High-dose-rate brachytherapy for non-small-cell lung carcinoma: a retrospective study of 226 patients

Purpose To evaluate the efficacy and toxicity of high-dose-rate (HDR) brachytherapy in patients with inoperable endobronchial carcinoma. Methods and Materials We retrospectively reviewed the records (April 1991—May 2004) of patients with non–small-cell carcinoma, with no extrabronchial spread on computed tomography scans, who underwent HDR brachytherapy because of contraindications to surgery and external beam radiation therapy. Kaplan-Meier survival curves were compared by the log-rank test. Prognostic factors were analyzed by multivariate analysis. Results 226 patients (223 men, 3 women, mean age: 62.2 years (range, 40–84)) were included. Of those, 217 (97%) had squamous cell carcinoma (Tis/T1/T2/Tx: 60/153/9/4). Dose was prescribed at 1 cm from the radius (24–35 Gy in 4–6 fractions). Mean follow-up was 30.4 months (range, 9–116). Complete endoscopic response rate was 93.6% at 3 months. One hundred twenty-eight patients (56%) died of intercurrent disease ( n = 45), local failure ( n = 36), metastasis ( n = 10), local failure and metastasis ( n = 11), complications ( n = 13), and other causes ( n = 12). The 2-year and 5-year survival rates were, respectively, 57% and 29% (overall) (median, 28.6 months), 81% and 56% (cancer-specific), and 68% and 50% (local disease-free). Acute toxicity included pneumothorax (1.5%) and mucosal inflammation (10%). Late complications were hemoptysis (6.6% with 5% of fatalities), bronchitis (19.5%), and necrosis (3.5%). In multivariate analysis, a distal tumor location and the use of two catheters were associated with improved local disease-free survival ( p = 0.003 and p = 0.007, respectively) and a distal tumor location with improved overall survival ( p = 0.0001). Conclusions This large retrospective study confirms that HDR brachytherapy is an efficient and safe treatment in patients with inoperable endobronchial carcinoma.