UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

支气管内近距离治疗

Author
Henri G Colt, MD
Section Editor
Praveen N Mathur, MB;BS
Deputy Editor
Geraldine Finlay, MD
Translators
惠周光, 主任医师

引言

近距离治疗是指将放射源置于恶性肿瘤内或紧邻恶性肿瘤，使紧邻肿瘤区域获得高剂量照射[1,2]。支气管内近距离治疗(endobronchial brachytherapy, EBBT)是一种治疗累及气道的局部晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)的治疗方法，很大程度上为姑息性治疗。然而，现在对于这一技术的需求已下降，主要原因是其他有效且成本较低的支气管镜下消融技术的推广，如掺钕钇铝石榴石(neodymium-doped yttrium aluminium garnet, Nd:YAG)激光、氩离子束凝固术(又称氩气刀)、电烙术和冷冻疗法。

本文将总结EBBT用于治疗NSCLC的内容。其他干预治疗方法，如气道支架、支气管镜下激光切除、支气管内电烙术、冷冻疗法和氩气刀，将单独讨论。 (参见“气道支架”和“支气管镜激光在成人气道疾病治疗中的应用”和“支气管内电烙术”和“成人支气管镜冷冻技术”和“支气管镜下氩气刀在成人气道疾病处理中的应用”)

技术

EBBT的主要目标是缩小肿瘤，从而缓解气道症状。对于适合进行EBBT的患者(参见下文‘患者选择’)，通常使用可屈性支气管镜将放射源(通常为铱-192)置于支气管内靶病灶(通常为恶性肿瘤)内或紧邻病灶处[3-7]。相较于外照射(external beam radiation therapy, EBRT)，EBBT对病灶提供局部照射，目的在于不照射外照射线束路径的组织。

支气管镜 — 尽管过去使用的是硬管支气管镜[8]，但现在可屈性支气管镜是EBBT的首选典型方式。使用可屈性支气管镜，将一个有不透射线金属丝的聚乙烯导管在直视下经鼻穿入(通过一个侧孔或沿着支气管镜)并置于气道内的靶位置。随后，通过透视确认导管位置。完成确认后，取出支气管镜，并将导管固定于患者鼻部。必要时，可在移除导管内的导丝并在导管中放置放射源(“后装”)之前，行胸部平片再次确认位置。后装技术通常通过遥控后装装置实现，但需要时也可手动实施。

偶尔，带有放射源的导管所放的位置不是在气道正中，而是紧邻气道壁。此时，支气管镜医师可使用定心装置(如球囊、笼子或鞘)将放射源保持于支气管腔中央，避免剂量分布不均[7]。

              

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-07 . | This topic last updated: 2015-08-04.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Hilaris BS, Mastoras DA. Contemporary brachytherapy approaches in non-small-cell lung cancer. J Surg Oncol 1998; 69:258.
  2. Raben A, Mychalczak B. Brachytherapy for non-small cell lung cancer and selected neoplasms of the chest. Chest 1997; 112:276S.
  3. Mendiondo OA, Dillon M, Beach LJ. Endobronchial brachytherapy in the treatment of recurrent bronchogenic carcinoma. Int J Radiat Oncol Biol Phys 1983; 9:579.
  4. Schray MF, McDougall JC, Martinez A, et al. Management of malignant airway obstruction: clinical and dosimetric considerations using an iridium-192 afterloading technique in conjunction with the neodymium-YAG laser. Int J Radiat Oncol Biol Phys 1985; 11:403.
  5. Schray MF, McDougall JC, Martinez A, et al. Management of malignant airway compromise with laser and low dose rate brachytherapy. The Mayo Clinic experience. Chest 1988; 93:264.
  6. Seagren SL, Harrell JH, Horn RA. High dose rate intraluminal irradiation in recurrent endobronchial carcinoma. Chest 1985; 88:810.
  7. Nag S, Kelly JF, Horton JL, et al. Brachytherapy for carcinoma of the lung. Oncology (Williston Park) 2001; 15:371.
  8. Nori D, Hilaris BS, Martini N. Intraluminal irradiation in bronchogenic carcinoma. Surg Clin North Am 1987; 67:1093.
  9. Villanueva AG, Lo TC, Beamis JF Jr. Endobronchial brachytherapy. Clin Chest Med 1995; 16:445.
  10. Shaw, EG, McDougall, JC. Bronchoscopic brachytherapy. In: Bronchoscopy, Prakash, UBS (Eds), Raven Press, New York 1994. p.293-300.
  11. Simoff MJ, Lally B, Slade MG, et al. Symptom management in patients with lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e455S.
  12. Reveiz L, Rueda J-R, Cardona AF. Palliative endobronchial brachytherapy for non-small cell lung cancer. Cochrane Database Syst Rev 2012; :CD004284.
  13. Goldberg M, Timotin E, Farrell T, et al. A prospective analysis of high-dose-rate endobronchial brachytherapy in the palliation of obstructive symptoms in lung cancer patients: A single-institution experience. Brachytherapy 2015; 14:655.
  14. Allen MD, Baldwin JC, Fish VJ, et al. Combined laser therapy and endobronchial radiotherapy for unresectable lung carcinoma with bronchial obstruction. Am J Surg 1985; 150:71.
  15. Ofiara L, Roman T, Schwartzman K, Levy RD. Local determinants of response to endobronchial high-dose rate brachytherapy in bronchogenic carcinoma. Chest 1997; 112:946.
  16. Kelly JF, Delclos ME, Morice RC, et al. High-dose-rate endobronchial brachytherapy effectively palliates symptoms due to airway tumors: the 10-year M. D. Anderson cancer center experience. Int J Radiat Oncol Biol Phys 2000; 48:697.
  17. Taulelle M, Chauvet B, Vincent P, et al. High dose rate endobronchial brachytherapy: results and complications in 189 patients. Eur Respir J 1998; 11:162.
  18. Guarnaschelli JN, Jose BO. Palliative high-dose-rate endobronchial brachytherapy for recurrent carcinoma: the University of Louisville experience. J Palliat Med 2010; 13:981.
  19. Ozkok S, Karakoyun-Celik O, Goksel T, et al. High dose rate endobronchial brachytherapy in the management of lung cancer: response and toxicity evaluation in 158 patients. Lung Cancer 2008; 62:326.
  20. Saito M, Yokoyama A, Kurita Y, et al. Treatment of roentogenographically occult endobronchial carcinoma with external beam radiotherapy and intraluminal low dose rate brachytherapy. Int J Radiat Oncol Biol Phys 1996; 34:1029.
  21. Yokomise H, Nishimura Y, Fukuse T, et al. Long-term remission after brachytherapy with external irradiation for locally advanced lung cancer. Respiration 1998; 65:489.
  22. Hernandez P, Gursahaney A, Roman T, et al. High dose rate brachytherapy for the local control of endobronchial carcinoma following external irradiation. Thorax 1996; 51:354.
  23. Saito M, Yokoyama A, Kurita Y, et al. Treatment of roentgenographically occult endobronchial carcinoma with external beam radiotherapy and intraluminal low-dose-rate brachytherapy: second report. Int J Radiat Oncol Biol Phys 2000; 47:673.
  24. Huber RM, Fischer R, Hautmann H, et al. Does additional brachytherapy improve the effect of external irradiation? A prospective, randomized study in central lung tumors. Int J Radiat Oncol Biol Phys 1997; 38:533.
  25. Langendijk H, de Jong J, Tjwa M, et al. External irradiation versus external irradiation plus endobronchial brachytherapy in inoperable non-small cell lung cancer: a prospective randomized study. Radiother Oncol 2001; 58:257.
  26. Stout R, Barber P, Burt P, et al. Clinical and quality of life outcomes in the first United Kingdom randomized trial of endobronchial brachytherapy (intraluminal radiotherapy) vs. external beam radiotherapy in the palliative treatment of inoperable non-small cell lung cancer. Radiother Oncol 2000; 56:323.
  27. Speiser B, Spratling L. Intermediate dose rate remote afterloading brachytherapy for intraluminal control of bronchogenic carcinoma. Int J Radiat Oncol Biol Phys 1990; 18:1443.
  28. Shea JM, Allen RP, Tharratt RS, et al. Survival of patients undergoing Nd:YAG laser therapy compared with Nd:YAG laser therapy and brachytherapy for malignant airway disease. Chest 1993; 103:1028.
  29. de Aquino Gorayeb MM, Gregório MG, de Oliveira EQ, et al. High-dose-rate brachytherapy in symptom palliation due to malignant endobronchial obstruction: a quantitative assessment. Brachytherapy 2013; 12:471.
  30. Burt PA, O'Driscoll BR, Notley HM, et al. Intraluminal irradiation for the palliation of lung cancer with the high dose rate micro-Selectron. Thorax 1990; 45:765.
  31. Speiser BL, Spratling L. Remote afterloading brachytherapy for the local control of endobronchial carcinoma. Int J Radiat Oncol Biol Phys 1993; 25:579.
  32. Chang LF, Horvath J, Peyton W, Ling SS. High dose rate afterloading intraluminal brachytherapy in malignant airway obstruction of lung cancer. Int J Radiat Oncol Biol Phys 1994; 28:589.
  33. Gollins SW, Burt PA, Barber PV, Stout R. High dose rate intraluminal radiotherapy for carcinoma of the bronchus: outcome of treatment of 406 patients. Radiother Oncol 1994; 33:31.
  34. Pisch J, Villamena PC, Harvey JC, et al. High dose-rate endobronchial irradiation in malignant airway obstruction. Chest 1993; 104:721.
  35. Nori D, Allison R, Kaplan B, et al. High dose-rate intraluminal irradiation in bronchogenic carcinoma. Technique and results. Chest 1993; 104:1006.
  36. d'Amato TA, Galloway M, Szydlowski G, et al. Intraoperative brachytherapy following thoracoscopic wedge resection of stage I lung cancer. Chest 1998; 114:1112.
  37. Skowronek J, Piorunek T, Kanikowski M, et al. Definitive high-dose-rate endobronchial brachytherapy of bronchial stump for lung cancer after surgery. Brachytherapy 2013; 12:560.
  38. Marsiglia H, Baldeyrou P, Lartigau E, et al. High-dose-rate brachytherapy as sole modality for early-stage endobronchial carcinoma. Int J Radiat Oncol Biol Phys 2000; 47:665.
  39. Hennequin C, Bleichner O, Trédaniel J, et al. Long-term results of endobronchial brachytherapy: A curative treatment? Int J Radiat Oncol Biol Phys 2007; 67:425.
  40. Fuwa N, Kodaira T, Tachibana H, et al. Long-term observation of 64 patients with roentgenographically occult lung cancer treated with external irradiation and intraluminal irradiation using low-dose-rate iridium. Jpn J Clin Oncol 2008; 38:581.
  41. Sutedja G, Baris G, van Zandwijk N, Postmus PE. High-dose rate brachytherapy has a curative potential in patients with intraluminal squamous cell lung cancer. Respiration 1994; 61:167.
  42. Pérol M, Caliandro R, Pommier P, et al. Curative irradiation of limited endobronchial carcinomas with high-dose rate brachytherapy. Results of a pilot study. Chest 1997; 111:1417.
  43. Aumont-le Guilcher M, Prevost B, Sunyach MP, et al. High-dose-rate brachytherapy for non-small-cell lung carcinoma: a retrospective study of 226 patients. Int J Radiat Oncol Biol Phys 2011; 79:1112.
  44. Wisnivesky JP, Yung RC, Mathur PN, Zulueta JJ. Diagnosis and treatment of bronchial intraepithelial neoplasia and early lung cancer of the central airways: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e263S.
  45. Kramer MR, Katz A, Yarmolovsky A, et al. Successful use of high dose rate brachytherapy for non-malignant bronchial obstruction. Thorax 2001; 56:415.
  46. Tscheikuna J, Disayabutr S, Kakanaporn C, et al. High dose rate endobronchial brachytherapy (HDR-EB) in recurrent benign complex tracheobronchial stenosis: experience in two cases. J Med Assoc Thai 2013; 96 Suppl 2:S252.
  47. Allen AM, Abdelrahman N, Silvern D, et al. Endobronchial brachytherapy provides excellent long-term control of recurrent granulation tissue after tracheal stenosis. Brachytherapy 2012; 11:322.
  48. Meyer A, Warszawski-Baumann A, Baumann R, et al. HDR brachytherapy: an option for preventing nonmalignant obstruction in patients after lung transplantation. Strahlenther Onkol 2012; 188:1085.
  49. Khanavkar B, Stern P, Alberti W, Nakhosteen JA. Complications associated with brachytherapy alone or with laser in lung cancer. Chest 1991; 99:1062.
  50. Hara R, Itami J, Aruga T, et al. Risk factors for massive hemoptysis after endobronchial brachytherapy in patients with tracheobronchial malignancies. Cancer 2001; 92:2623.
  51. Hennequin C, Tredaniel J, Chevret S, et al. Predictive factors for late toxicity after endobronchial brachytherapy: a multivariate analysis. Int J Radiat Oncol Biol Phys 1998; 42:21.
  52. Zaric B, Perin B, Jovelic A, et al. Clinical risk factors for early complications after high-dose-rate endobronchial brachytherapy in the palliative treatment of lung cancer. Clin Lung Cancer 2010; 11:182.
  53. Bedwinek J, Petty A, Bruton C, et al. The use of high dose rate endobronchial brachytherapy to palliate symptomatic endobronchial recurrence of previously irradiated bronchogenic carcinoma. Int J Radiat Oncol Biol Phys 1992; 22:23.
  54. Lo TC, Beamis JF Jr, Weinstein RS, et al. Intraluminal low-dose rate brachytherapy for malignant endobronchial obstruction. Radiother Oncol 1992; 23:16.
  55. Mehta MP, Shahabi S, Jarjour NN, Kinsella TJ. Endobronchial irradiation for malignant airway obstruction. Int J Radiat Oncol Biol Phys 1989; 17:847.
  56. Speiser, B, Spratling, L. High dose rate remove afterloading brachytherapy in the control of endobronchial carcinoma. In: Brachytherapy HDR and LDR, Martinez, AA, Orton, CG, Mould, RF (Eds), Nucletron Corp, Columbia, MD 1990. p.10.
  57. Sutedja G, Baris G, Schaake-Koning C, van Zandwijk N. High dose rate brachytherapy in patients with local recurrences after radiotherapy of non-small cell lung cancer. Int J Radiat Oncol Biol Phys 1992; 24:551.
  58. Chawla M, Getzen T, Simoff MJ. Medical pneumonectomy: interventional bronchoscopic and endovascular management of massive hemoptysis due to pulmonary artery pseudoaneurysm, a consequence of endobronchial brachytherapy. Chest 2009; 135:1355.
  59. Matsumoto I, Oda M, Imagawa T, et al. Management of tracheobronchial ulceration induced by high-dose brachytherapy. Ann Thorac Surg 2009; 87:1301.