Endobronchial brachytherapy for metastasis from extrapulmonary malignancies as an effective treatment for palliation of symptoms

PURPOSE

Endobronchial metastasis (EBM) originating from primary cancers outside the lung is rare. External beam radiotherapy is often attempted for control of symptoms with variable effectiveness and retreatment is challenging if symptoms recur. There is limited documentation of high-dose-rate brachytherapy for EBM in the literature.

METHODS AND MATERIALS

A prospective database was created from 2006 to 2015. Patients with EBM who received high-dose-rate brachytherapy were included. Cough, dyspnea, chest pain, and hemoptysis were assessed and graded (0-4) at the time of initial consult and in followup. Symptom-free survival and re-expansion were assessed.

RESULTS

Thirty-five patients with EBM were identified. Most patients received three fractions of 700 cGy, and 17 patients had prior external beam radiotherapy. Median symptom-free and overall survival were 67 and 117 days. After brachytherapy, improvement in cough was documented in 75.0%, hemoptysis in 76.4%, dyspnea in 60.0% for a median of 3-6 months. Of the 22 patients who had subsequent chest imaging, re-expansion was documented in 32%. There were no significant toxicities reported.

CONCLUSIONS

Brachytherapy appears effective in achieving durable symptom control of cough hemoptysis, and dyspnea in patients with EBM and should be considered routinely for palliation where available. Further studies are required to better characterize expected symptom improvement, lung re-expansion rates, and efficacy in comparison with other local treatments.

Usefulness of transbronchial biopsy in immunosuppressed patients with pulmonary infiltrates

In a retrospective study of thirty-one immunosuppressed patients with new pulmonary infiltrates transbronchial biopsy provided a specific diagnosis in 11 of the 31 (36%) patients. In a further five patients, whose biopsy showed non-specific interstitial pneumonitis, a specific diagnosis was established by other means. Overall a specific diagnosis was obtained in 52% of patients. Twelve patients were left with a diagnosis of non-specific interstitial pneumonitis. In three out of 31 (10%) patients insufficient tissue was obtained. The seven patients who had metastatic carcinoma of the lung did poorly. The nine with other specific diagnoses did better in that five of them were alive after more than 11 months of follow-up. Patients with non-specific pneumonitis did well; eight out of 12 (67%) were alive after an average follow-up of 13.4 months. In 27 of the 31 (87%) patients the procedure was felt to have influenced therapeutic decisions. This was true whether the biopsy yielded a specific or a non-specific diagnosis. In our series making a specific diagnosis did not improve the patients' survival. Those with non-specific pneumonitis who were treated empirically did well, as did patients with specific diagnoses other than metastatic carcinoma of the lung.