Taulelle M, Chauvet B, Vincent P, Félix-Faure C, Bucciarelli B, Garcia R, Reboul F
Département de radiothérapie, clinique Sainte-Catherine, Avignon, France.
Bull Cancer Radiother. 1996;83(3):127-34. doi: 10.1016/0924-4212(96)81744-0.
Between September 1990 and March 1995, 189 patients were treated with high-dose-rate endobronchial brachytherapy. Most patients (70%) presented with either recurrent or persistent symptomatic endobronchial tumor after standard therapy. A minority of the patients (12%) had small endobronchial tumor and were unfit for surgical resection or radiotherapy. Treatment was delivered weekly and consisted of three to four 8- to 10-Gy radiotherapy fractions applied at 10 mm from the source. Major symptomatic improvement was obtained on hemoptysis (74%), dyspnea (54%), and cough (54%). Complete endoscopic response occurred in 54.5% of the cases. Median survival was 7 months for the entire group. For small strictly endobronchial tumors, complete response rate was 95.5%, median survival was 17 months, and 30-month survival was 46%, with a plateau starting at 18 months. The rate of late grade 3 to 4 toxicity was 17%, including hemoptysis (n = 13), stenosis (n = 12), local necrosis (n = 8), and bronchial fistula (n = 3). By univariate analysis, no factor was found to be predictive of late toxicity. Our study confirms the benefit of endobronchial brachytherapy in the palliative treatment of endobronchial recurrences and in the curative intent treatment of small endobronchial tumors in patients not suitable for other forms of therapy.
1990年9月至1995年3月期间，189例患者接受了高剂量率支气管内近距离放射治疗。大多数患者（70%）在标准治疗后出现复发性或持续性有症状的支气管内肿瘤。少数患者（12%）有小的支气管内肿瘤，不适合手术切除或放射治疗。治疗每周进行一次，包括在距放射源10毫米处给予三到四个8至10戈瑞的放射治疗分次。咯血（74%）、呼吸困难（54%）和咳嗽（54%）等主要症状有明显改善。54.5%的病例出现了完全内镜缓解。整个组的中位生存期为7个月。对于单纯的小支气管内肿瘤，完全缓解率为95.5%，中位生存期为17个月，30个月生存率为46%，从18个月开始出现平台期。3至4级晚期毒性发生率为17%，包括咯血（n = 13）、狭窄（n = 12）、局部坏死（n = 8）和支气管瘘（n = 3）。单因素分析未发现有因素可预测晚期毒性。我们的研究证实了支气管内近距离放射治疗在支气管内复发的姑息治疗以及不适合其他治疗形式的患者中小支气管内肿瘤的根治性治疗中的益处。
