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LONG-TERM CLINICAL BENEFITS OF LOW DOSE RATE EN)OBROEICHIAL IRRADIATION OF MALIGNANT AIRWAY OBSTRUCTION. I. ~p&ovB, J. Petera, J. Andrle. Institute of Chest Diseases, Insti- tute of Radiation Oncology, Prague Czech Republic.

Brachytherapy allows the delivery of higher radiation doses, possibly leading to improved locoregional tumor con- trol and subsequent prolonged survival.

From Feb 1,199O to May 31, 1993, 55 patients with ma- lignant inoperable tracheobronchial compromise underwent 69 brachytherapy treatments with 137Cs. Either microSelectron (n=54) or Selectron (n=15) was used. All except 4 patients received external irradiation. 20 received chemotherapy. 32 received laser excision. A dose rate between 0.50 and 12.15 (in average 0.75 in microSelectron and 11.33 in Sele- ctron) Gy/h at 1 cm was used, delivering between 3 and 10 (in average 8.5) Gy total dose to the tumor.

Significant bleeding was observed in 1 procedure and an inability to tolerate the afterloading catether for the whole planned time in 3 cases. I 2 cases it was not possib- le to place an applicator through the extreme hypoxia. The median time from time of diagnosis to death was 18.5 mon- ths. The median length of survival after the first brachy- therapy was 13.6 months. 62.3 % of the patients were alive after six months, 30.2 % after one year and 18.9 % after 18 months following the first brachytherapy treatment. 11 patients are still living after 42, 35, 28, 20, 20, 17, 17, 11, 7, 6 and 6 months.

We conclude that LOR endobronchial brachytherapy is a well-tolerated, safe and effective technique for palliation of malignant airway occlusion.

515

CURATIVE IRRAMATION OF LIMITED ENDOBRONCHIAL CARCINOMAS WITH HDR BRACHYTHERAPY. RESULTS OF A PILOT STUDY. M. Perol, J.M. Ardiet, P. Pommier, F. Mornex, P.J. Souquet, J.P. Gerard. Groupe Lyonnais d’0ncologie Thoracique. Lyon. France. We have conducted between 7/l 990 and S/l 993 a pilot study about HDR endoluminal brachytherapy as exclusive treatment for limited endobronchial non small cell lung carcinomas in patients not suitable for surgery or external beam irradiation because of severe respiratory deficiency. inclusion criterias were: proximal non small cell carcinoma accessible to fiberoptic bronchoscopy, diameter < 1 cm, absence of visible tumor on CT scan. Eighteen patients were included in this trial; surgery or external beam radiotherapy were prevented by respiratory deficiency (5 patients), previous surgery for 10 patients (pneumonectomy in 6 patients), previous radiotherapy (2 patients), HIV infection (1 patient). Patients received 3 to 5 fractions of 7 Gy, specified at 1 cm from the source, once a week, over 3 to 5 weeks. We used an escalating dose protocol to assess tolerance of bronchial wall to HDR brachytherapy with first 3 fractions (Group 1: n=2), then 4 fractions (Group 2: n-4), and finally 5 fractions (Group 3: n=l2).Seventeen patients are evaluable for local control with median follow up of 12 months (r. 3-33 mo.): l/2 patients in Group 1, 3/4 patients in Group 2 and 9/l 1 patients in Group 3 are locally controlled. Immediate toxicity was uncommon (one pneumothorax for 82 applications). We observed an asymptomatic radiation bronchial stenosis in 10 patients (Group 1: l/2, Group 2: l/4, Group 3: 7/l 1). One locally controlled patient (4 x7 Gy) died from hemoptysis 12 months after treatment. We found no increase in functional respiratory deficiency. HDR brachytherapy seems efficient in the treatment of small endobronchial tumors, with particular interest for patients with severe respirarory deficiency. Further follow up is needed to appreciate late toxicity, particularly on bronchial wall.

SYMPTOM RESPONSE AFTER ENDOBRONCHIAL THERAPY IN PRETREATED BRONCHIAL CARCINOMA. G. Duchesne, A. N&r, G. Sadler, M. Hetzel. UCL Hospitals, London, U.K. Symptomatic response data for 61 pre-treated patients aged 30-91 treated with endobronchial brachytherapy (EBT) (15Gy at lcm), with or without preceding laser (Lr) ablation, have been evaluated to identify criteria for use of these modalities. Response was defined as improvement by at least 1 WHO grade at lm in post-treatment symptoms:

Cough Haemoptysis SOB EBT alone: PR/CR 6 5 12

(35) NR 7 0 10 Died* 7 2 11

EBT + Lr: PR/CR 7 12 10 (26) NR 7 0 6

Died* 1 1 3 * prior to assessment

The median time to progression of symptoms in surviving patients was 2.9m for EBT alone and 2.8m for EBT + Lr. Survival duration was dependent on pre-treatment performance status. Haemoptysis was rapidly palliated with EBT alone. EBT alone took up to 4 weeks to relieve dyspnoea and cough, restricting benefit in those of limited prognosis. Lr was not indicated with predominantly extrinsic obstruction. In those with intrinsic airways tumour, fit for GA, Lr + EBT provided more effective and longer relief of dyspnoea, but not of cough, than EBT alone. Therapy can be tailored to symptoms/prognosis.

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ENDOBRONCHIAL HIGH-DOSE RATE BRACEYTEERAPY @DR-BT): LOCAL EFFICACY AND COMPLICATIONS IN 111 PATIENTS (PTS). F.Ret&,B. Chawet, P. Vincent, Y. Brewer, C. Felix-Faw, M. Taulelle. Thoracic ChxologyDepartment. CliniqueSainteCatherine.BP846.Avignon.France.

Fmm September 1990 to May 1993, 111 pts were treated with eadobronchial HDR- BT. Median age was 68 years. Predominant location of the honor was upper lobe (38.8%), lower lobe (25.2%) and main bronchus (27%). Squamous cell carcinoma accounted for 84.7% of cases. Prior treatments included surgery (28%), chemotherapy (45%) and radiotherapy (64%) to a median dose of 55 Gy. 28 pts (25%) had a laser procedure prior to HDR-BT. The majority of these pts had late local endobroncbial wurrence (38.8%) or persistent tumor following regional therapy (27.9%). In some p!s, HDR-BT was carried out upfront for major obs!mctive tumor (20.7%) or small inoperable en&bronchial tamor (12.6%). Main symptoms before treatment were cough (82.9%). dyspnea (71.2%) and hemoptysis (36%). The degree of bmncbial ob&w!ion was SO%or more in 80% of cases. Treatment protocol consisted of weekly Iridium-192 imolants of 10 Gv x 3 at 10 mm in the iirst 35 ots, and 8 Gv x 4 in the following 76, fdr a total of 37i implants. Treatment was applkat lidI do& in 65.7% and 73.7% of cases, respectively. Immediate tolerance was good in 95.4% despite moderate macosltis in 22.6%. Response rate was assessed endosmpically 1 month following completion of therapy. 72% of pts bad a major local response including 57.7% mmolete remonse (CR) and 45 netive biwsies at the initial lumor site. A bigh CR rate (92.9%) was obtakd in the s&I inol&a!Jle honor group. Symptomatic improvement was pmspectively assessed in 79 pts with disappearance of cough in 69.5%, dyspnea in 65.9% and hemoplysis in 88.9% of pis. Severe toxicity analysis demonstrated 6 necmses, 9 stenosea, 1 pneumothorax and 6 cases of fatal hemoptyses, for an overall rate of 18%. Treatment protocol, tumor location, volume of irradiation were not found to be predictive for these complications by multivariate analysis. With a median follow-up of 24.5 months, 16.2 % are alive and 63% are dead from disease ~romession for a l- and 2-w survivaI of 23.3 % and 3.6%. mmec!ively. In the group treated with curative kentent (small tumors, n=14), 7 pts are aike d&se-free with a median survival of 17 months. In conclusion, endobmncbial BDR-BT is a well tolerated treatment resulting in rapid and significant improvement of obstmction and distressing symptoms, with ao acceptable rate of late complications. Local control and survival in small inoperable tumors are encoora@g. Future studies should focus on minlmikg late toxic@’ before HDR-BT can be integrated in the primary non-surgical treatment of lung cancer.