PURPOSE: HDIR is used to treat endobronchial lung cancers with high dose radiation administered directly into the tumor. Due to its short treatment distance, HDIR maximizes the radiation dose given to tumor tissue while minimizing radiation effects on adjacent normal tissue. Current practice limits HDIR administration to proximal tumors seen via the videoscope or fluoroscopy. This report describes 3 patients with peripheral lung lesions effectively treated by HDIR with placement guided via ENB and REBUS.
METHODS: All three patients had non-small cell lung cancer. Two patients were classified as stage IIB (T2N1M0) and one as IA (T1N0M0). None of the patients were surgical candidates. The bronchoscope was inserted into the general airway where the peripheral lesion was located. Superdimension(TM) ENB was used for the procedures. Under ENB guidance, the ENB working channel was navigated to the peripheral tumor. The position was then confirmed via Olympus REBUS. Under fluoroscopic guidance, a 6 Fr. catheter(with distal tip sealed) was inserted through the working channel and into the peripheral lesion. Subsequently, a Varian VariSource HDIR apparatus was used to implant a 10 Cu Iridium-192 radioactive source into the catheter and a dose cloud treatment of 16 Gy was given according to a 3D CT planning program.
RESULTS: None of the three patients experienced post-procedure complications. One is alive 6 months and another 12 months post-procedure. Post treatment chest CT demonstrated dramatic interval decrease in tumor size in both patients. The third patient died one month post-procedure as a result of a myocardial infraction unrelated to the procedure. A 1 month post-procedure CXR documented interval decrease in tumor size.
CONCLUSION: Placement of HDIR by ENB and REBUS is a feasible treatment approach which demonstrates dramatic tumor regression and may decrease morbidity and increase survival rates by focusing radiation at the tumor site and adjacent lymphatic structures.
CLINICAL IMPLICATIONS: This technique may serve as a radiosurgical alternative to conventional surgery in non-operative lung cancer patients.
DISCLOSURE: Ajay Bedekar, No Financial Disclosure Information; No Product/Research Disclosure Information