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Brachytherapy in the treatment of lung cancer - a valuable solution.

Skowronek J - J Contemp Brachytherapy (2015)

Bottom Line: Efforts to relieve this obstructive process are worthwhile, because patients may experience improved quality of their life (QoL).This option is fast, inexpensive, and easy to perform on an outpatient basis.Clinical indications, different techniques, results, and complications are presented in this work.

View Article: PubMed Central - PubMed

Affiliation: Brachytherapy Department, Greater Poland Cancer Center ; Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland.

ABSTRACT
The majority of patients with lung cancer are diagnosed with clinically advanced disease. Many of these patients have a short life expectancy and are treated with palliative aim. Because of uncontrolled local or recurrent disease, patients may have significant symptoms such as: cough, dyspnea, hemoptysis, obstructive pneumonia, or atelectasis. Brachytherapy is one of the most efficient methods in overcoming difficulties in breathing that is caused by endobronchial obstruction in palliative treatment of bronchus cancer. Efforts to relieve this obstructive process are worthwhile, because patients may experience improved quality of their life (QoL). Brachytherapy plays a limited but specific role in definitive treatment with curative intent in selected cases of early endobronchial disease as well as in the postoperative treatment of small residual peribronchial disease. Depending on the location of the lesion, in some cases brachytherapy is a treatment of choice. This option is fast, inexpensive, and easy to perform on an outpatient basis. Clinical indications, different techniques, results, and complications are presented in this work.

No MeSH data available.


Related in: MedlinePlus

A, B) Tumor infiltrating carina and both main bronchi beforeapplication and after application of two brachytherapy catheters. Inthis cases, irradiated area includes carina and both main bronchi [ownmaterial]
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Figure 0007: A, B) Tumor infiltrating carina and both main bronchi beforeapplication and after application of two brachytherapy catheters. Inthis cases, irradiated area includes carina and both main bronchi [ownmaterial]

Mentions: In order to evaluate the airway, locate the tumor size, and define the site ofobstruction, an initial bronchoscopy in local anesthesia is performed.Premedication is to provide anxiolytic drugs (e.g. midazolam 2.5 mgsubcutaneous), parasympatic blocking agent (often atropine 1 mg), andantitussive drug (often codeine). The catheters (one or two, either a 5- or6-French) used to deliver the brachytherapy should be inserted through the brushchannel of the bronchoscope (Figure 2and 3). If a 6-French catheter is used,a large bronchoscope with brush channel diameter of at least 2.2 mm is required.If the HDR source has to pass tight curves, it is not possible with the 5-Frenchcatheter and the use of a 6-French catheter is necessary. If the bronchoscope isconnected to a teaching head or a video monitor, the physician performing theapplication can visualize the lesion and the catheter. For the patient'scomfort and to secure the catheter, the bronchoscope should be inserted throughthe nose. Then the afterloading catheter is inserted through the brush channelof the bronchoscope, passes through the tumor, and is lodged in one of thesmaller bronchi. It is recommended to perform a fluoroscopic confirmation of thecatheter's position. Then the distance between the proximal extent of thetumor and fixed structures such as the carina is measured. While the radiationoncologist pushes the catheter in, the assisting physicist or nurse (dependingof local organization) carefully withdraws the bronchoscope. The use offluoroscopy helps to keep the catheter in place during this push-pull techniqueof bronchoscope removal. The catheter should be secured with tape at the nose,and its position is marked in ink to alert the medical staff in case ofdisplacement. In some situations (tumor localized in the carina of the mainbronchi or smaller bronchi), multiple catheters (mostly two) are to be used. Insuch case, the procedure is repeated, making sure to clearly mark and describeeach catheter. Localization X-rays with radio-opaque dummy wires in the catheterare then obtained Figures 4 and 5. To determine the length to beirradiated and the initial dwell position, the location of the obstruction andthe target length are marked on the X-rays (in palliative treatment planning).The length to be irradiated usually covers the endobronchial tumor and ±2.0 cm proximal and distal margins. The dose has been commonly prescribed at 1cm from the source, although various points from 0.5 to 2 cm are used. Ifstandard lengths and doses are used, the whole time of brachytherapy procedurecan be shortened by starting treatment without any delay. When a single catheteris used and if there is minimal curvature in the area to be irradiated, it ispossible to minimize the treatment planning time by using pre-calculatedstandard treatment plans for 3-10 cm lengths to be irradiated from 5 to 10 Gy at1 cm from the source using equal dwell times. However, individualizedimage-based treatment planning must be performed if multiple catheters are used[35, 36]. Examples of implanted catheters in bronchi arepresented in Figures 6 and 7.


Brachytherapy in the treatment of lung cancer - a valuable solution.

Skowronek J - J Contemp Brachytherapy (2015)

A, B) Tumor infiltrating carina and both main bronchi beforeapplication and after application of two brachytherapy catheters. Inthis cases, irradiated area includes carina and both main bronchi [ownmaterial]
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4643732&req=5

Figure 0007: A, B) Tumor infiltrating carina and both main bronchi beforeapplication and after application of two brachytherapy catheters. Inthis cases, irradiated area includes carina and both main bronchi [ownmaterial]
Mentions: In order to evaluate the airway, locate the tumor size, and define the site ofobstruction, an initial bronchoscopy in local anesthesia is performed.Premedication is to provide anxiolytic drugs (e.g. midazolam 2.5 mgsubcutaneous), parasympatic blocking agent (often atropine 1 mg), andantitussive drug (often codeine). The catheters (one or two, either a 5- or6-French) used to deliver the brachytherapy should be inserted through the brushchannel of the bronchoscope (Figure 2and 3). If a 6-French catheter is used,a large bronchoscope with brush channel diameter of at least 2.2 mm is required.If the HDR source has to pass tight curves, it is not possible with the 5-Frenchcatheter and the use of a 6-French catheter is necessary. If the bronchoscope isconnected to a teaching head or a video monitor, the physician performing theapplication can visualize the lesion and the catheter. For the patient'scomfort and to secure the catheter, the bronchoscope should be inserted throughthe nose. Then the afterloading catheter is inserted through the brush channelof the bronchoscope, passes through the tumor, and is lodged in one of thesmaller bronchi. It is recommended to perform a fluoroscopic confirmation of thecatheter's position. Then the distance between the proximal extent of thetumor and fixed structures such as the carina is measured. While the radiationoncologist pushes the catheter in, the assisting physicist or nurse (dependingof local organization) carefully withdraws the bronchoscope. The use offluoroscopy helps to keep the catheter in place during this push-pull techniqueof bronchoscope removal. The catheter should be secured with tape at the nose,and its position is marked in ink to alert the medical staff in case ofdisplacement. In some situations (tumor localized in the carina of the mainbronchi or smaller bronchi), multiple catheters (mostly two) are to be used. Insuch case, the procedure is repeated, making sure to clearly mark and describeeach catheter. Localization X-rays with radio-opaque dummy wires in the catheterare then obtained Figures 4 and 5. To determine the length to beirradiated and the initial dwell position, the location of the obstruction andthe target length are marked on the X-rays (in palliative treatment planning).The length to be irradiated usually covers the endobronchial tumor and ±2.0 cm proximal and distal margins. The dose has been commonly prescribed at 1cm from the source, although various points from 0.5 to 2 cm are used. Ifstandard lengths and doses are used, the whole time of brachytherapy procedurecan be shortened by starting treatment without any delay. When a single catheteris used and if there is minimal curvature in the area to be irradiated, it ispossible to minimize the treatment planning time by using pre-calculatedstandard treatment plans for 3-10 cm lengths to be irradiated from 5 to 10 Gy at1 cm from the source using equal dwell times. However, individualizedimage-based treatment planning must be performed if multiple catheters are used[35, 36]. Examples of implanted catheters in bronchi arepresented in Figures 6 and 7.

Bottom Line: Efforts to relieve this obstructive process are worthwhile, because patients may experience improved quality of their life (QoL).This option is fast, inexpensive, and easy to perform on an outpatient basis.Clinical indications, different techniques, results, and complications are presented in this work.

View Article: PubMed Central - PubMed

Affiliation: Brachytherapy Department, Greater Poland Cancer Center ; Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland.

ABSTRACT
The majority of patients with lung cancer are diagnosed with clinically advanced disease. Many of these patients have a short life expectancy and are treated with palliative aim. Because of uncontrolled local or recurrent disease, patients may have significant symptoms such as: cough, dyspnea, hemoptysis, obstructive pneumonia, or atelectasis. Brachytherapy is one of the most efficient methods in overcoming difficulties in breathing that is caused by endobronchial obstruction in palliative treatment of bronchus cancer. Efforts to relieve this obstructive process are worthwhile, because patients may experience improved quality of their life (QoL). Brachytherapy plays a limited but specific role in definitive treatment with curative intent in selected cases of early endobronchial disease as well as in the postoperative treatment of small residual peribronchial disease. Depending on the location of the lesion, in some cases brachytherapy is a treatment of choice. This option is fast, inexpensive, and easy to perform on an outpatient basis. Clinical indications, different techniques, results, and complications are presented in this work.

No MeSH data available.


Related in: MedlinePlus