Escobar Sacristán J, de Granda Orive J I, Gutiérrez Jiménez T, Martínez Albiach J M, Fuentes Ramos M, Herrera de la Rosa A
Servicio de Neumología, Hospital Militar Universitario Gómez Ulla, Madrid.
Arch Bronconeumol. 1997 Jun;33(6):278-83.
To assess clinical and bronchoscopic evolution as well as outcome in patients treated with high dose rate (HDR) endobronchial brachytherapy in order to determine its effectiveness for treating malignant airway obstruction. From May 1993 to January 1996, 10 patients (9 men and 1 woman) with bronchogenic carcinoma received 24 HDR endobronchial treatments. The mean age was 61.9 years (range 34 to 78 years). Inclusion criteria were, for palliative treatment, incurable endobronchial cancer, and, for curative treatment, residual tumor in the margins after resection, or endobronchial tumor that could not be treated surgically. Exclusion criteria were site of lesion unsuitable for placement of the brachytherapy catheter, life expectancy less than two months, Karnofsky index less than 60 or absence of signed consent from the patient. Response criteria was either complete or partial for symptoms and endobronchial tumor. Ten patients received 24 HDR endobronchial treatment from and HDR source of I192 radiation with remote afterloading. A flexible bronchoscope was passed down the bronchial tree toward the area affected by the tumor. At intervals of one week, four separate fractions between 5 and 10 Gy were delivered to a depth of 0.5 to 1 cm and a length of 1 to 5 cm. One month after the last session, each patient underwent endoscopic examination with removal of a histology specimen. Response was considered complete based on clinical signs in 66%; response was complete based on endoscopy in 50%. Three patients died within the first year after treatment and one patient did not return for a follow-up examination. Five patients who had been followed for less than one year were still living. The remaining patient was living 18 months after treatment. All tolerated the treatments well, showing neither early nor late complications. HDR endobronchial brachytherapy is effective both for preventing and relieving malignant endobronchial obstruction. Response to therapy is good, as shown by clinical symptoms and endobronchial examination. HDR endobronchial brachytherapy can cure in carefully selected patients.
评估高剂量率（HDR）支气管内近距离放射治疗患者的临床和支气管镜检查演变情况以及治疗结果，以确定其治疗恶性气道阻塞的有效性。1993年5月至1996年1月，10例支气管源性癌患者（9例男性，1例女性）接受了24次HDR支气管内治疗。平均年龄为61.9岁（范围34至78岁）。纳入标准为，姑息治疗时为无法治愈的支气管内癌，根治性治疗时为切除术后切缘残留肿瘤或无法手术治疗的支气管内肿瘤。排除标准为病变部位不适合放置近距离放射治疗导管、预期寿命少于两个月、卡诺夫斯基指数低于60或患者未签署知情同意书。症状和支气管内肿瘤的反应标准为完全缓解或部分缓解。10例患者接受了24次来自铱192辐射源的HDR支气管内治疗，采用远程后装技术。将可弯曲支气管镜经支气管树插入肿瘤累及区域。每隔一周，分4次给予5至10 Gy的剂量，照射深度为〇.5至1 cm，长度为1至5 cm。最后一次治疗后1个月，每位患者接受内镜检查并取组织学标本。66%的患者根据临床体征判断为完全缓解；50%的患者根据内镜检查判断为完全缓解。3例患者在治疗后第一年内死亡，1例患者未返回进行随访检查。5例随访时间少于1年的患者仍存活。其余1例患者在治疗后18个月仍存活。所有患者对治疗耐受性良好，未出现早期或晚期并发症。HDR支气管内近距离放射治疗在预防和缓解恶性支气管内阻塞方面均有效。临床症状和支气管内检查显示，治疗反应良好。HDR支气管内近距离放射治疗在经过精心挑选的患者中可实现治愈。
