Advanced tracheal carcinoma--a therapeutic significance of HDR brachytherapy in palliative treatment.

The purpose of this study was to determine the benefit of high dose rate endotracheal brachytherapy as an exclusive palliative treatment of obstructive tracheal cancer. Thirty-five patients with advanced tracheal carcinoma were treated between May 1999 and March 2001 in Greatpoland Cancer Center. They were qualified for brachytherapy due to life-threatening situations. Fourteen patients were irradiated using three fractions 7.5 Gy each one every week, six patients received three fractions 10 Gy each one every week and fifteen patients received one fraction of 10 Gy. Survival time was compared with chosen clinical factors (age, sex, Karnofsky status, tumor location, lymph nodes involvement and percent of obturation) and prescribed dose. The median survival (Kaplan-Meier) for all patients was 6.6 months. Patients with an endoscopically controlled complete remission 4 weeks after the treatment had a significantly better survival in comparison to patients with a partial remission or no change of tumor size (p=0.0003). Univariate analysis revealed significant difference between patients with Karnofsky score equal with 60 or lower (28/35, 80%) and higher than 60 (7/35, 20.0%) (p=0.005). Difference between the grade of tumor obturation (more than 60% of tracheal lumen (27/35, 77.1%), 60% or lower (8/35, 22.9%) was found in univariate analysis (p=0.04). In multivariate analysis statistically important prognostic factor for survival was Karnofsky score (p=0.04). Statistical analysis revealed no differences in survival according to sex and age (p=0.43 for age, p=0.19 for sex), tumor localization (p=0.13), lymph node involvement (p=0.48) or fractionation scheme (p=0.62). Exclusive HDR brachytherapy of advanced tracheal carcinoma was a safe palliative method of treatment and caused in many patients prolonged survival and improved quality of life. Most important prognostic factor for survival, confirmed in both univariate and multivariate analysis, was Karnofsky score.