Chest
Volume 97, Issue 3, March 1990, Pages 662-665
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Clinical Investigations
Effect of Endobronchial Radiation Therapy on Malignant Bronchial Obstruction

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We evaluated the effect of endobronchial radiation therapy in 52 patients with malignant airway occlusion. Fifty-five endobronchial applications of the radioisotope iridium 192 were carried out. Response was assessed by change in performance status, symptom resolution, duration of symptom relief, roentgenographic reaeration, pulmonary function tests, and postimplant bronchoscopy. Thirty-three patients showed at least a one-level improvement in performance status. Of a total of 166 symptoms present prior to therapy, 131 resolved or improved. Approximately 70 percent of a patient's lifetime was rendered symptom improved or symptom free. A roentgenographic reaeration response of 30/41 (73 percent) was achieved. The average FEV1 and FVC improved from 1.5 to 2.1 L and from 2.3 to 2.9 L, respectively. Posttherapy bronchoscopy was performed between one and two months following the implant in 15 patients who agreed to undergo the procedure. Eleven (73 percent) of 15 had complete tumor regression. Major long-term complications were noted in seven patients. Endobronchial radiation, therefore, appears to be a safe and effective technique to palliate malignant airway occlusion.

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MATERIALS AND METHODS

Between October 1986 and March 1989, 52 patients underwent 55 endobronchial procedures. The technical and dosimetric details have been published previously.5, 6 Median age at presentation was 67 years with a male to female ratio of 42 to 10. Forty-six patients had primary lung malignant neoplasms and six had nonpulmonary tumors. Twenty-three patients had metastatic disease at implantation. Eleven patients had received prior chemotherapy and 31 had undergone external radiation prior to

RESULTS

Thirty-three patients showed at least a one-level improvement in PS, 17 remained unchanged, and five showed at least a one-level deterioration one month following EBRT (Table 1A). A total of 166 symptoms were present prior to therapy; 131 of these resolved or improved, 20 remained unchanged, and 15 worsened (Table 1C). When measured as an average parameter, approximately 70 percent of a patients lifetime was rendered symptom free or symptom improved (Fig 1). Fourteen patients were

DISCUSSION

Several therapeutic modalities are currently available for malignant airway occlusion. These include external beam radiation,9, 10, 11 laser therapy,12, 13 and endobronchial radiation.14, 15 To our knowledge, no randomized study has evaluated these modalities prospectively. Although laser therapy achieves immediate airway recanalization, the duration of response is unlikely to be long, as considerable endobronchial as well as extrabronchial tumor is likely to be left untreated. A recent study9

ACKNOWLEDGMENTS

The authors wish to thank Susan Higgins for manuscript preparation.

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Manuscript received May 25; revision accepted August 24.

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