New technique for treating occlusive and stenosing tumours of the trachea and main bronchi: endobronchial irradiation by high dose iridium-192 combined with laser canalisation.

Abstract

A new technique is described for treating patients with inoperable malignant tumours causing occlusion or stenosis of the trachea or main bronchi. High dose iridium-192 (20 Ci) was introduced by an afterloading device under computer control via a 4mm delivery tube into the tumour mass. In 29 of the 56 patients the tumour mass was canalised by a neodymium-YAG laser immediately before the afterloading delivery tube was introduced. In 44 (79%) of the patients, there was impressive relief of dyspnoea, accompanied by tumour regression observed at endoscopy and also by highly significant improvement in ventilatory function values, lung perfusion scans, and levels of arterial oxygen tension. In the other 12 patients (21%) there was no detectable improvement. The findings suggest that this recently developed combination treatment is of value in patients with advanced tumours of the trachea and main bronchi in whom there is no possibility of further treatment by external irradiation or repeated laser coagulation.

Nd-YAG Laser under Local Anaesthesia in Obstructive Endobronchial Tumours

“…Brachythcrapy, photodynamic therapy, the use of rig id bronchoscope and biopsy forceps to remove tu mour tissue, cryotherapy and endobronchial stents have been reported to be feasible and effective [7][8][9][10][11]. However, in most cases, these techniques were used for palliation.…”

High-Dose Rate Brachytherapy of Bronchial Cancer: Treatment Optimization Using Three Schemes of Therapy

“…Palliation of endoluminal obstruction is the main application of HDRBT [5,13,16,20]. The symptomatic relief (of cough, breathlessness, hemoptysis) is generally rapid [4,8,18,21] and a favorable impact on survival time has sometimes been observed [5,20,22,23].…”

“…Endobronchial BT has been used since the introduction of the after-loading technique and the advances in RT technology [16]; thus it is now generally performed as HDRBT. It has been used in some cases as primary treatment for cure of small endobronchial tumors [17], a boost to complete a course of external RT [8], or as palliative therapy in patients with recurrent tumors treated with EBRT and/or chemotherapy [12,13,18,19].…”

Malignant tumors of the trachea

“…Adequate dose delivery requires at least CT-based planning and three dimensional conformal treatment techniques with position verification. Another approach is to deliver the boost dose through intraluminal brachytherapy 71,73,[75][76][77][78][79] To this end, the use of a special applicator which secures central positioning of the source within the tracheal lumen is mandatory. Central positioning of the brachytherapy catheter in the lumen enables a homogeneous dose distribution and prevents high contact doses delivered to the tracheal mucosa.…”