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

Abstract

Purpose

Brachytherapy 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 methods

Between 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.

Results

Four 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.

Conclusions

• 1.

  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.