- 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 .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Hilaris BS, Mastoras DA. Contemporary brachytherapy approaches in non-small-cell lung cancer. J Surg Oncol 1998; 69:258.
- Raben A, Mychalczak B. Brachytherapy for non-small cell lung cancer and selected neoplasms of the chest. Chest 1997; 112:276S.
- Mendiondo OA, Dillon M, Beach LJ. Endobronchial brachytherapy in the treatment of recurrent bronchogenic carcinoma. Int J Radiat Oncol Biol Phys 1983; 9:579.
- 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.
- 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.
- Seagren SL, Harrell JH, Horn RA. High dose rate intraluminal irradiation in recurrent endobronchial carcinoma. Chest 1985; 88:810.
- Nag S, Kelly JF, Horton JL, et al. Brachytherapy for carcinoma of the lung. Oncology (Williston Park) 2001; 15:371.
- Nori D, Hilaris BS, Martini N. Intraluminal irradiation in bronchogenic carcinoma. Surg Clin North Am 1987; 67:1093.
- Villanueva AG, Lo TC, Beamis JF Jr. Endobronchial brachytherapy. Clin Chest Med 1995; 16:445.
- Shaw, EG, McDougall, JC. Bronchoscopic brachytherapy. In: Bronchoscopy, Prakash, UBS (Eds), Raven Press, New York 1994. p.293-300.
- 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.
- Reveiz L, Rueda J-R, Cardona AF. Palliative endobronchial brachytherapy for non-small cell lung cancer. Cochrane Database Syst Rev 2012; :CD004284.
- 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.
- 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.
- 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.
- 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.
- 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.
- Guarnaschelli JN, Jose BO. Palliative high-dose-rate endobronchial brachytherapy for recurrent carcinoma: the University of Louisville experience. J Palliat Med 2010; 13:981.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Speiser BL, Spratling L. Remote afterloading brachytherapy for the local control of endobronchial carcinoma. Int J Radiat Oncol Biol Phys 1993; 25:579.
- 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.
- 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.
- Pisch J, Villamena PC, Harvey JC, et al. High dose-rate endobronchial irradiation in malignant airway obstruction. Chest 1993; 104:721.
- Nori D, Allison R, Kaplan B, et al. High dose-rate intraluminal irradiation in bronchogenic carcinoma. Technique and results. Chest 1993; 104:1006.
- d'Amato TA, Galloway M, Szydlowski G, et al. Intraoperative brachytherapy following thoracoscopic wedge resection of stage I lung cancer. Chest 1998; 114:1112.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Kramer MR, Katz A, Yarmolovsky A, et al. Successful use of high dose rate brachytherapy for non-malignant bronchial obstruction. Thorax 2001; 56:415.
- 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.
- 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.
- 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.
- Khanavkar B, Stern P, Alberti W, Nakhosteen JA. Complications associated with brachytherapy alone or with laser in lung cancer. Chest 1991; 99:1062.
- 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.
- 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.
- 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.
- 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.
- Lo TC, Beamis JF Jr, Weinstein RS, et al. Intraluminal low-dose rate brachytherapy for malignant endobronchial obstruction. Radiother Oncol 1992; 23:16.
- Mehta MP, Shahabi S, Jarjour NN, Kinsella TJ. Endobronchial irradiation for malignant airway obstruction. Int J Radiat Oncol Biol Phys 1989; 17:847.
- 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.
- 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.
- 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.
- Matsumoto I, Oda M, Imagawa T, et al. Management of tracheobronchial ulceration induced by high-dose brachytherapy. Ann Thorac Surg 2009; 87:1301.
- 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