1
|
Das A, Giuliani M, Bezjak A. Radiotherapy for Lung Metastases: Conventional to Stereotactic Body Radiation Therapy. Semin Radiat Oncol 2023; 33:172-180. [PMID: 36990634 DOI: 10.1016/j.semradonc.2022.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
The lung parenchyma and adjacent tissues are one of the most common sites of metastatic disease. Traditionally, the approach to treatment of a patient with lung metastases has been with systemic therapy, with radiotherapy being reserved for palliative management of symptomatic disease. The concept of oligo metastatic disease has paved the way for more radical treatment options, administered either alone or as local consolidative therapy in addition to systemic treatment. The modern-day management of lung metastases is guided by a number of factors, including the number of lung metastases, extra-thoracic disease status, overall performance status, and life expectancy, which all help determine the goals of care. Stereotactic body radiotherapy (SBRT) has emerged as a safe and effective method in locally controlling lung metastases, in the oligo metastatic or oligo-recurrent setting. This article outlines the role of radiotherapy in multimodality management of lung metastases.
Collapse
|
2
|
Jooya A, Talla K, Wei R, Huang F, Dennis K, Gaudet M. Systematic review of brachytherapy for symptom palliation. Brachytherapy 2022; 21:912-932. [PMID: 36085137 DOI: 10.1016/j.brachy.2022.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Brachytherapy is most often applied in the curative or salvage setting, but many forms of brachytherapy can be helpful for symptom palliation. Declining utilization is seen, for multiple reasons, such as lack of awareness, insufficient expertise, or poor access to equipment. High level evidence for many types of palliative brachytherapy has been lacking. The objective of the current study was to review the evidence for utilization and efficacy of brachytherapy to palliate symptoms from cancer. MATERIALS AND METHODS We performed a systematic search in EMBASE and MEDLINE for English-language articles published from January 1980 to May 2022 that described brachytherapy used for a palliative indication in adults with a diagnosis of cancer (any subtype) and at least one symptom related outcome. Individual case reports and conference abstracts were excluded. All publications were independently screened by two investigators for eligibility. RESULTS The initial search identified 3637 abstracts of which 129 were selected for in-depth review. The number of studies (total number of patients) included in the final analysis varied widely by tumor site with the majority (68.2%) involving either lung or esophageal cancer. Despite a limited number of prospective trials that assessed the efficacy of brachytherapy for symptom management, there was a positive effect on palliation of symptoms across all tumor types. There was no clear trend in the number of publications over time. The most commonly cited symptom indications for palliation by brachytherapy were dysphagia, dyspnea, pain and bleeding. CONCLUSIONS Brachytherapy can provide palliation for patients with advanced cancer, across different tumor sites and clinical scenarios. However, high level evidence in the literature to support palliative applications of brachytherapy is lacking or limited for many tumor sites. There appears to be a strong publication bias towards positive studies in favor of brachytherapy. Beyond anecdotal reports and individual practices, outcomes research can further our understanding of the role of brachytherapy in palliating advanced cancers of all types, and should be encouraged.
Collapse
Affiliation(s)
- Alborz Jooya
- Division of Radiation Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Kota Talla
- Division of Radiation Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Randy Wei
- Memorial Radiation Oncology Medical Group, Long Beach, CA
| | - Fleur Huang
- Division of Radiation Oncology, Cross Cancer Institute and University of Alberta, Edmonton, AB, Canada
| | - Kristopher Dennis
- Division of Radiation Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Marc Gaudet
- Division of Radiation Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada.
| |
Collapse
|
3
|
Ito A, Yamaguchi D, Kaneda S, Kawaguchi K, Shimamoto A, Kubooka M, Nomoto Y, Takao M. Endobronchial brachytherapy as definitive treatment for endobronchial metastasis after surgery of non-small cell lung cancer. World J Surg Oncol 2021; 19:322. [PMID: 34743722 PMCID: PMC8574013 DOI: 10.1186/s12957-021-02434-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background Endobronchial metastasis is a very rare type of recurrence after lung cancer surgery. Surgical intervention may be difficult to perform due to the postoperative reduction in the activities of daily living (ADL) and the invasiveness associated with redo surgery. In such cases, endobronchial brachytherapy (EBBT) plays an important role not only as a palliative treatment, but also as a definitive treatment with curative intent. Case presentation Three men (64, 69, and 74 years old) underwent combination therapy of external beam radiation therapy (EBRT) and EBBT for endobronchial metastasis after lobectomy of stage I–II non-small cell lung cancer (NSCLC): 2 cases of squamous cell carcinoma and 1 of adenocarcinoma. We used a special source-centralizing applicator for EBBT to avoid eccentric distribution of the radiation dose. Follow-up was considered to start from the end of brachytherapy. None of our patients experienced severe adverse events, and none needed extensive outpatient treatment. Local control was achieved in all cases by a bronchoscopic evaluation. All patients were alive after 31, 38, and 92 months of follow-up, respectively. In the adenocarcinoma patient, two metastases to the lung were discovered 3 years after EBBT, and the patient underwent partial wedge resection. Conclusions EBBT may be a promising treatment with curative intent for endobronchial metastasis after surgery of NSCLC.
Collapse
Affiliation(s)
- Atsushi Ito
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Daisuke Yamaguchi
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Shinji Kaneda
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Koji Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Akira Shimamoto
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Makiko Kubooka
- Department of Radiology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yoshihito Nomoto
- Department of Radiation Oncology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Motoshi Takao
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| |
Collapse
|
4
|
Omori K, Nomoto Y, Kawamura T, Kubooka M, Kawaguchi K, Ii N, Takada A, Toyomasu Y, Sakuma H. Endobronchial brachytherapy combined with surgical procedure for synchronous multiple primary lung cancer: A case report. Thorac Cancer 2021; 12:1252-1255. [PMID: 33651465 PMCID: PMC8046068 DOI: 10.1111/1759-7714.13911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 11/30/2022] Open
Abstract
The management of synchronous multiple primary lung cancer is a challenge. In this report, we describe our experience in a patient with three synchronous multiple cancers. The first lesion was completely surgically removed, the second lesion received postoperative irradiation, and the third lesion was treated with radiotherapy alone. Radiation therapies were performed using a combination of external irradiation and endobronchial brachytherapy. Endobronchial brachytherapy is an effective radiation therapy for endobronchial tumors owing to its advantage of high-dose concentration. However, adverse events (AEs) such as hemoptysis or severe bronchitis are a problem. Thus, we have developed an applicator to keep the radioactive source in the center of the bronchial lumen. A total of 28 months after treatment, the patient had not experienced any relapses or AEs. Endobronchial brachytherapy using an applicator can be an alternative treatment for cases in which surgery is expected to lead to pulmonary dysfunction.
Collapse
Affiliation(s)
- Kazuki Omori
- Department of Radiology, Mie University, Tsu, Japan
| | | | | | | | - Koji Kawaguchi
- Department of Thoracic Surgery, Mie University, Tsu, Japan
| | - Noriko Ii
- Department of Radiation Oncology, Ise Red Cross Hospital, Ise, Japan
| | | | | | | |
Collapse
|
5
|
Ma K, Sun F, Yang X, Wang S, Wang L, Jin Y, Shi Y, Jiang W, Zhan C, Wang Q. Prognosis of patients with primary malignant main stem bronchial tumors: 7,418 cases based on the SEER database. Onco Targets Ther 2017; 11:83-95. [PMID: 29317836 PMCID: PMC5744741 DOI: 10.2147/ott.s142847] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background The aim of this study was to identify risk factors for patients with malignant main stem bronchial tumors (MBTs) and to develop a nomogram for predicting prognosis in those patients using data from the Surveillance, Epidemiology, and End Results (SEER) database. Method A process was used for case screening from the SEER database. The effect of prognostic factors on survival was evaluated using the Kaplan–Meier method and log-rank test, a competing risk model, and the Cox proportional hazards regression model. A nomogram was established for predicting 1-, 3-, and 5-year overall survival (OS) in patients with MBTs. Results A total of 7,418 cases were included in this study. Age, gender, pathologic grade, histologic type, tumor size, involvement of lymph nodes, tumor extension, chemotherapy, and surgery were identified as independent risk factors by univariate and multivariate analyses. A nomogram was established based on the results of the Cox model, which was validated by a C-index of 0.672 (95% CI, 0.664–0.680), and a group of calibration plots. Conclusion Age, gender, pathologic grade, histologic type, tumor size, involvement of lymph nodes, tumor extension, chemotherapy, and surgery were independent risk factors for OS of patients with MBTs. A nomogram was formulated to predict 1-, 3-, and 5-year OS in patients with MBTs based on individual clinical characteristics.
Collapse
Affiliation(s)
- Ke Ma
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Fenghao Sun
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Xiaodong Yang
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Shuai Wang
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Lin Wang
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Yulin Jin
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Yu Shi
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Wei Jiang
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, People's Republic of China
| |
Collapse
|
6
|
Nomoto Y, Ii N, Murashima S, Yamashita Y, Ochiai S, Takada A, Toyomasu Y, Kawamura T, Sakuma H. Endobronchial brachytherapy with curative intent: the impact of reference points setting according to the bronchial diameter. JOURNAL OF RADIATION RESEARCH 2017; 58:849-853. [PMID: 29106573 PMCID: PMC5710514 DOI: 10.1093/jrr/rrx031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/04/2017] [Indexed: 06/07/2023]
Abstract
Endobronchial brachytherapy (EBB) is an effective treatment for endobronchial tumors. However, bronchial toxicity caused by over-irradiation remains problematic. To decrease bronchial toxicity, we developed a source-centralizing applicator for EBB. The purpose of the present study was to assess the efficacy and safety of EBB with varying reference dose points according to the bronchial diameter, using a source-centralizing applicator. We reviewed 15 patients with endobronchial carcinoma who were treated with curative intent using a combination of external beam radiotherapy (EBRT) and high-dose-rate EBB between 2005 and 2014. During each EBB session, we used a source-centralizing applicator that maintained the source-delivering catheter in the center of the bronchial lumen. Reference dose points were 5-7 mm from the source axis, depending on the bronchial diameter. The median radiation doses of EBRT and EBB were 40 Gy in 20 fractions and 18 Gy in 3 fractions, respectively. The median observation period was 36 months. The 3-year overall survival, progression-free survival and local control rates were 79%, 77% and 100%, respectively. Grade 2 radiation pneumonitis was observed in two cases. Bronchial toxicities, such as hemoptysis or the symptoms of chronic bronchitis, were not observed. EBB with varying reference dose points according to bronchial diameter, using a source-centralizing applicator, is a promising procedure that may be effective for tumor elimination and reducing toxicity to the bronchial wall.
Collapse
Affiliation(s)
- Yoshihito Nomoto
- Department of Radiation Oncology, Graduate School of Medicine, Mie University, 2–174 Edobashi, Tsu, Mie 514-8507, Japan
- Department of Radiation Oncology, Mie University Hospital, 2–174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Noriko Ii
- Department of Radiation Oncology, Mie University Hospital, 2–174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Shuichi Murashima
- Department of Radiology, Matsusaka Central Hospital, 102 Kobou Kawai-machi, Matsusaka, Mie, 515-8566, Japan
| | - Yasufumi Yamashita
- Department of Radiology, Matsusaka Central Hospital, 102 Kobou Kawai-machi, Matsusaka, Mie, 515-8566, Japan
| | - Satoru Ochiai
- Department of Radiology, Matsusaka Central Hospital, 102 Kobou Kawai-machi, Matsusaka, Mie, 515-8566, Japan
| | - Akinori Takada
- Department of Radiation Oncology, Mie University Hospital, 2–174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Yutaka Toyomasu
- Department of Radiation Oncology, Mie University Hospital, 2–174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Tomoko Kawamura
- Department of Radiation Oncology, Mie University Hospital, 2–174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Hajime Sakuma
- Department of Radiology, Graduate School of Medicine, Mie University, 2–174 Edobashi, Tsu, Mie 514-8507, Japan
| |
Collapse
|
7
|
Choi CH, Park JM, Park SY, Kang S, Cho JD, Kim JI. Evaluation of Dosimetric Effect and Treatment Time by Plan Parameters for Endobronchial Brachytherapy. ACTA ACUST UNITED AC 2017. [DOI: 10.14316/pmp.2017.28.2.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Chang Heon Choi
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Center for Convergence Research on Robotics, Advance Institutes of Convergence Technology, Suwon, Korea
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Center for Convergence Research on Robotics, Advance Institutes of Convergence Technology, Suwon, Korea
| | - So-Yeon Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Center for Convergence Research on Robotics, Advance Institutes of Convergence Technology, Suwon, Korea
| | - SungHee Kang
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jin Dong Cho
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jung-in Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
8
|
Abstract
The trachea and bronchus surgery is generally performed due to stenosis, traumatic injury, foreign body and tumors. Preoperative evaluation and anesthesia management are very important issues because of higher mortality and morbidity rates. Patients may be asymptomatic, but airway difficulties, hypoxia, stridor, cough, hemoptysis are common conditions in these patient population. The collaboration between the surgeon and the anesthesiologist is very substantial and necessary. Anesthetic techniques include various applications such as one lung ventilation, fiberoptic intubation, jet ventilation, and apneic oxygenation, general anesthesia with or without neuromuscular blockade. In this review, anesthesia management of the trachea and bronchus surgery is evaluated in the light of new knowledge.
Collapse
Affiliation(s)
- Zehra Hatipoglu
- Department of Anesthesiology and Reanimation, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Mediha Turktan
- Department of Anesthesiology and Reanimation, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Alper Avci
- Department of Thoracic Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| |
Collapse
|