Irradiated volume and the risk of fatal hemoptysis in patients submitted to high dose-rate endobronchial brachytherapy

Carvalho, Heloísa de Andrade; Gonçalves, S.; Pedreira, Wilson Leite; Gregório, Marcelo Gervilla; Castro, Isac de; Aisen, Salim

doi:10.1016/j.lungcan.2006.10.015

Cited by 16 publications

(9 citation statements)

References 33 publications

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“…Fatal hemoptysis, ulcer, necrosis, or stenosis of the bronchi have been reported as late severe respiratory complications related with EBBT [ 10 , 11 , 12 ]. Direct contact of EBBT applicator to the tracheobronchial wall [ 10 ] or large V100 [ 12 ] was reported to be a risk factor of massive hemoptysis in EBBT.…”

Section: Discussionmentioning

confidence: 99%

“…Endobronchial brachytherapy (EBBT) is an established treatment method for patients with tumors of the tracheobronchial system either as a palliative [ 1 , 2 , 3 , 4 , 5 ] or a definitive treatment [ 6 , 7 , 8 , 9 ]. Fatal hemoptysis, ulcer, necrosis, or stenosis of the bronchi have been reported as late severe respiratory complications related with EBBT [ 10 , 11 , 12 ]. However, little is known about the tolerance of dose for organ at risk (OAR) in EBBT presumably because EBBT is mainly applied as palliative intent and it is difficult to distinguish between treatment-related toxicities or symptoms caused by tumor progression, and most patients die of present disease before late complications develop.…”

Section: Purposementioning

confidence: 99%

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A total EQD 2 greater than 85 Gy for trachea and main bronchus D 2cc being associated with severe late complications after definitive endobronchial brachytherapy

Murakami¹,

Kobayashi²,

Nakamura³

et al. 2015

jcb

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PurposeThe endobronchial brachytherapy (EBBT) is an established treatment method for tumors of the tracheobronchial system, however, little is known about the tolerance dose for organ at risk (OAR) in EBBT. The purpose of this study is to analyze patients with superficial bronchial carcinoma treated with definitive EBBT, and to investigate a relationship between late complications and dose for OAR.Material and methodsEndobronchial brachytherapy was performed 6 Gy per fraction for three to four fractions with or without external beam radiation therapy (EBRT). For the purpose of dosimetric analysis, the wall of the lower respiratory tract (LRT: trachea, main bronchus, and lobar bronchiole), trachea, and main bronchus (TMB) was extracted. D0.5cc, D1cc, and D2cc of LRT and TMB were calculated in each EBBT session and added together. V100, V150, and V200 of LRT were also calculated.ResultsBetween March 2008 and April 2014, EBBT was performed in 14 patients for curative intent. The 2-year overall survival (OS), progression-free survival (PFS), and local recurrence free survival (LRFS) was 82.1%, 77.9%, and 91.7%, respectively. There was one patient with grade 5, one grade 4, and three grade 3 obstruction of trachea or bronchus. The mean EQD2 of LRT D2cc, TMB D2cc, D1cc, and D0.5cc of patients with or without late severe respiratory complications was significantly different between two groups (p = 0.018, 0.008, 0.009, and 0.013, respectively). The 2-year incidence rates of late severe complications in patients with TMB D2cc ≤ 85 Gy in EQD2 and > 85 Gy were 0% and 83.3%, respectively with a statistically significance (p = 0.014).ConclusionsIt was discovered that TMB D2cc > 85 Gy in EQD2 is a strong risk factor for severe late respiratory complication after EBBT.

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Section: Discussionmentioning

confidence: 99%

Section: Purposementioning

confidence: 99%

A total EQD 2 greater than 85 Gy for trachea and main bronchus D 2cc being associated with severe late complications after definitive endobronchial brachytherapy

Murakami¹,

Kobayashi²,

Nakamura³

et al. 2015

jcb

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“…The treatment volume can be, among others, a risk factor for complications (6) . A general conclusion in the present study is that smaller implants present a more "concentrated" dose distribution, given the characteristics of brachytherapy.…”

Section: Discussionmentioning

confidence: 99%

Braquiterapia endobrônquica de alta taxa de dose: estudo dosimétrico

Lopes¹,

Rodrigues²,

Carvalho

2010

Radiol Bras

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OBJECTIVE: To evaluate the dose distribution in different situations of high dose-rate endobronchial brachytherapy, focusing especially on high-dose volumes, and try to identify better or worse situations in terms of dose distribution to aid as guidance in the clinical practice. MATERIALS AND METHODS: Theoretical study simulating high dose-rate endobronchial brachytherapy utilizing two catheters, varying the loading extent, angle between the catheters, prescription depth, and source step. With a prescription dose of 7.5 Gy, the volumes involved by the 100%, 150% and 200% isodoses (V100, V150 and V200, respectively) and V150/V100 and V200/V100 ratios were calculated. RESULTS: There was a volume enhancement with larger loaded lengths, increase in prescription depth and angles, with a tendency towards a proportionally smaller increase with larger angulations. In general, the V150/V100 and V200/V100 ratios were homogeneous, respectively around 0.50 and 0.30. CONCLUSION: Overall, the dose distribution in the standard situation was appropriate. No specific parameter that could be related to a higher toxicity was identified. The authors recommend a swift evaluation of the treatment quality through the analysis of the V150/V100 and V200/ V100 ratios. Keywords: Radiotherapy; Endobronchial brachytherapy; Dosimetry.OBJETIVO: Avaliar a distribuição de dose em diferentes situações de braquiterapia endobrônquica de alta taxa de dose, com foco principalmente nos volumes de altas doses, e tentar definir situações de melhor ou pior distribuição de dose que possam servir de guia na prática clínica. MATERIAIS E MÉTODOS: Estudo teórico, simulando braquiterapia endobrônquica de alta taxa de dose utilizando dois cateteres, com variação da extensão de carregamento, angulação entre os cateteres, profundidade de cálculo e o intervalo entre as paradas da fonte. Com prescrição de 7,5 Gy, foram calculados os volumes englobados pelas isodoses correspondentes a 100%, 150% e 200% da dose prescrita (V100, V150 e V200, respectivamente) e as razões V150/V100 e V200/V100. RESULTADOS: Os volumes aumentaram com o aumento da extensão de carregamento dos cateteres, profundidade de cálculo e angulação, com tendência a um aumento proporcionalmente menor para angulações maiores. As relações V150/V100 e V200/V100 foram, em geral, homogêneas, ao redor de 0,50 e 0,30, respectivamente. CONCLUSÃO: A distribuição de dose na situação considerada padrão é em geral adequada. Nenhum parâmetro específico que pudesse ser relacionado à maior toxicidade foi identificado. Recomendamos uma avaliação rápida da qualidade do implante por meio da análise das relações V150/V100 e V200/V100. Unitermos: Radioterapia; Braquiterapia endobrônquica; Dosimetria. most appropriate possible dose distribution. However, in spite of the fact that the calculations do consider three dimensions, in most of times the planning is based on orthogonal or semi-orthogonal plain radiographs, without radiological image of the lesion and respective anatomical correlations.In endobronchial brachythe...

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“…When 15 Gy HDR-EB was applied alone, the observed incidence of FH was 6% however, when 30 Gy ERT was given concurrently with 15 Gy HDR-EB, the incidence increased to 18%. Other reported risk factors for FH are volume of disease, irradiated volume length, fraction size of brachytherapy and previous laser resections [3,12,19,22,23,25,26]. In addition, case selection of patients included in the study and the duration of follow-up can also influence the frequency of fatal hemoptysis.…”

Section: Toxicitymentioning

confidence: 99%

“…The treatment time is short and patients can realize symptomatic relief sometimes after the first application of HDR-EB. There are, however, potential complications with this modality, the most serious of which is fatal hemoptysis (FH) [3,12,19,22,23,25,26]. The main cause of FH due to HDR-EB is the direct contact between the HDR applicator and bronchial wall, which produces a high dose that is most problematic in the vicinity of great vessels.…”

Section: Introductionmentioning

confidence: 99%

High dose rate endobronchial brachytherapy in the management of lung cancer: Response and toxicity evaluation in 158 patients

et al. 2008

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Irradiated volume and the risk of fatal hemoptysis in patients submitted to high dose-rate endobronchial brachytherapy

Cited by 16 publications

References 33 publications

A total EQD 2 greater than 85 Gy for trachea and main bronchus D 2cc being associated with severe late complications after definitive endobronchial brachytherapy

A total EQD 2 greater than 85 Gy for trachea and main bronchus D 2cc being associated with severe late complications after definitive endobronchial brachytherapy

Braquiterapia endobrônquica de alta taxa de dose: estudo dosimétrico

High dose rate endobronchial brachytherapy in the management of lung cancer: Response and toxicity evaluation in 158 patients

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