Tomberlin J K, Halperin E C, Kusin P, Leopold K, Bentel G, George S, Powers M, Wolfe W
Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
J Surg Oncol. 1992 Apr;49(4):213-9. doi: 10.1002/jso.2930490403.
Nineteen patients with non-small-cell bronchogenic carcinoma, recurrent following initial conventional external beam radiotherapy, were treated with endobronchial implantation of Au-198 seeds. Seventeen patients were symptomatic with primary symptoms of persistent hemoptysis (9), bronchial obstruction (2), or worsening dyspnea (6). Two patients were asymptomatic and implanted for bronchoscopic evidence of tumor recurrence. The dose delivered was described by three dosimetric parameters: 1) the total activity implanted (m Ci); 2) the midbronchial dose point; and 3) the volume of tissue that received greater than 20 Gy. Response was determined based on a system reflecting the primary indication for the implant. Seven of nine (78%) presenting with hemoptysis, four of six (67%) with increasing dyspnea, and one of two with bronchial obstruction responded. The overall median survival was 5.25 months (2.5-10 months 95% confidence interval). There was no clear correlation between any of the dosimetric parameters evaluated and a clinical response to therapy. Technical complications related to the inability to penetrate the scirrhous tumor surface adequately often led to less than optimal dose distribution. Endobronchial Au-198 implantation is associated with a poor calculated dose distribution but is, nonetheless, a relatively simple and comparatively inexpensive technique that often produces a clinical response and can be a useful option in the management of patients with recurrent bronchogenic carcinoma.
19例非小细胞支气管癌患者在接受初始常规外照射放疗后复发，接受了198金种子支气管内植入治疗。17例患者有症状，主要症状为持续咯血（9例）、支气管阻塞（2例）或进行性呼吸困难（6例）。2例患者无症状，因支气管镜检查发现肿瘤复发而植入。所给予的剂量由三个剂量学参数描述：1）植入的总活度（m Ci）；2）支气管中点剂量点；3）接受大于20 Gy剂量的组织体积。根据反映植入主要指征的系统来确定反应情况。咯血患者中9例有7例（78%）有反应，进行性呼吸困难患者中6例有4例（67%）有反应，支气管阻塞患者中2例有1例有反应。总体中位生存期为5.25个月（2.5 - 10个月，95%置信区间）。所评估的任何剂量学参数与治疗的临床反应之间均无明显相关性。与无法充分穿透硬癌肿瘤表面相关的技术并发症常常导致剂量分布不理想。支气管内198金植入与计算出的剂量分布不佳相关，但尽管如此，它仍是一种相对简单且成本较低的技术，常常能产生临床反应，在复发性支气管癌患者的管理中可能是一种有用的选择。
