- Henri G Colt, MD
Henri G Colt, MD
- Professor of Medicine
- University of California Irvine
Brachytherapy refers to the placement of a radioactive source within or in close proximity to a malignancy in order to provide high doses of radiation in close proximity to the tumor [1,2]. Endobronchial brachytherapy is largely a palliative therapy for the treatment of locally advanced non-small cell lung cancer (NSCLC) involving the airway. However, the need for this technique has declined largely due to the expansion of other effective and less costly bronchoscopic ablative techniques including neodymium-doped yttrium aluminium garnet (Nd:YAG) laser, argon plasma coagulation, electrocautery, and cryotherapy.
The use of endobronchial brachytherapy for the treatment of NSCLC will be reviewed here. Other interventional treatment modalities, such as airway stents, bronchoscopic laser resection, endobronchial electrocautery, cryotherapy, and argon plasma coagulation are discussed separately. (See "Airway stents" and "Bronchoscopic laser in the management of airway disease in adults" and "Endobronchial electrocautery" and "Bronchoscopic cryotechniques in adults" and "Bronchoscopic argon plasma coagulation in the management of airway disease in adults".)
The major goal of endobronchial brachytherapy (EBBT) is a reduction in tumor size so that airway symptoms can be relieved. For patients suitable for EBBT (see 'Patient selection' below), a flexible bronchoscope is typically used to place a radioactive source (usually Iridium-192) within or in close proximity to the target endobronchial lesion (usually malignancy) [3-7]. Compared with external beam radiation therapy (EBRT), local radiation is provided to the lesion with the intent of sparing the tissues in the pathway of external beam.
Bronchoscopy — While in the past, rigid bronchoscopy was used , flexible bronchoscopy is the typical modality of choice for EBBT. Using a flexible bronchoscope, a polyethylene catheter with a radiopaque wire is passed transnasally (through a side port or alongside the bronchoscope) and placed in the desired position within the airway under direct visualization. The catheter position is verified fluoroscopically. The bronchoscope is removed and the catheter is secured to the nose of the patient. Additional reverification of the position with a plain chest radiograph can be performed, if necessary, before removing the dummy and loading the catheter with a radioactive source (“afterloading”). Afterloading is usually performed with a remote afterloading device, but can be performed manually if needed.
Occasionally the catheter containing the radioactive seed is not centered inside the airway and lies directly adjacent to the airway wall. In such cases, the bronchoscopist can use centering devices such as balloons, cages, or sheaths, to maintain the radioactive source within the center of the bronchial lumen and avoid dose inhomogeneity .
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- Radiation type
- PATIENT SELECTION
- Palliation of central obstructing airway tumors
- - Patient and tumor characteristics
- - Efficacy
- - Recurrent or metastatic airway tumors
- - Airway tumors without extrabronchial spread
- - Benign airway stenosis
- SUMMARY AND RECOMMENDATIONS