Endobronchial brachytherapy

Lung cancer continues to be the leading cause of cancer death in both men and women in the United States. At the time of diagnosis, only a small percentage of patients are surgical candidates. It is not uncommon for patients to present with symptoms of malignant obstruction, such as hemoptysis, cough, dyspnea, and/or obstructive pneumonitis. Therapeutic options for localized disease include neodymium, ytrium, aluminum, garnet (ND:YAG) laser resection, photodynamic therapy (PDT), external beam radiation therapy, cryotherapy, and brachytherapy. These treatments offer palliation in late-stage or recurrent disease and may have curative potential in early, roentgenographically occult disease. Endobronchial brachytherapy is designed to bring radiation doses directly to the tumor for localized treatment. This allows intense radiation to the intraluminal tumor, sparing the surrounding normal tissue. There are several modes of brachytherapy used in the treatment of lung cancer. The most widely used and investigated is endobronchial or intraluminal brachytherapy. Iridium 192 is the most commonly used radiation source. Dose rates vary between institutions and to date there is no consensus as to the optimal dose and frequency of fractionation for brachytherapy. Intraluminal brachytherapy has been shown to be effective in the management of recurrent or obstructing bronchogenic carcinoma. It has an acceptable complication rate when used in both low-dose and high-dose rates. Preliminary evidence suggests that it may be effective as a curative treatment for very superficial radiographically occult cancer.