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Vol. 15. Issue 2.
Pages 151-164 (March - April 2009)
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Vol. 15. Issue 2.
Pages 151-164 (March - April 2009)
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Endoluminal high dose rate brachytherapy in the treatment of primary and recurrent bronchogenic tree malignancies
Braquiterapia endoluminal HDR no tratamento de tumores primários ou recidivas na árvore traqueobrônquica
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Maria Fortunato1,
Corresponding author
mfortunatoruivo@hotmail.com

Correspondence to/Correspondência: Serviço de Radioterapia do Hospital de Santa Maria, CHLN, Avenida Professor Egas Moniz, Lisboa, Portugal.
, Salvato Feijó3, Telma Almeida1, Vera Mendonça1, Margarida Aguiar3, Marília Jorge1, Isabel Monteiro Grillo1,2
1 Hospital de Santa Maria, Serviço de Radioterapia
2 Instituto de Medicina Molecular, Faculdade de Medicina – Universidade de Lisboa
3 Hospital de Santa Maria, Serviço de Pneumologia
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Abstract
Introduction

Locally advanced tumours as the initial form of presentation of tumours in the bronchial tree are not a rare event. Bronchogenic recurrence is frequent in the natural history of some tumours. The choice of therapeutic options from the raft available depends on such variables as initial therapy, place of recurrence, symptoms and patient's physical status.

Aim

To demonstrate the advantages of endoluminal brachytherapy (EBT) with high dose rate (HDR) in primary and recurrent tumour of the bronchial tree.

Material and methods

A retrospective study of seven patients (pts) with primary tumours of the colon, trachea and lung. Tracheobronchial recurrence (trachea, two pts, bronchus, five pts) occurred between

March 2003 and September 2004. Patients under-went EBT with HDR for primary or recurrent therapy in association with external radiotherapy, laser therapy and chemotherapy with palliative or curative intention. EBT with HDR doses of 5 to 7 Gy in 2 to 4 fractions at 1 cm from the source axis were given. Treatment included endoluminal application of Ir192 with a French 6 catheter.

Results

There was symptomatic relief related to reduction of tumour in six of the seven patients treated. In one of the six patients studied, there was progression of the local disease between the second and third fractions of the treatment (obstruction of the trachea). In a mean follow up of 17 (2-40) months between EBT and this study, three patients are alive, one has no evidence of disease while two have had bronchial recurrence, four patients have died, one after massive haemoptysis and three due to disease progression.

Discussion and conclusions

Patients undergoing brachytherapy for symptomatic primary tumours or endobronchial recurrence show good tolerance, important symptom relief and improved quality of life. Despite the small size of our sample, it is clear that EBT with HDR plays an important role in the palliative/curative treatment of these patients.

Key-words:
High dose brachytherapy
lung cancer
tracheobronchial obstruction
Resumo
Introdução

Tumores localmente avançados como forma de apresentação inicial dos tumores localizados na árvore traqueobrônquica não são um fenómeno raro. A recidiva brônquica é um acontecimento frequente na história natural de algumas neoplasias. As opções terapêuticas são múltiplas, sendo no entanto dependentes de variáveis, como a terapêutica inicial utilizada, o local da recorrência, a sintomatologia e as condições físicas do doente.

Objectivos

Demonstrar as principais vantagens terapêuticas da braquiterapia endoluminal (BTE) com alta taxa de dose (HDR) em tumores primários e na recidiva tumoral localizada na árvore traqueobrônquica.

Material e métodos

Avaliámos retrospectivamente sete doentes (dts) com tumor primário do cólon, traqueia e pulmão. A recidiva traqueobrônquica (dois dts na traqueia e cinco dts no brônquio) ocorreu entre Março de 2003 e Setembro de 2004, os dts foram submetidos a BT HDR como terapêutica primária ou na recidiva, em associação com RTE, laserterapia e quimioterapia (QT), com intuito paliativo/ curativo. Na BTE HDR foram utilizadas doses de 5 a 7 Gy em duas a quatro fracções, prescritas a 1 cm do eixo da fonte. O tratamento consistiu na aplicação endoluminal de Ir192, utilizando um cateter 6 French.

Resultados

Verificámos o rápido alívio sintomático associado à redução da massa tumoral em seis dos sete doentes submetidos a esta técnica. Em um dos seis doentes estudados observou-se uma progressão da doença local entre a 2.ª e a 3.ª fracções de tratamento (obstrução da traqueia). Com um follow-up mediano entre a terapêutica com BT e a avaliação do presente estudo de 17 meses (2-40), três doentes estão vivos, um sem evidência de doença e dois apresentam uma recidiva brônquica; quatro faleceram, um após hemoptise maciça e três por progressão da doença.

Discussão e conclusões

Os dts submetidos a BT após recidiva tumoral endobrônquica ou com tumores primários sintomáticos apresentam uma boa tolerância e um alívio sintomático associado a uma boa qualidade de vida. Apesar da reduzida amostra, os resultados demonstram as eventuais vantagens da BTE de HDR no tratamento paliativo/ curativo destes doentes.

Palavras-chave:
Braquiterapia de alta taxa de dose
carcinoma do pulmão
obstrução da árvore traqueobrônquica
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Bibliography/Bibliografia
[1.]
P. Boyle, J. Ferley.
Cancer incidence and mortalaty in Europe.
Annals Oncol, 16 (2005), pp. 481-488
[2.]
Kaiser S, Gommer AM. Mortalaty (ASR) from lung cancer for men and women of all ages in UE -27, in 2002. In: EUPHIX, Euphact. Bilthoven: RIUM/(GLOBOCAN 2007).
[3.]
Bethesda, MD, USA. International Commission on Radiation Units and Measurements. ICRU report 38: Dose and volume specification for reporting intracavitary therapy in gynecology. International Commission on Radiation Units and Measurements (1985).
[4.]
G. Gustafson, F. Vicini, L. Freedman, E. Johston, G. Edmunson, S. Sherman, S. Pursel, M. Komic, P. Chen, J.C. Borrego, J. Seidman, A. Martinez.
High dose rate endobronchial brachytherapy in the management of primary and recurrent bronchogenic malignancies.
Cancer, 75 (1995), pp. 2345-2350
[5.]
F.B. Zimmermann, M. Molls, B. Jeremic.
Treatment of recurrent disease in lung cancer.
Semin Surg Oncol, 21 (2003), pp. 122-127
[6.]
R.J. Ginsberg, M.G. Kris, J.G. Armstrong, D.C. Ihde, H.I. Pass, E.J. Glatstein.
Cancer of the lung.
Cancer principles and practice of oncology, ed 4., pp. 673-758
[7.]
L.L. Chang, J. Horvath, W. Peyton, S.S. Ling.
High dose rate afterloading intraluminal brachytherapy in malignant airway obstruction of lung cancer.
Int J Radiat Oncol Biol Phys, 28 (1994), pp. 589-596
[8.]
J. Pisch, P.C. Villamena, J.C. Harvey, E. Rosenblatt, S. Mishra, E.J. Beatie.
High dose rate endobronchial irradiation in malignant airway obstruction.
Chest, 104 (1993), pp. 721-725
[9.]
S.L. Seagren, J.H. Harrell, R.A. Horn.
High dose rate intraluminal irradiation in recurrent endobronchial carcinoma.
Chest, 88 (1985), pp. 810-814
[10.]
B.L. Speiser, L. Spratling.
Remote afterloading brachytherapy for the local control of endobronchial carcinoma.
Int J Radiat Oncol Biol Phys, 25 (1993), pp. 579-587
[11.]
G. Sutedja, G. Baris, C. Schaake-Koning, N. Van zandwijk.
High dose rate brachytherapy in patients with local recurrences after radiotherapy of non small cell lung cancer.
Int J Radiat Oncol Biol Phys, 24 (1992), pp. 551-553
[12.]
B. Khanavkar, P. Stern, W. Alberti, J.A. Nakhosteen.
Complications associated with brachytherapy alone or with laser in lung cancer.
Chest, 99 (1991), pp. 1062-1065
[13.]
C. Personne, A. Colchen, M. Leroy, H.G. Vourc, L. Toty.
Indications and technique for endoscopic laser resections in bronchology.
J Thorac Cardiovasc Surg, 91 (1986), pp. 710-715
[14.]
M.F. Schray, A. Martinez, J.C. McDougall, G.K. Edmundson, D.A. Cortese, W.M. Brutinel.
Malignant airway obstruction: management with temporary intraluminal brachytherapy and laser treatment.
Endocurietherapy/Hiperthermia Oncol, 1 (1985), pp. 237-245
[15.]
H.N. Macha, K. Koch, M. Stadler, W. Schumacher, D. Krumhaar.
New technique for treatment occlusive and stenosing tumors of the trachea and main bronchi: endobronchial irradiation by high dose iridium 192 combined with last canalization.
Thorax, 42 (1987), pp. 511-515
[16.]
M. Mehta, D. Petereit, L. Chosy, M. Harmon, J. Fowler, S. Shahabi, et al.
Sequential comparison of low dose rate and hyperfractionated high dose rate endobronchial radiation for malignant airway occlusion.
Int J Radiat Oncol Biol Phys, 23 (1992), pp. 133-139
[17.]
A. Prevost, G. Berthiot, B. Picavet, D. Froissart, M. Loirette, B. Costa, A. Cauchois, T.D. Nguyen.
Endobronchial brachytherapy in combination with external beam irradiation in obstructing malignant bronchial tumors.
Oncology Reports, 10 (2003), pp. 921-925
[18.]
S.J. Quantrill, P.A. Burt, P.V. Barber, R. Stout.
Treatment of endobronchial metastases with intraluminal radiotherapy.
Respir Med, 94 (2000), pp. 369-372
[19.]
J. Bedwinek, A. Petty, C. Bruton, et al.
The use of high dose rate endobronchial brachytherapy to palliate syntomatic endobronchial recurrence of previously irradiated bronchogenic carcinoma.
Int J Radiat Oncol Biol Phys, 22 (1991), pp. 23-30
[20.]
M. Gauwitz, N. Ellerbroek, R. Komaki, et al.
High dose endobronchial irradiation in recurrent bronchogenic carcinoma.
In J. Radiat Oncol Biol Phys, 23 (1992), pp. 397-400
[21.]
M.E. Delclos, R. Komaki, R.C. Morice, et al.
Endobronchial brachytherapy with high dose rate remote afterloading for recurrent endobronchial lesions.
Radiology, 201 (1996), pp. 279-282
[22.]
J.F. Kelly, M.E. Delclos, R.C. Morice, 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, 48 (2000), pp. 697-702
[23.]
E.L. Gressen, M. Werne-Wasik, J. Cohn, et al.
Thoracic reirradiation for syntomatic relief after prior radiotherapeutic management for lung cancer.
Am J Clin Oncol, 23 (2000), pp. 160-163
Copyright © 2009. Sociedade Portuguesa de Pneumologia
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