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E. Allan
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P3.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 214)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.03-028 - High Dose Rate (HDR) Dual Intraluminal Brachytherapy Catheter in Treatment of Bilateral Endobronchial Tumor Progression: A Case Report (ID 1517)
09:30 - 09:30 | Author(s): E. Allan
- Abstract
Background:
While radiation therapy is used for locoregional disease with a curative intent, the use of brachytherapy is one method of delivering a higher radiation dose to endobronchial tumor while sparing the surrounding normal tissues. Although commonly done with a single catheter we report on the simultaneous use of dual HDR-intraluminal brachytherapy catheters
Methods:
CASE PRESENTATION: We report a case of a 71-year-old gentleman with history of squamous cell carcinoma of left lung, status post left upper lobe resection in March, 2012. He developed biopsy proven,left mainstem recurrence in April, 2014 which was treated with concurrent chemoradiation (63 Gy/ 35 tx). In January, 2015, he was referred to interventional pulmonary clinic for bronchoscopy revealing extension of tumor involving carina and proximal 2 cm of both left and right mainstem bronchi (Fig.1) Biopsy demonstrated squamous cell carcinoma. He underwent rigid bronchoscopy with tumor debulking using Nd:YAG laser. He was than referred to radiation oncology for HDR-brachytherapy. Since both main stem bronchi were involved a decision was made to place two catheter to radiate both sides simultaneously. The patient was intubated with an 8.0 endotracheal tube and two brachytherapy catheters were placed into the left and right mainstem bronchus respectively under general anesthesia (Fig.2). The length and patency of the catheters were manually checked. The guidewire was removed from the catheters and replaced with the dummy source cables (Fig.3). A dose plan was then created to irradiate the proximal 5 cm of both the right and left mainstem bronchi and carina with a dose of 750cGy prescribed at 1 cm from the source. The computer was programmed to irradiate the above area (Fig.4). The catheters were connected to the high dose rate afterloader. A dose of 750 cGy at 1 cm from the source was delivered over actual time 466.2 seconds with the high activity (4.33 Ci) Ir-192 source (nominal treatment time = 201.6 seconds). Two additional weekly treatments of 750 cGy to the above area is planned.
Results:
DISCUSSION: Central airway obstruction worsens the quality of life in lung cancer patients. When surgical resection is not plausible, HDR-brachytherapy is effective in palliating dyspnea. Hennequin C, et al treated 106 patients with endobronchial lung cancer with HDR-bachytherapy which consisted of six fractions of 5 or 7 Gy, who were not eligible for surgery or external beam radiotherapy, and had relapse after surgery or external beam radiotherapy or respiratory insufficiency. The histologic response rate, evaluated at 3 months after HDR-brachytherapy, was 59.4% [1]. In our patient, given the bilaterality of tumor progression, routine HDR-intraluminal brachytherapy would have required our patient to undergo unilateral treatment separately in multiple sessions and may have resulted in overlap of the brachytherapy isodoses. By planning the bilateral HDR-intraluminal brachytherapy catheters simultaneous, the risk of future overlap is avoided, and the overall treatment interval is reduced in half
Conclusion:
CONCLUSION: Here we demonstrate the concomitant use of two intraluminal brachytherapy catheters placed in separate bronchi decreased the overall treatment interval. Future studies need to be conducted to evaluate efficacy.
