Endobronchial brachytherapy provides excellent long-term control of recurrent granulation tissue after tracheal stenosis

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• 作者：Aaron M. Allen¹ ; ^{aarona2@clalit.org.il} ; Nader Abdelrahman² ; David Silvern¹ ; Eyal Fenig¹ ; Oren Fruchter² ; Mordechai R. Kramer²
• 关键词：Tracheal stenosis ; Brachytherapy ; Bronchoscopy
• 刊名：Brachytherapy
• 出版年：2012
• 期刊代码：278_15384721
• 类别：med
• 出版时间：July-August, 2012
• 卷：11
• 期：4
• 页码：322-326
• 文件大小：401 K

摘要

Purpose

To review the experience of using endobronchial brachytherapy (EBB) as a treatment for recurrent tracheal granulation tissue.

Methods and Materials

Patients referred for EBB at the Rabin Medical Center for benign stenosis were reviewed with institutional review board approval. Patients underwent bronchoscopic resection of granulation tissue followed by insertion of self-expanding metallic stents. After stenting, repeat laser resection was done at least 1 week before brachytherapy. After CT simulation, patients had three-dimensional brachytherapy treatment planning. A single 10-Gy dose was prescribed to 1.0 cm from the source and treatment was delivered using high-dose-rate afterloader with ¹⁹²Ir source. Patients were followedup with bronchoscopy every 3 months after the completion of therapy.

Results

From November 2001 to January 2009, 29 patients were treated with EBB to prevent granulation tissue reformation. Median age was 70 years and 55%of patients were male. Ninety percent of patients were treated to the trachea and the remaining patients had stenoses in the main stem bronchi. The primary cause of stenosis was prolonged mechanical ventilation (76%). The median time from stent placement to brachytherapy was 69 days. Median active length of treatment was 7 cm. With a median followup of 36 months, 66%(19 of 29) of patients remained free of granulation tissue. Forty-eight percent of patients have died, with all except 1 patient dying of their underlying condition. A single patient experienced death from tracheoesophageal fistula.

Conclusion

EBB is an effective and safe treatment to prevent recurrent granulation tissue formation after endobronchial resection and should be considered in patients who are unable to undergo surgical resection.