[The role of high dose rate (HDR) brachytherapy in advanced non-small cell lung cancer].

The aim of this study was to determine the influence of brachytherapy on the prognosis in advanced NSCLC, elaboration of clinical criteria useful in patients qualification to brachytherapy and the radiation method optimization. Between January 1994 and June 1998, 325 patients with symptomatic inoperable endobronchial obstructing lung cancer received brachytherapy alone or combined with external beam irradiation with palliative or radical intent. Patients were given 1 to 4 temporary Ir-192 endobronchial implants at the site of obstruction. Implant doses ranged from 6 to 12 Gy specified at a radius of 1 cm from the centre of the source. Total implant doses ranged from 6 to 24 Gy. Depending on radical or palliative intents external beam irradiation doses ranged from 20 to 60 Gy. The results were compared with results achieved in control group (N = 191) treated exclusively with external beam irradiation. Patients who received combined treatment revealed higher frequency of release or disappearance of hemoptysis, dysponea and atelectasis. Also the duration of clinical remission was significantly longer with combined treatment. In the group treated with radical intent higher percentage of patients with total tumor regression in both endoscopic and radiologic view was observed after tele--and brachytherapy compared with teleradiotherapy alone (respectively 29.8% and 19.4%). The group treated with palliative intent brachytherapy alone provided response rates comparable to those achieved with external beam irradiation alone or tele and brachytherapy. The relative risk of fatal pulmonary haemorrhage (FPH) and radiation induced bronchitis (RIB) were higher when NTD > 70 Gy, brachytherapy and laser therapy were administered and in patients with lobar bronchus infiltration. Knowledge of risk doses of FPA and RIB allow to optimise brachytherapy in patients with advanced NSCLC.