini N, Bains MS, Burt ME, et al. Incidence of local recurrence and second primary tumors in resected stage I lung cancer. J Thorac Cardiovasc Surg. 1994;109:120–9.CrossRefGoogle Scholar
  32. 32.
    Warren WH, Faber LP. Segmentectomy versus lobectomy in patients with stage I pulmonary carcinoma: five year survival and patterns of intrathoracic recurrence. J Thorac Cardiovasc Surg. 1994;107:1087–94.PubMedGoogle Scholar
  33. 33.
    Landreneau RJ, Sugarbaker DJ, Mack MJ, et al. Wedge resection versus lobectomy for stage I (T1 N0 M0) non-small-cell lung cancer. J Thorac Cardiovasc Surg. 1997;113:691–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Warren WH, Faber LP. Segmentectomy versus lobectomy in patients with stage I pulmonary carcinoma. Five-year survival and patterns of intrathoracic recurrence. J Thorac Cardiovasc Surg. 1994;107:1087–93.PubMedGoogle Scholar
  35. 35.
    Ichinose Y, Yano T, Yokoyama H, et al. The correlation between tumor size and lymphatic vessel invasion in resected peripheral stage I non-small cell lung cancer. J Thorac Cardiovasc Surg. 1994;108:684–6.PubMedGoogle Scholar
  36. 36.
    Kennedy AS, Sonett JR, Orens JB, King K. High dose rate brachytherapy to prevent recurrent benign hyperplasia in lung transplant bronchi: theoretical and clinical considerations. J Heart Lung Transplant. 2000;19:155–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Read RC, Yoder G, Schaeffer RC. Survival after conservative resection for T1 N0 M0 non-small cell lung cancer. Ann Thorac Surg. 1990;49:391–400.PubMedCrossRefGoogle Scholar
  38. 38.
    Sienel W, Dango S, Kirshbaum A, et al. Sublobar resections in stage IA non-small cell lung cancer: segmentectomies result in significantly better cancer-related survival than wedge resections. Eur J Cardiothorac Surg. 2009;33:728–34.CrossRefGoogle Scholar
  39. 39.
    Mutyala S, Sugarbaker D. Thoracic brachytherapy. In: Devil PM, editor. Brachytherapy: applications and techniques. 1st ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 137–57.Google Scholar
  40. 40.
    U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2006 Incidence and mortality web-based report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute. http://www.cdc.gov/uscs (2010). Accessed 24 Sept 2010.
  41. 41.
    Herth F, Becker HD, LoCicero J, et al. Endobronchial ultrasound in therapeutic bronchoscopy. Eur Respir J. 2002;20:118–21.PubMedCrossRefGoogle Scholar
  42. 42.
    Freitag L, Ernst A, Thomas M, et al. Sequential photodynamic therapy (PDT) and high dose brachytherapy for endobronchial tumour control in patients with limited bronchogenic carcinoma. Thorax. 2004;59:790–3.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Pulmonary & Critical Care and Sleep MedicineTufts UniversityBostonUSA

Personalised recommendations