SESSION TITLE: Lung Cancer Cases
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Sunday, October 25, 2015 at 10:45 AM - 12:00 PM
INTRODUCTION: The use of brachytherapy is one method of delivering a higher radiation dose to endobronchial tumor while sparing the surrounding normal tissues. Although commonly done with a single catheter we report on the simultaneous use of dual HDR-intraluminal brachytherapy catheters.
CASE PRESENTATION: We report of a 71-year-old man with left mainstem recurrence of squamous cell carcinoma who was treated with chemoradiation (63 Gy/ 35 tx) previously. Three months ago, bronchoscopy revealed extension of tumor involving carina and proximal 2 cm of both left and right mainstem bronchi. Biopsy confirmed squamous cell carcinoma. He underwent tumor debulking using Nd:YAG laser first and then referred for HDR-brachytherapy to treat any submucosal extension. Since both main stem bronchi were involved, a decision was made to place two catheters to radiate both sides simultaneously. A pediatric bronchoscope was inserted next to the catheter to verify positioning (Fig. 1). The position of the catheters was confirmed with digital orthogonal x-rays and conebeam CT. Eclipse software was used to plan the treatment of the proximal 5 cm of both the right and left mainstem bronchi and carina with 750cGy prescribed to 1 cm from the source at the carina. The target volume is shown above (Fig.2). 750 cGy was delivered over actual time of 466.2 seconds with the high activity (4.33 Ci) Ir-192 source (nominal treatment time = 201.6 seconds). Two additional weekly treatments of 750 cGy to the above area were planned.
DISCUSSION: HDR-brachytherapy is effective in palliating dyspnea. In our patient, given the bilaterality of tumor progression, routine HDR-intraluminal brachytherapy would have required our patient to undergo unilateral treatment separately in multiple sessions and may have resulted in overlap of the brachytherapy isodoses. By planning the bilateral HDR-intraluminal brachytherapy catheters simultaneous, the risk of future overlap is avoided, and the overall treatment interval is reduced in half
CONCLUSIONS: HDR-intraluminal brachytherapy has demonstrated improvement of overall quality of life with single luminal therapies. We demonstrate the concomitant use of two intraluminal brachytherapy catheters placed in separate bronchi decreased the overall treatment interval. Future studies need to be conducted to evaluate efficacy.
Reference #1: Hennequin C, et al. Long-term results of endobronchial brachytherapy. Int J Radiat Oncol Biol Phys. 2007;67(2):425.
DISCLOSURE: The following authors have nothing to disclose: Larry Ladi, John Grecula, Eric Allen, Shaheen Islam
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