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116 Strategies and technical aspects in endoluminal HDR brachytherapy
s29
113
114
CURATIVE BRACHYTHERAPY ENDOBRONCHIAL CARCINOMAS
B F&&rick, E Chnt, L A Gerbaulet
FOR
LIMITED
STAGE
H Marsigl~a, P Baldeyrou, E La~gau. C Hale-Meder, Kochbati, M Deiap~erre, M Albano, E Bnot, C. Strauss, lnstltut Gustave-Roussy, VdleJtaf, France
A&. to evaluate the toxnty and the effucy of HDR bracbytherapy for Inoperable bmwd stage carcmomas Po~tdation 36 patents (mean age 62yrs. OMS 2) Sites I5 upper lobe bronchus, I9 mainstem bronchus, 2 tracheas TfWvl 21 Tl, I I T2, 2 T4. 2 Tx. NO MO Mean size I 5 cm Mean dimcal volume of the tumor 0 8 cm’. Previous surgery for 12 patients (pneumonectomy or lobe&my) and 24 medully Inoperable pattents Pm’ HDR bra&therapy : 6 x 5 Gy once the week. Broncboscopic follow-up at 2.6, I2 and I8 months. One to three catheter(s) for treatment and one to three spacing catheter(s) are inserted under endoscoplc guidance Chest X Ray and CT scan are used for dosimetry A single source of lndlum 192 with a nominal activity of 370 Gbq 1s remotly afterloaded Mean distance of catheter to deepest aspect of the tumor : 5 6 mm Mean distance of ,mm Mean distance of catheter to vessels catheter to bronchial wall with and v&out spanng catheter I 5 mm and 3 mm, respectively Mean active length IS 5 cm. Mean prescribed dose&8 IO cm’, 200 % 3 cm’ mm Mean volume of prescription I00 % Specified dose at I cm Mean volume of speclficatmn 100 % I2 cm’, 200 % 4 cm’ Median ratio treated volume/tumor volume 30 Mean overall treatment tmx 34 days As a result, the mean follow-up 1s 2 years The S-year local regional control rates IS 83 % one late fallore (at 22 months) and one local regmnal progewon 2 months after treatment The 2-year overall surwal and the dwase specific surwval 1s 78 % and 97 % respezt~vely All the acute and late toxIntIes were hmlted to Grade I Overall survival and local-regmnal control afier HDR Cooelusion brachytherapy appear Improved at 2 years compared to hlstonc controls usntg external beam radmtherapy (2-3 year OS 36-56%). In h&t of these results , a multlcader study IS proposed wtlt an overall treatment time accelerated to three weeks (6 x 5 Cy) to mcrease the bmlogc effect of the total dose
115 CURATIVE HDR BRACHYTHERAF’Y FOR ENCOBRONCHIAL CARCINOMAS: THE OSCAR LAMBRET CEMER EXPERIENCE.
From May 1993 to October 1995, PC, patients with limited endobronchial carcinomas were treated in a curative intent by HDR endoluminal brachytherapy. Patients were separated into 3 groups: Strictly endobronchial tumon in inoperable patienta (group1 , n=21 ); recurrent lesions in non-previously irradiated patienta ( group 2, n=3 ): booat after external radiotherapy ( group 3. n=3 ). Inclusion criteria were squamous cell carcinomas with a diameter less than 1 cm and normd CT scan. 1 patient was treated for 2 successive lesions, so a total of 27 treatmenta we& applied. Patients received fractions of 6 Gy ( n=3 ) or 7 Gy (n=24 ) specified at 1 cm tram the source. 4 to 6 fractions were admiiM,ed onoe a week to groupa 1 and 2 in group 3 the protocol was limitedto 2 fractions. 24 patients were avaluable for response with a median follow-up of 7 months ( t-25 ). We noted 20 endoscopic and histological complete responses and 4 local failures. Median survival was 11 months 12 patients died; 4 with evolutive neoplasic disease, 3 by hemoptyais, 5 by non-tumoral disease. 26 patients were evaluable for complications. No immediate complications were noted. 16 late complications observed were identified as radiation bronchitis which were symptomatic in 6 patients. The radiation bronchitis was distributed as follows: grade 1 in 7 patients, grade 2 in 4. grade 3 in 4 and grade 4 in 3 accotding to SPEISER’s score. Because of the high rate of complete responses (20/26). we consider HDR brachytherapy as an effective treatment of limited endobronchial carcinoma in inoperable patients. However, ou, study was also marked by a high incidence of radiatkm bronchitis. So we suggest improving procedures for catheter placement to avoid close contact of the iridium source with the bronchial mwoaa and using a lower dose per fraction ( 5 Gy i fraction with 6 fractions once a week ). Reference: SF’;yER
and al. lot. J. Radiat.
Oncol. Biol. Phys., 25: 569-597;
HDR INTRALUMENAL BRACHYTHERAPY CANCER: REVIEW OF OUR EXPERIENCE.
IN
P. Muto, l V. Raw, l R Murheril. lstituto di Scieue Radialo@c - I Cattedrr Univenitl degli Studi di Napoti”Fedcrico II”- ltalia l Centm di Rndiotempia “Villa del Sole”- Napoli, llnlia
BRONCHIAL
113
114
CURATIVE BRACHYTHERAPY ENDOBRONCHIAL CARCINOMAS
B F&&rick, E Chnt, L A Gerbaulet
FOR
LIMITED
STAGE
H Marsigl~a, P Baldeyrou, E La~gau. C Hale-Meder, Kochbati, M Deiap~erre, M Albano, E Bnot, C. Strauss, lnstltut Gustave-Roussy, VdleJtaf, France
A&. to evaluate the toxnty and the effucy of HDR bracbytherapy for Inoperable bmwd stage carcmomas Po~tdation 36 patents (mean age 62yrs. OMS 2) Sites I5 upper lobe bronchus, I9 mainstem bronchus, 2 tracheas TfWvl 21 Tl, I I T2, 2 T4. 2 Tx. NO MO Mean size I 5 cm Mean dimcal volume of the tumor 0 8 cm’. Previous surgery for 12 patients (pneumonectomy or lobe&my) and 24 medully Inoperable pattents Pm’ HDR bra&therapy : 6 x 5 Gy once the week. Broncboscopic follow-up at 2.6, I2 and I8 months. One to three catheter(s) for treatment and one to three spacing catheter(s) are inserted under endoscoplc guidance Chest X Ray and CT scan are used for dosimetry A single source of lndlum 192 with a nominal activity of 370 Gbq 1s remotly afterloaded Mean distance of catheter to deepest aspect of the tumor : 5 6 mm Mean distance of ,mm Mean distance of catheter to vessels catheter to bronchial wall with and v&out spanng catheter I 5 mm and 3 mm, respectively Mean active length IS 5 cm. Mean prescribed dose&8 IO cm’, 200 % 3 cm’ mm Mean volume of prescription I00 % Specified dose at I cm Mean volume of speclficatmn 100 % I2 cm’, 200 % 4 cm’ Median ratio treated volume/tumor volume 30 Mean overall treatment tmx 34 days As a result, the mean follow-up 1s 2 years The S-year local regional control rates IS 83 % one late fallore (at 22 months) and one local regmnal progewon 2 months after treatment The 2-year overall surwal and the dwase specific surwval 1s 78 % and 97 % respezt~vely All the acute and late toxIntIes were hmlted to Grade I Overall survival and local-regmnal control afier HDR Cooelusion brachytherapy appear Improved at 2 years compared to hlstonc controls usntg external beam radmtherapy (2-3 year OS 36-56%). In h&t of these results , a multlcader study IS proposed wtlt an overall treatment time accelerated to three weeks (6 x 5 Cy) to mcrease the bmlogc effect of the total dose
115 CURATIVE HDR BRACHYTHERAF’Y FOR ENCOBRONCHIAL CARCINOMAS: THE OSCAR LAMBRET CEMER EXPERIENCE.
From May 1993 to October 1995, PC, patients with limited endobronchial carcinomas were treated in a curative intent by HDR endoluminal brachytherapy. Patients were separated into 3 groups: Strictly endobronchial tumon in inoperable patienta (group1 , n=21 ); recurrent lesions in non-previously irradiated patienta ( group 2, n=3 ): booat after external radiotherapy ( group 3. n=3 ). Inclusion criteria were squamous cell carcinomas with a diameter less than 1 cm and normd CT scan. 1 patient was treated for 2 successive lesions, so a total of 27 treatmenta we& applied. Patients received fractions of 6 Gy ( n=3 ) or 7 Gy (n=24 ) specified at 1 cm tram the source. 4 to 6 fractions were admiiM,ed onoe a week to groupa 1 and 2 in group 3 the protocol was limitedto 2 fractions. 24 patients were avaluable for response with a median follow-up of 7 months ( t-25 ). We noted 20 endoscopic and histological complete responses and 4 local failures. Median survival was 11 months 12 patients died; 4 with evolutive neoplasic disease, 3 by hemoptyais, 5 by non-tumoral disease. 26 patients were evaluable for complications. No immediate complications were noted. 16 late complications observed were identified as radiation bronchitis which were symptomatic in 6 patients. The radiation bronchitis was distributed as follows: grade 1 in 7 patients, grade 2 in 4. grade 3 in 4 and grade 4 in 3 accotding to SPEISER’s score. Because of the high rate of complete responses (20/26). we consider HDR brachytherapy as an effective treatment of limited endobronchial carcinoma in inoperable patients. However, ou, study was also marked by a high incidence of radiatkm bronchitis. So we suggest improving procedures for catheter placement to avoid close contact of the iridium source with the bronchial mwoaa and using a lower dose per fraction ( 5 Gy i fraction with 6 fractions once a week ). Reference: SF’;yER
and al. lot. J. Radiat.
Oncol. Biol. Phys., 25: 569-597;
HDR INTRALUMENAL BRACHYTHERAPY CANCER: REVIEW OF OUR EXPERIENCE.
IN
P. Muto, l V. Raw, l R Murheril. lstituto di Scieue Radialo@c - I Cattedrr Univenitl degli Studi di Napoti”Fedcrico II”- ltalia l Centm di Rndiotempia “Villa del Sole”- Napoli, llnlia
BRONCHIAL