Brachytherapy as a palliative treatment in non-small cell lung cancer

Purpose: To evaluate the efficacy of endobronchial brachytherapy as a palliative treatment in reducing bronchial obstruction relieving dyspnea, cough, and the frequency of hemoptysis. Methods: 23 patients with non-small cell lung cancer (NSCLC) were studied: 17 pt stage III (2 pt IIIa, 15 IIIb), 5 pt stage IV, 1 pt stage II (post operative relapse). Every patient underwent a weekly endobronchial brachytherapy treatment with a fraction of 300 cGy each session for a complessive total of 1200 cGy calculated at 1 cm. from the iridium-192 treatment source. Results: 18 of the 23 patients studied completed the treatment. In 12 pt a complete regression of the bronchial obstruction was obtained, in 6 patients the effect on bronchial patency was only partial. One month after having completed the endobronchial radiation treatment the patients underwent a further fiberbronchoscopic evaluation which revealed the persistence of complete airways patency in 12 pts, and partial obstruction in 3 cases. In 70% of the patients studied we have found chest x-ray stability at successive radiological controls taken in the following three months. All patients reported a reduction of dyspnea and cough and an almost complete absence of hemoptysis. Conclusions: Endobronchial brachytherapy is effective in palliating symptoms caused by bronchial obstruction and most of the patients can be rendered asymptomatic providing an improved quality of life. The technique is cost effective when compared to laser therapy.