• 5
    May
  • Effect of Endobronchial Radiation Therapy on Malignant Bronchial Obstruction: 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 1С). 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 roentgeno- graphically not assessable because neither pretherapy pulmonary atelectasis nor collapse was present. Of the remaining 41 implants, complete roentgenographic reaeration, as illustrated in Figure 2, was achieved in 18 and partial reaeration in 12, for an overall roent­genographic reaeration rate of 30 of 41 or 73 percent (Table 1B).

Table 1—Response to Endobronchial Radiation

A. Change in

Performance
Status

PS (ECOG)
0

1 2 3

4

Pretherapy
1

9 23 14

8

Posttherapy
8

23 12 6

6

B.
Roentgenographic Response

Reaeration

No.
(%)

Partial

12 (29)

Complete

18 (44)

Overall

30 (73)

C. Change in
Symptoms

No. of Patients

Symptom

Pretherapy

Improved Same

Worse

Cough

52

39 9

4

Dyspnea

51

41 5

5

Pneumonia

23

19 2

2

Hemoptysis

21

17 0

4

Chest pain

19

15 3

1

Total

166

131 19

16

Postimplant pulmonary function studies and bron­choscopy were not performed in all patients principally because of patient reluctance to undergo more pro­cedures in their advanced disease state. In the 14 patients who underwent pulmonary function testing, the average FEV. improved from 1.5 to 2.1 L and the had a complete bronchoscopic response, with no evidence of endobronchial tumor. Of the 52 patients, 13 are currently alive. The median survival of the entire group is five months, with a range of one to 29 months.

Table 2—Complications of Endobronchial Radiation

Type

Interval

XRT, rad

Laser

EBRT (rad)

2

cm
1
cm

1

TEF

3

5500

Y

2400

5800

2

TVF

5

7200

N

2200

4300

3

TVF

6

6000

Y x 4

2000

4400

4

TVF

9

6700

N

2000

5000

5


CMS

10

6400

Y

2000

6000

6


CMS

4

6000

Y x 3

5300

9600

7


CMS

5

6000

N

1600

3900

FIGURE 1. Percentage of lifetime rendered symptom free or improved.

Other than one case of acute local edema resulting in immediate postbronchoscopy lung collapse that reaerated completely within 48 h, no significant acute complications related to catheter placement or EBRT were noted. Seven long-term radiation-associated or radiation-exacerbated complications were encoun­tered. These are summarized in Table 2. One intra­operative death secondary to hemorrhage was directly attributable to laser vaporization as this patient had not even undergone catheter placement for implan­tation. avodart 0.5 mg

FIGURE 2. Pre-implant and postimplant chest roentgenogram showing an example of complete roentgenographic reaeration.

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