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High Dose Rate Brachytherapy for Nonmalignant Airway Obstruction^*

New Treatment Option

^* From the Oncology (Drs. Brenner, Brenner-Weissmann, Sulkes, and Fenig) and Pulmonary Institutes (Dr. Kramer), Radiotherapy Unit (Dr. Katz), and Department of Otolaryngology (Dr. Feinmesser), Rabin Medical Center, Beilinson Campus, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Correspondence to: Mordechai Kramer, MD, FCCP, Head, Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49100, Israel; e-mail: pulm{at}netvision.net.il

Study objectives: High dose rate (HDR) endobronchial brachytherapy is widely used as a palliative treatment for symptomatic airway obstruction by primary or secondary malignant tumors. We report on a successful use of HDR brachytherapy in patients with nonmalignant airway obstruction.

Design: Case series

Patients: Six patients received HDR brachytherapy for airway obstruction caused by granulation tissue around a metal stent placed for restoration of the airway patency for nonmalignant causes. In four patients, brachytherapy was performed following recurrent occlusion of the airway by granulation tissue formation; in two patients, it was done as a prophylactic procedure.

Intervention: HDR brachytherapy catheters were passed through the metal stents under direct fluoroscopic guidance. Simulation and computerized treatment planning were done, and a single dose of 10 Gy was administered using a brachytherapy remote afterloader with a ¹⁹²Ir source. The dose was prescribed to a distance of 1 cm from the center of the source, with a margin of 1 cm from the proximal and distal ends of the stent.

Results: At a median follow-up of 15 months, moderate granulation tissue formation was observed in only one patient; in four others, it was categorized as minimal, 5 to 30 months from the procedure. Restoration of the lumen was complete in four patients, near complete in one patient, and partial in one patient. In one patient, previously treated by external radiotherapy, local tissue necrosis was evident.

Conclusion: HDR brachytherapy can be used safely for nonmalignant airway obstruction. Further studies including more patients and longer follow-up are needed.

Key Words: airway stenting • high dose rate brachytherapy • nonmalignant airway obstruction • radiation therapy

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