Brachytherapy for Carcinoma of the Lung

An estimated 157,000 patients died of lung cancer in the United States in the year 2000.[1] Although surgery can be curative, only about 20% of patients are amenable to complete surgical resection. Most of the other patients are treated with radiation therapy (external-beam irradiation and/or brachytherapy) and/or chemotherapy, with less than 10% surviving to 5 years.

Most patients referred for radiation therapy have large tumor volumes requiring high doses of radiation for control of locoregional disease. Dose escalation with external-beam radiation therapy is limited by tolerance of the surrounding normal structures. Brachytherapy is one method of delivering a higher radiation dose to the tumor while sparing the surrounding normal tissues, in an attempt to improve local control. Small or occult carcinomas of the lung in medically inoperable patients are another subgroup in whom brachytherapy can be used to boost the external-beam radiation dose.

The majority of lung cancer patients eventually have symptoms related to local progression and subsequently die from locoregional failure. Commonly reported symptoms from failure of local control include cough, dyspnea, pain, and hemoptysis, with the majority related to endobronchial disease. Therefore, management of the endobronchial and peribronchial component of lung cancer is quite important, even in patients with metastatic disease. Brachytherapy can be used for palliation in these patients.

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