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Brachytherapy for Lung Cancer

  • A. Polo
  • M. Castro
  • A. Montero
  • P. Navío
Chapter
Part of the Medical Radiology book series (MEDRAD)

Abstract

Brachytherapy is the direct placement of a radioactive source inside or close to a tumor mass. The use of endobronchial brachytherapy for bronchogenic carcinoma is not new, being the initial use reported back in the early 1920s. Brachytherapy for lung cancer can be done either by implanting the source directly via the upper airway (endoluminal brachytherapy) or by placing the source interstitially during tumor resection (intraoperative interstitial brachytherapy) or using a percutaneous technique (interstitial brachytherapy). Endoluminal high dose rate brachytherapy is largely used for the curative and palliative treatment of endobronchial tumors. Endoluminal brachytherapy can be used to treat patients with respiratory symptoms which are predominantly due to the endobronchial component of their disease. Brachytherapy can obtain palliation with less morbidity than external irradiation. Endoluminal brachytherapy can be used in combination with external beam radiotherapy for dose escalation as a part of a more radical approach. Finally, brachytherapy may be given to patients who require further palliation having relapsed after previous treatments, including high dose external beam irradiation. Interstitial brachytherapy has been described for the treatment of malignant thoracic tumors. Intraoperative permanent radioactive 125-I seed implantation can be used in the treatment of lung cancer when resection margins are close or involved with tumor or for palliation of inoperable disease. Percutaneous implantation of radioactive seeds has also been reported for the management of stage T1N0M0 medically inoperable NSCLC with CT-guided brachytherapy. During the last two decades, technological advances helped the development of brachytherapy and now it is a safe and effective standard procedure in the treatment of lung cancer. 

Keywords

Seed Implantation Interstitial Brachytherapy Sublobar Resection Radioactive Seed Endobronchial Tumor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Aumont-le Guilcher M, Prevost B, Sunyach MP et al (2011) High-dose-rate brachytherapy for non-small-cell lung carcinoma: a retrospective study of 226 patients. Int J Radiat Oncol Biol Phys 79:1112–1116PubMedCrossRefGoogle Scholar
  2. Aygun C, Blum JE (1995) Treatment of unresectable lung cancer with brachytherapy. World J Surg 19:823–827PubMedCrossRefGoogle Scholar
  3. Aygun C, Weiner S, Scariato A, Spearman D, Stark L (1992) Treatment of non-small cell lung cancer with external beam radiotherapy and high dose rate brachytherapy. Int J Radiat Oncol Biol Phys 23:127–132PubMedCrossRefGoogle Scholar
  4. Bedwinek J, Petty A, Bruton C, Sofield J, Lee L (1992) The use of high dose rate endobronchial brachytherapy to palliate symptomatic endobronchial recurrence of previously irradiated bronchogenic carcinoma. Int J Radiat Oncol Biol Phys 22:23–30PubMedCrossRefGoogle Scholar
  5. Birdas TJ, Koehler RP, Colonias A et al (2006) Sublobar resection with brachytherapy versus lobectomy for stage Ib nonsmall cell lung cancer. Ann Thorac Surg 81:434–438 discussion 438–439PubMedCrossRefGoogle Scholar
  6. Brach B, Buhler C, Hayman MH, Joyner LRJ, Liprie SF (1994) Percutaneous computed tomography-guided fine needle brachytherapy of pulmonary malignancies. Chest 106:268–274PubMedCrossRefGoogle Scholar
  7. Cardona AF, Reveiz L, Ospina EG, Ospina V, Yepes A (2008) Palliative endobronchial brachytherapy for non-small cell lung cancer. Cochrane Database Syst Rev. :CD004284PubMedGoogle Scholar
  8. Celebioglu B, Gurkan OU, Erdogan S et al (2002) High dose rate endobronchial brachytherapy effectively palliates symptoms due to inoperable lung cancer. Jpn J Clin Oncol 32:443–448PubMedCrossRefGoogle Scholar
  9. Chen A, Galloway M, Landreneau R et al (1999) Intraoperative 125I brachytherapy for high-risk stage I non-small cell lung carcinoma. Int J Radiat Oncol Biol Phys 44:1057–1063PubMedCrossRefGoogle Scholar
  10. Colonias A, Betler J, Trombetta M et al (2011) Mature follow-up for high-risk stage I non-small-cell lung carcinoma treated with sublobar resection and intraoperative iodine-125 brachytherapy. Int J Radiat Oncol Biol Phys 79:105–109PubMedCrossRefGoogle Scholar
  11. Cotter GW, Lariscy C, Ellingwood KE, Herbert D (1993) Inoperable endobronchial obstructing lung cancer treated with combined endobronchial and external beam irradiation: a dosimetric analysis. Int J Radiat Oncol Biol Phys 27:531–535PubMedCrossRefGoogle Scholar
  12. Delclos ME, Komaki R, Morice RC, Allen PK, Davis M, Garden A (1996) Endobronchial brachytherapy with high-dose-rate remote afterloading for recurrent endobronchial lesions. Radiology 201:279–282PubMedGoogle Scholar
  13. Furuta M, Tsukiyama I, Ohno T et al (1999) Radiation therapy for roentogenographically occult lung cancer by external beam irradiation and endobronchial high dose rate brachytherapy. Lung Cancer 25:183–189PubMedCrossRefGoogle Scholar
  14. Fuwa N, Ito Y, Matsumoto A, Morita K (2000) The treatment results of 40 patients with localized endobronchial cancer with external beam irradiation and intraluminal irradiation using low dose rate (192)Ir thin wires with a new catheter. Radiother Oncol 56:189–195PubMedCrossRefGoogle Scholar
  15. Gaspar LE (1998) Brachytherapy in lung cancer. J Surg Oncol 67:60–70PubMedCrossRefGoogle Scholar
  16. Gauwitz M, Ellerbroek N, Komaki R et al (1992) High dose endobronchial irradiation in recurrent bronchogenic carcinoma. Int J Radiat Oncol Biol Phys 23:397–400PubMedCrossRefGoogle Scholar
  17. Ginsberg RJ, Martini N, Zaman M et al (1994) Influence of surgical resection and brachytherapy in the management of superior sulcus tumor. Ann Thorac Surg 57:1440–1445PubMedCrossRefGoogle Scholar
  18. Gollins SW, Ryder WD, Burt PA, Barber PV, Stout R (1996) Massive haemoptysis death and other morbidity associated with high dose rate intraluminal radiotherapy for carcinoma of the bronchus. Radiother Oncol 39:105–116PubMedCrossRefGoogle Scholar
  19. Heelan RT, Hilaris BS, Anderson LL et al (1987) Lung tumors: percutaneous implantation of I-125 sources with CT treatment planning. Radiology 164:735–740PubMedGoogle Scholar
  20. Hennequin C, Bleichner O, Tredaniel J et al (2007) Long-term results of endobronchial brachytherapy: A curative treatment? Int J Radiat Oncol Biol Phys 67:425–430PubMedCrossRefGoogle Scholar
  21. Henschke UK, Hilaris BS, Mahan GD (1964) Remote afterloading with intracavitary applicators. Radiology 83:344–345PubMedGoogle Scholar
  22. Hilaris BS, Martini N (1979) Interstitial brachytherapy in cancer of the lung: a 20 year experience. Int J Radiat Oncol Biol Phys 5:1951–1956PubMedCrossRefGoogle Scholar
  23. Hilaris BS, Martini N (1988) The current state of intraoperative interstitial brachytherapy in lung cancer. Int J Radiat Oncol Biol Phys 15:1347–1354PubMedCrossRefGoogle Scholar
  24. Hilaris BS, Martini N, Wong GY, Nori D (1987) Treatment of superior sulcus tumor (Pancoast tumor). Surg Clin North Am 67:965–977PubMedGoogle Scholar
  25. Huber RM, Fischer R, Hautmann H et al (1995) Palliative endobronchial brachytherapy for central lung tumors. A prospective, randomized comparison of two fractionation schedules. Chest 107:463–470PubMedCrossRefGoogle Scholar
  26. Huber RM, Fischer R, Hautmann H, Pollinger B, Haussinger K, Wendt T (1997) Does additional brachytherapy improve the effect of external irradiation? A prospective, randomized study in central lung tumors. Int J Radiat Oncol Biol Phys 38:533–540PubMedCrossRefGoogle Scholar
  27. Kelly JF, Delclos ME, Morice RC, Huaringa A, Allen PK, Komaki R (2000) High-dose-rate endobronchial brachytherapy effectively palliates symptoms due to airway tumors: the 10-year M. D. Anderson cancer center experience. Int J Radiat Oncol Biol Phys 48:697–702PubMedCrossRefGoogle Scholar
  28. Kohek PH, Pakisch B, Glanzer H (1994) Intraluminal irradiation in the treatment of malignant airway obstruction. Eur J Surg Oncol 20:674–680PubMedGoogle Scholar
  29. Kubaszewska M, Skowronek J, Chichel A, Kanikowski M (2008) The use of high dose rate endobronchial brachytherapy to palliate symptomatic recurrence of previously irriadiated lung cancer. Neoplasma 55:239–245PubMedGoogle Scholar
  30. Langendijk H, de Jong J, Tjwa M et al (2001) External irradiation versus external irradiation plus endobronchial brachytherapy in inoperable non-small cell lung cancer: a prospective randomized study. Radiother Oncol 58:257–268PubMedCrossRefGoogle Scholar
  31. Lee W, Daly BD, DiPetrillo TA et al (2003) Limited resection for non-small cell lung cancer: observed local control with implantation of I-125 brachytherapy seeds. Ann Thorac Surg 75:237–242 discussion 242-3PubMedCrossRefGoogle Scholar
  32. Lo TC, Beamis JFJ, Weinstein RS et al (1992) Intraluminal low-dose rate brachytherapy for malignant endobronchial obstruction. Radiother Oncol 23:16–20PubMedCrossRefGoogle Scholar
  33. Lo TC, Girshovich L, Healey GA et al (1995) Low dose rate versus high dose rate intraluminal brachytherapy for malignant endobronchial tumors. Radiother Oncol 35:193–197PubMedCrossRefGoogle Scholar
  34. Mallick I, Sharma SC, Behera D (2007) Endobronchial brachytherapy for symptom palliation in non-small cell lung cancer–analysis of symptom response, endoscopic improvement and quality of life. Lung Cancer 55:313–318PubMedCrossRefGoogle Scholar
  35. Marsiglia H, Baldeyrou P, Lartigau E et al (2000) High-dose-rate brachytherapy as sole modality for early-stage endobronchial carcinoma. Int J Radiat Oncol Biol Phys 47:665–672PubMedCrossRefGoogle Scholar
  36. Martinez-Monge R, Pagola M, Vivas I, Lopez-Picazo JM (2008) CT-guided permanent brachytherapy for patients with medically inoperable early-stage non-small cell lung cancer (NSCLC). Lung Cancer 61:209–213PubMedCrossRefGoogle Scholar
  37. McKenna RJJ, Mahtabifard A, Yap J et al (2008) Wedge resection and brachytherapy for lung cancer in patients with poor pulmonary function. Ann Thorac Surg 85:S733–S736PubMedCrossRefGoogle Scholar
  38. Mehta M, Petereit D, Chosy L et al (1992) Sequential comparison of low dose rate and hyperfractionated high dose rate endobronchial radiation for malignant airway occlusion. Int J Radiat Oncol Biol Phys 23:133–139PubMedCrossRefGoogle Scholar
  39. Mendiondo OA, Dillon M, Beach LJ (1983) Endobronchial brachytherapy in the treatment of recurrent bronchogenic carcinoma. Int J Radiat Oncol Biol Phys 9:579–582PubMedCrossRefGoogle Scholar
  40. Moylan D, Strubler K, Unal A, Mohiuddin M, Giampetro A, Boon R (1983) Work in progress. Transbronchial brachytherapy of recurrent bronchogenic carcinoma: a new approach using the flexible fiberoptic bronchoscope. Radiology 147:253–254PubMedGoogle Scholar
  41. Muto P, Ravo V, Panelli G, Liguori G, Fraioli G (2000) High-dose rate brachytherapy of bronchial cancer: treatment optimization using three schemes of therapy. Oncologist 5:209–214PubMedCrossRefGoogle Scholar
  42. Nag S, Kelly JF, Horton JL, Komaki R, Nori D (2001) Brachytherapy for carcinoma of the lung. Oncology (Williston Park) 15:371–381Google Scholar
  43. Nomoto Y, Shouji K, Toyota S et al (1997) High dose rate endobronchial brachytherapy using a new applicator. Radiother Oncol 45:33–37PubMedCrossRefGoogle Scholar
  44. Nori D, Allison R, Kaplan B, Samala E, Osian A, Karbowitz S (1993) High dose-rate intraluminal irradiation in bronchogenic carcinoma. Technique and results. Chest 104:1006–1011PubMedCrossRefGoogle Scholar
  45. Ornadel D, Duchesne G, Wall P, Ng A, Hetzel M (1997) Defining the roles of high dose rate endobronchial brachytherapy and laser resection for recurrent bronchial malignancy. Lung Cancer 16:203–213PubMedCrossRefGoogle Scholar
  46. Ozkok S, Karakoyun-Celik O, Goksel T et al (2008) High dose rate endobronchial brachytherapy in the management of lung cancer: response and toxicity evaluation in 158 patients. Lung Cancer 62:326–333PubMedCrossRefGoogle Scholar
  47. Peiffert D, Spaeth D, Menard O, Winnefeld J (2000) High dose endobronchial brachytherapy: a curative treatment. Cancer Radiother 4:197–201PubMedCrossRefGoogle Scholar
  48. Perol M, Caliandro R, Pommier P et al (1997) Curative irradiation of limited endobronchial carcinomas with high-dose rate brachytherapy. Results of a pilot study. Chest 111:1417–1423PubMedCrossRefGoogle Scholar
  49. Rodrigues G, Videtic GM, Sur R (2011) Palliative thoracic radiotherapy in lung cancer: an American Society for Radiation Oncology evidence-based clinical practice guideline. Pract Radiat Oncol :60–71CrossRefGoogle Scholar
  50. Saito M, Yokoyama A, Kurita Y, Uematsu T, Tsukada H, Yamanoi T (2000) Treatment of roentgenographically occult endobronchial carcinoma with external beam radiotherapy and intraluminal low-dose-rate brachytherapy: second report. Int J Radiat Oncol Biol Phys 47:673–680PubMedCrossRefGoogle Scholar
  51. Santos R, Colonias A, Parda D et al (2003) Comparison between sublobar resection and 125Iodine brachytherapy after sublobar resection in high-risk patients with Stage I non-small-cell lung cancer. Surgery 134:691–697 discussion 697PubMedCrossRefGoogle Scholar
  52. Schraube P, Fritz P, Becker HD, Wannenmacher M (1993) The results of the endoluminal high-dose-rate irradiation of central non-small cell bronchial carcinomas. Strahlenther Onkol 169:228–234PubMedGoogle Scholar
  53. Schray MF, McDougall JC, Martinez A, Edmundson GK, Cortese DA (1985) Management of malignant airway obstruction: clinical and dosimetric considerations using an iridium-192 afterloading technique in conjunction with the neodymium-YAG laser. Int J Radiat Oncol Biol Phys 11:403–409PubMedCrossRefGoogle Scholar
  54. Schray MF, McDougall JC, Martinez A, Cortese DA, Brutinel WM (1988) Management of malignant airway compromise with laser and low dose rate brachytherapy. The Mayo Clinic experience. Chest 93:264–269PubMedCrossRefGoogle Scholar
  55. Seagren SL, Harrell JH, Horn RA (1985) High dose rate intraluminal irradiation in recurrent endobronchial carcinoma. Chest 88:810–814PubMedCrossRefGoogle Scholar
  56. Sider L, Mittal BB, Nemcek AAJ, Bobba VS (1988) CT-guided placement of iodine-125 seeds for unresectable carcinoma of the lung. J Comput Assist Tomogr 12:515–517PubMedGoogle Scholar
  57. Skowronek J, Kubaszewska M, Kanikowski M, Chichel A, Mlynarczyk W (2009) HDR endobronchial brachytherapy (HDRBT) in the management of advanced lung cancer—Comparison of two different dose schedules. Radiother Oncol 93:436–440PubMedCrossRefGoogle Scholar
  58. Speiser BL, Spratling L (1993a) Remote afterloading brachytherapy for the local control of endobronchial carcinoma. Int J Radiat Oncol Biol Phys 25:579–587CrossRefGoogle Scholar
  59. Speiser BL, Spratling L (1993b) Radiation bronchitis and stenosis secondary to high dose rate endobronchial irradiation. Int J Radiat Oncol Biol Phys 25:589–597CrossRefGoogle Scholar
  60. Stewart AJ, Mutyala S, Holloway CL, Colson YL, Devlin PM (2009) Intraoperative seed placement for thoracic malignancy—a review of technique, indications, and published literature. Brachytherapy 8:63–69PubMedCrossRefGoogle Scholar
  61. Stout R, Barber P, Burt P et al (2000) Clinical and quality of life outcomes in the first United Kingdom randomized trial of endobronchial brachytherapy (intraluminal radiotherapy) vs. external beam radiotherapy in the palliative treatment of inoperable non-small cell lung cancer. Radiother Oncol 56:323–327PubMedCrossRefGoogle Scholar
  62. Sutedja G, Baris G, van Zandwijk N, Postmus PE (1994) High-dose rate brachytherapy has a curative potential in patients with intraluminal squamous cell lung cancer. Respiration 61:167–168PubMedCrossRefGoogle Scholar
  63. Taulelle M, Chauvet B, Vincent P et al (1998) High dose rate endobronchial brachytherapy: results and complications in 189 patients. Eur Respir J 11:162–168PubMedCrossRefGoogle Scholar
  64. Tredaniel J, Hennequin C, Zalcman G et al (1994) Prolonged survival after high-dose rate endobronchial radiation for malignant airway obstruction. Chest 105:767–772PubMedCrossRefGoogle Scholar
  65. Ung YC, Yu E, Falkson C et al (2006) The role of high-dose-rate brachytherapy in the palliation of symptoms in patients with non-small-cell lung cancer: a systematic review. Brachytherapy 5:189–202PubMedCrossRefGoogle Scholar
  66. Vergnon JM, Huber RM, Moghissi K (2006) Place of cryotherapy, brachytherapy and photodynamic therapy in therapeutic bronchoscopy of lung cancers. Eur Respir J 28:200–218PubMedCrossRefGoogle Scholar
  67. Voynov G, Heron DE, Lin CJ et al (2005) Intraoperative (125)I Vicryl mesh brachytherapy after sublobar resection for high-risk stage I non-small cell lung cancer. Brachytherapy 4:278–285PubMedCrossRefGoogle Scholar
  68. Yankauer S (1922) Two cases of lung tumor treated bronchoscopically. NY Med J 21:741Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.Department of Radiation Oncology Ramon y Cajal University HospitalMadridSpain
  2. 2.Department of PneumologyRamon y Cajal University HospitalMadridSpain

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