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
Maria Fortunato1,
, Salvato Feijó3, Telma Almeida1, Vera Mendonça1, Margarida Aguiar3, Marília Jorge1, Isabel Monteiro Grillo1,2
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mfortunatoruivo@hotmail.com
Correspondence to/Correspondência: Serviço de Radioterapia do Hospital de Santa Maria, CHLN, Avenida Professor Egas Moniz, Lisboa, Portugal.
Correspondence to/Correspondência: Serviço de Radioterapia do Hospital de Santa Maria, CHLN, Avenida Professor Egas Moniz, Lisboa, Portugal.
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class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto de Medicina Molecular, Faculdade de Medicina – Universidade de Lisboa" "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital de Santa Maria, Serviço de Pneumologia" "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondence to/Correspondência: Serviço de Radioterapia do Hospital de Santa Maria, CHLN, Avenida Professor Egas Moniz, Lisboa, Portugal." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Braquiterapia endoluminal HDR no tratamento de tumores primários ou recidivas na árvore traqueobrônquica" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-08-01" "fechaAceptado" => "2008-11-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec159963" "palabras" => array:3 [ 0 => "High dose brachytherapy" 1 => "lung cancer" 2 => "tracheobronchial obstruction" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec159962" "palabras" => array:3 [ 0 => "Braquiterapia de alta taxa de dose" 1 => "carcinoma do pulmão" 2 => "obstrução da árvore traqueobrônquica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Aim</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">To demonstrate the advantages of endoluminal brachytherapy (EBT) with high dose rate (HDR) in primary and recurrent tumour of the bronchial tree.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">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</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Discussion and conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span class="elsevierStyleSectionTitle">Introdução</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Objectivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Material e métodos</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">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 Ir<span class="elsevierStyleSup">192</span>, utilizando um cateter 6 French.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">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 <span class="elsevierStyleItalic">follow-up</span> 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.</p> <span class="elsevierStyleSectionTitle">Discussão e conclusões</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">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. 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| Year/Month | Html | Total | |
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