Matthew Knox
St George Hospital, Kogarah, NSW
Junior Medical Officer

Andrej Bece
Research and Clinical Fellow
Department of Radiation Oncology, St George Hospital, Kogarah, NSW

Joseph Bucci
Radiation Oncologist
Department of Radiation Oncology, St George Hospital, Kogarah, NSW

John Moses
Respiratory Physician
Department of Respiratory Medicine, St George Hospital, Kogarah, NSW

Peter Graham
Radiation Oncologist
Department of Radiation Oncology, St George Hospital, Kogarah, NSW

Background and Purpose:

Management in patients with end-stage primary and metastatic lung cancers focuses on symptom control, including airway obstruction and haemoptysis. In this context, endobronchial brachytherapy (EBB) is an approach allowing safe delivery of clinically meaningful radiation doses with evidence supporting its ability to effectively palliate symptoms.(1) EBB also has an acceptable risk of local bronchial adverse effects, whilst its sharp dose fall-off minimises non-bronchial side-effects.(2)

Use of EBB in Australia is currently infrequent and as such, local research is limited. This study attempts to provide a broad summary of the characteristics of both high dose-rate (HDR) and pulsed dose-rate (PDR) treatments in a single centre.

Methods:

This study was designed as a retrospective audit. Palliative EBB procedures performed at the St George Cancer Care Centre, NSW between 1997 and 2016 inclusive were included in the study. Records (paper and electronic) were retrospectively reviewed and data pertaining to oncological diagnosis, treatment and clinical follow-up were collected.

Data and their analysis were primarily descriptive, providing a summary of the characteristics of treatment at our unit.

Results:

95 EBB cases were identified in 86 patients, with 78 cases treated with PDR and 17 with HDR. Clinical and/or radiological airway obstruction in a prior high-dose irradiated volume was the most common indication for treatment (81%). The majority of cases involved primary lung lesions (73%), with squamous cell carcinoma (38%) the most common histological subtype.

Lesions were treated throughout the bronchial tree, though the right lower lobe bronchus (22%) and left main bronchus (17%) were the most common anatomical locations for treatment. Of the 78 patients treated with PDR, the median dose was 10 Gy (range=5-15) delivered in 10 pulses (1997-2011). Of the 17 patients treated with HDR, the median dose was 10 Gy (range=5-10) in 1 fraction (2005-2016).

Of 86 cases with documented clinical outcomes, 63 (73%) had a partial or complete response of symptoms. There was no difference in the rate of clinical response between PDR and HDR patients (p=0.202). There were no grade≥2 complications recorded.

Conclusions:

We present the largest Australian series of EBB to date. EBB is an effective approach to the palliation of symptoms in patients with malignant lung lesions. Despite a variety of symptomatic presentations, histologies and anatomical locations, the majority of patients in our study experienced an improvement in reported symptoms. Given its low risk of toxicity,(2) EBB should continue to be considered an option in the palliative treatment of lung malignancies.

References:

1) Tofts RP, Lee PM, Sung AW. Interventional pulmonology approaches in the diagnosis and treatment of early stage non-small-cell lung cancer. Transl Lung Cancer Res. Oct 2013; 2(5):316-31

2) Nguyen NTA, Sur RK. Brachytherapy in lung cancer: a review. Transl Cancer Res. Aug 2015; 4(4):381-96


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