Prodromal face of a study: High dose rate endobronchial brachytherapy (HDERB) as a first step introductory treatment of a multimodality therapy approach in non operable NSCLC with endobronchial obstruction

Introduction: Lung cancer patients frequently present with advanced stage. HDREB has always been used as a palliative treatment option in end-stage disease, and has not yet been thought of as a first-step therapeutic approach of a multimodality treatment strategy. We strongly feel that HDERB could be the method of choice in carefully selected patients with endobronchial obstruction, prior to other treatments. Aim: HDERB could be used as a first-step, introductory treatment in selected patients with inoperable obstructive endobronchial carcinoma of the lungs. Methods: A catheter is placed through bronchoscopy in the obstructed lumen. HDREB is delivered in two sessions separated by one week. Bronchoscopy is performed 3 weeks later. Pulmonary function tests are preformed before and after HDREB monthly. Evaluation of quality of life is assesed with Saint Georges Respiratory Questionaire. Obstruction score is also evaluated before and after treatment. Results: Six patients with previously untreated, inoperable NSCLC associated with endobronchial obstruction, were treated with HDREB as an introductory treatment of a multimodality therapeutic approach. We found significant improvement on symptoms (cough, dyspnoea, hemoptysis) and intraluminal reduction of the obstruction. Conclusions: HDREB is a low-cost, semi-invasive, and well-tolerated method that has been applied with a limited palliative purpose, whilst it could provide an improved performance status and partial disease regression early enough, giving the patient the opportunity of a better outcome of treatment, overall.