Endobronchial brachytherapy for NSCLC

[tnmynatt]

My FIL saw a local story on this in Ft. Myers, FL this evening. They add high dose radiation given directly to the tumor site after regular external radiation. This is a study done on patients that were medically inoperable (they didn't qualify for surgery due to pulmonary function insufficiency, etc.) that showed much better results by adding this internal radiation.

http://rtsx.client.shareholder.com/down ... nchial.pdf

Brachytherapy 3 (2004) 183–190

Endobronchial brachytherapy and optimization of local

disease control in medically inoperable non-small cell

lung carcinoma: A matched-pair analysis

Constantine A. Mantz1,*, Daniel E. Dosoretz1, James H. Rubenstein1, Peter H. Blitzer1,

Michael J. Katin1, Graciela R. Garton1, Bruce M. Nakfoor1, Alan D. Siegel2,

Kenneth A. Tolep2, Stephen E. Hannan2, Razak Dosani3, Abusayeed Feroz3, Carlos Maas4,

Saligrama Bhat4, George Panjikaran, Sunil Lalla4, Komal Belani4, Rudolf H. Ross1

121st Century Oncology, Fort Myers, FL

2Associates in Pulmonary Medicine, Port Charlotte, FL

3Pulmonary Associates, Naples, FL

4Solo practice, Sarasota, FL

ABSTRACT PURPOSE: External beam radiation therapy (EBRT) alone for early stage, medically inoperable nonsmall

cell lung cancer (MILC) can produce local disease control and sometimes cure. We have

previously reported that higher EBRT doses result in improved disease control and, for patients

with tumors 3.0 cm, improved survival. This report describes the impact of dose escalation with

endobronchial brachytherapy boost during or following EBRT upon local disease control.

METHODS AND MATERIALS: Medical records of 404 patients with MILC treated with

radiotherapy alone were reviewed. Thirty-nine patients received a planned endobronchial

brachytherapy boost during or following a course of EBRT. A matched-pair analysis of disease

control and survival was performed by matching each brachytherapy patient to 2 EBRT patients

from a reference group of the remaining patients.

RESULTS: Endobronchial brachytherapy boost significantly improved local disease control over

EBRT alone (58% vs. 32% at 5 years). The local control benefit for brachytherapy was found to

be limited to patients with T1–2 disease or tumors 5.0 cm. Among these patients treated with

endobronchial boost, EBRT doses of 6500 cGy were necessary to optimize local disease control.

No overall survival differences were observed at 3 years. Excess toxicity with brachytherapy was

not observed.

CONCLUSION: Endobronchial brachytherapy boost enhances local disease control rates in MILC

treated with EBRT. Local control outcome is optimized when radical EBRT doses are used in

conjunction with brachytherapy. 2004 American Brachytherapy Society. All rights reserved.

Keywords: Medically inoperable lung cancer; Endobronchial brachytherapy

Introduction

External beam radiotherapy (EBRT) alone for technically

resectable but medically inoperable non-small cell lung

cancer (MILC) achieves long-term local disease control for

Received 27 July 2004; received in revised form 10 September 2004;

accepted 14 September 2004.

* Corresponding author. 21st Century Oncology, 3680 Broadway, Fort

Myers, FL 33901. Tel.: 1-239-936-0380; fax: 1-239-936-6684.

E-mail address: cmanz@rtsx.com (C.A. Mantz).

1538-4721/04/$ – see front matter 2004 American Brachytherapy Society. All rights reserved.

doi:10.1016/j.brachy.2004.09.005

30–60% of treated patients (1–7). Among patients with disease

less than 3.0 cm, control of the primary tumor signifi-

cantly reduces the risk for distant metastasis and improves

overall survival. Higher radiation doses, specifically 6500

cGy and greater, have been found to improve local control

rates over lesser doses with subsequent improvements in

distant disease control and survival (8–10).

Despite the use of radical radiation doses, local failure

is still a predominant pattern of failure in this disease

(2, 4, 6). To improve upon local disease control with

radiotherapy, we have employed conformal techniques,

hyperfractionation, and endobronchial brachytherapy