[The results of the endoluminal high-dose-rate irradiation of central non-small cell bronchial carcinomas].

Between November 1987 and July 1991 34 patients with a non-small-cell lung cancer were treated with an endobronchial iridium-192 high-dose-rate afterloading therapy. In 13 patients with relapses after percutaneous irradiation brachytherapy was the sole radiotherapy modality with 20 (5 to 29) Gy within 14 (one to 42) days in four (one to six) fractions in a palliative sense. Endoscopically controlled, seven remissions (four complete, three partial) could be achieved. The median duration to local progression was two months, the median survival of this group was nine months. In 21 patients with a medically or surgically unresectable tumor a combined percutaneous (51 [46 to 60] Gy within 4.5 to six weeks) and endobronchial irradiation was done. This patient group consisted of one stage IV, eight stage IIIb, 8 stage IIIa, 1 stage II, 1 stage I patients and two patients with tumor relapses after surgery. Patients were selected for combined therapy by a mostly endo/peribronchial tumor volume. The brachytherapy was applied after an interval of 16 (one to 48) days with 17.5 (9 to 20) Gy in three to four fractions. In 13 patients six to eight weeks after treatment a complete remission by endoscopy was found. Patients with a complete remission had a statistically better survival than the remaining patients. The median estimated survival of this group until local progression was 16 months, the median survival 20 months. In all patients there were two occurrences of hemorrhage (one group I, one group II) and one tracheo-mediastinal fistula (group II), but in no case of these fatal events a local tumor control had been reached. In three patients radiogenic bronchitis occurred up to a degree, which demanded endoscopic interventions. This study suggests, that there might be a subgroup of centrally located lung cancer with endo/peribronchial tumor mass, which gains by a combined radiation treatment with an acceptable risk of side effects. The results should be evaluated in further randomized studies.