Brachytheray By Suspension Of Iodine-125 Seeds In Respiratory Tract For Malignant Airway Stenosis

Objective: To appraise the feasibility and safety of implantation of iodine-125 seeds in respiratory tract, and to evaluate the efficacy and complications of brachytherapy by suspension of iodine-125 seeds in respiratory tract for malignant airway stenosis. Methods: From November 2002 to January 2004, 48 specimens of lung cancer with malignant airway obstruction were collected. Diagnosis was confirmed by biopsy. All patients were not treated by radiotherapy or chemotherapy during the study because of objective or subjective reasons. The patients consisted of 39 males and 9 females. Their age range was from 46 to 75 years with a mean of 63.71±7.04 years. Histological diagnoses included squamous cell carcinoma in 24 patients, adenocarcinoma in 11 and small cell carcinoma in 13. According to the International Staging System for lung cancer, 26 were stage IIIA, 15 stage IIIB and 11 stage IV. Karnofsky performance status (KPS) rang from 40 to 70. The patients were divided into the control group (26 cases) and study group (22 cases) randomly. Both groups were comparable with respect to age, sex, tumor stage, KPS, and histology (P>0.05). The treatment in control group was only ordinary methods, such as anti-infection, spasmolysis, relieving cough, eliminating phlegm, haemostasis and nutritional support. The patients of study group were treated by brachytherapy and ordinary methods. Prospective evaluation before and 3 months after treatment of brachytherapy included assessment of performance status, symptoms, pulmonary function, extent of atelectasis (chest radiography) and bronchoscopic determination of degree of endobronchial obstruction. Results (1) The method of implantation of iodine-125 seeds in respiratory tract was convenient. All operations were successfully fulfilled. The vital signs of patients were stable during the operation. Only one patient had not finished the treatment program for multiple organ failure. (2) The short term effect of brachytherapy by suspension of iodine-125 seeds in respiratory tract: ①clinical symptom: In the study group, 2 with complete and 9 with partial relief of cough; 6 with complete and 9 with partial relief of dyspnea; 3 with complete and 5 with partial relief of hemoptysis; 1 with complete and 3 with partial relief of obstructive pneumonia. The symptomatic response rate is 50.00% for cough, 68.18% for dyspnea, 72.73% for hemoptysis and 66.67% for obstructive pneumonia. Significant difference existed between the two groups (P<0.05). ②Quality of life: According to KPS, the improvement of performance status in study group was significant compare tocontrol group:5 with complete and 9 partial relief vs 0 with complete and 5 with partial relief (p<0.05). ③Chest radiography and bronchoscopy:In study group,63.64 percent of patients had radiographic improvement and 72.73 percent achieved a bronchoscopic response. Statistically significant difference was observed between the two groups (P<0.05). ④Respiratory function test after treatment of study group showed improvements in VC from 2.11±0.36L to 2.75±0.56L (P<0.01), FEV1 from 0.99±0.3L to 1.56±0.49L (P<0.01) and FVC from 1.7±0.29L to 2.3±0.37L (p<0.01). (3) The relation of clinical effect and histological type: No statistically significant difference was observed when the patients were classified according to histological type. (4) The relation of clinical effect and airway constriction: The improvements in cough, dyspnea and quality of life were more significant in the central tumor group than in peripheral tumor group (P<0.05). (5) Complications: No significant complications related to brachytherapy by suspension of iodine-125 in respiratory tract were observed during the study. (6) Survival:The survival time of study group (2.5-7.2 months) was similar to control group (1.9-6.8 months). ( P>0.05) Conclusion: Brachytherapy by suspension of iodine-125 seeds in respiratory tract can not improve significantly the...