Strahlentherapie und Onkologie

, Volume 188, Issue 12, pp 1085–1090 | Cite as

HDR brachytherapy: an option for preventing nonmalignant obstruction in patients after lung transplantation

  • A. Meyer
  • A. Warszawski-Baumann
  • R. Baumann
  • J.H. Karstens
  • H. Christiansen
  • J. Gottlieb
  • T. Welte
Original article

Abstract

Purpose

Interventional bronchoscopy is the main treatment modality in managing benign airway obstructions following lung transplantation. We analyzed the effect of intraluminal brachytherapy on preventing recurrence of hyperplastic tissue.

Patients and methods

From September 2002 to September 2004, a total of 24 intraluminal brachytherapy applications were carried out on 12 lung transplant patients in 15 different locations. A single dose of 3 Gy was calculated at a 5-mm distance from the catheter surface; the target volume included a stenosis plus safety interval of 0.5–1.0 cm.

Results

All patients had a mean 10.6 local interventions (Argon plasma coagulation, balloon dilatations, stenting) over 4.4 months before the first application of endobronchial brachytherapy, with a mean amount of 2.4 applications per month. The mean forced expiratory volume in 1 s (FEV1) was 2,219 ml in the 3 months before application of brachytherapy. After endobronchial brachytherapy, all patients experienced improvement in clinical status and respiratory function. The mean level of FEV1 in the 3 months after application was 2,435 ml (p = 0.02), and the number of invasive interventions dropped to a mean rate of 5.2 interventions in the 5.1 months after the first intervention, with an amount of 1 application per month. No treatment-related complications were seen. Four patients were treated twice, 1 patient three times, and 1 patient four times at the same localization.

Conclusions

Recurrent symptomatic benign airway obstruction from hyperplastic tissue in the bronchus after lung transplantation can be successfully treated with intraluminal high-dose-rate brachytherapy with a dose of 3 Gy at a 5-mm distance from the catheter surface and a longitudinal safety margin of 1 cm.

Keywords

Benign bronchial obstruction Complications High-dose-rate brachytherapy Hyperplastic tissue Lung transplantation 

HDR-Brachytherapie: eine Option zur Verhinderung benigner Stenosen bei Patienten nach Lungentransplantation

Zusammenfassung

Hintergrund

Die interventionelle Bronchoskopie ist die Standardtherapie bei benignen Stenosen des Bronchus, die durch hyperplastisches Gewebe nach Transplantation einer Lunge verursacht werden. Wir berichten über den Effekt einer intraluminalen Brachytherapie zur Prävention dieser Stenosen.

Material und Methode

Von 9/2002 bis 9/2004 wurden insgesamt 24 intraluminale Applikationen mittels Brachytherapie bei 12 Patienten nach Lungentransplantation an 15 verschiedenen Lokalisationen durchgeführt. Vier Patienten wurden an derselben Lokalisationen 2-mal, ein Patient 3-mal und ein Patient 4-mal behandelt. Die Applikation erfolgte mit einer Einzeldosis von 3 Gy in 5 mm Tiefe, bezogen auf die Katheteroberfläche, das Zielvolumen beinhaltete die Stenose mit einem Sicherheitssaum von 0,5–1,0 cm in longitudinaler Richtung.

Ergebnisse

In einem Zeitraum von 4,4 Monaten vor der ersten Applikation hatten alle Patienten eine durchschnittliche Anzahl von 10,6 endoskopischen Interventionen wie z. B. Argon-Plasma-Koagulation, Ballondilatation oder Stentanlage, was einer durchschnittlichen Anzahl von 2,4/Monat entspricht. Das mittlere forcierte expiratorische Volumen in 1 s (FEV1) betrug 2219 ml in den 3 Monaten vor der Bestrahlung. Nach der Applikation wiesen alle Patienten eine Verbesserung der respiratorischen Funktion mit einem mittleren FEV1-Wert in den folgenden 3 Monaten von 2435 ml auf (p = 0,02). Die notwendige Anzahl endoskopischer lokaler Interventionen fiel auf 1/Monat. Bei den Patienten wurden keine radiogenen Nebenwirkungen beobachtet.

Schlussfolgerung

Wiederkehrende symptomatische Stenosen des Bronchus durch hyperplastisches Gewebe bei Patienten mit einer Lungentransplantation können erfolgreich mit einer intraluminalen High-Dose-Rate(HDR)-Brachytherapie behandelt werden.

Schlüsselwörter

Benigne bronchiale Obstruktion Nebenwirkungen High-Dose-Rate-Brachytherapie Hyperplastisches Gewebe Lungentransplantation 

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Copyright information

© Urban & Vogel 2012

Authors and Affiliations

  • A. Meyer
    • 1
  • A. Warszawski-Baumann
    • 1
    • 3
  • R. Baumann
    • 1
    • 3
  • J.H. Karstens
    • 1
  • H. Christiansen
    • 1
  • J. Gottlieb
    • 2
  • T. Welte
    • 2
  1. 1.Department of Radiation OncologyMedical School HannoverHannoverGermany
  2. 2.Department of Respiratory MedicineMedical School HannoverHannoverGermany
  3. 3.Medical Practice for Radiotherapy and Radiation OncologyHannoverGermany

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