PURPOSE: Limited treatment options exist for patients with stage IV lung cancer and metastatic endobronchial lesions. Endobronchial brachytherapy treatment (EBBT) remains a viable option to provide localized radiation to reestablish airway patency and reduce symptoms with minimal side effects.
METHODS: The radiation oncology database of patients treated with EBBT in our institution from February 1996 to April 2009 was used for a retrospective chart review of 88 patients. Each patient record was reviewed for symptoms of cough, dyspnea, chest pain, hemoptysis, pneumothorax, and respiratory failure necessitating hospital admission before and after EBBT.
RESULTS: A small percentage of procedure related side effects were noted in our cohort (4.5%). One patient (2.5%) developed cough immediately after the procedure. Three patients (3.8%) developed respiratory failure after the procedure, necessitating transfer to a higher level of care for either increased oxygen therapy or closer monitoring (without endotracheal intubation). There were no deaths during treatment. There were no documented symptoms of shortness of breath, chest pain, hemoptysis, or pneumothorax documented related to EBBT.EBBT improved the following symptoms: hemoptysis (90.9%), respiratory failure (85.7%), cough (79.5%), chest pain (76.9%), and shortness of breath (73.2%).The incident of catheter malposition was 25% in the right upper lobe (RUL). The survival benefit was documented as days alive after EBBT. Survival was divided by diagnostic category into small cell carcinoma, non-small cell carcinoma, and metastatic. The survival benefit was highest in the metastatic/other category (272) days, followed by non-small cell carcinoma (122 days), and small cell carcinoma (112 days).
CONCLUSION: EBBT is a safe procedure with a low complication rate. Careful patient selection and modification of the number of intended treatments in cases where there is evidence of radiation-induced damage to the airway epithelium seems to have averted significant procedural complications.
CLINICAL IMPLICATIONS: EBBT in conjunction with other invasive interventional procedures can be a good option for palliating hemoptysis, cough, and shortness of breath.
DISCLOSURE: Sara Shadchehr, No Financial Disclosure Information; No Product/Research Disclosure Information