SP-0184: Underestimated importance of Intraluminal brachytherapy: bronchus, oesophageal, anorectal and hepatobiliary duct cancer

Abstract

Intraluminal brachytherapy is still an important part of brachytherapy procedures done especially in palliative patients. But large differences between countries over the world are observed. It is not clear how the future of intraluminal brachytherapy will look like. Brachytherapy is one of the most efficient methods in overcoming difficulties in breathing that is caused by endobronchial obstruction in palliative treatment of bronchus cancer. Depending on the location of the lesion in some cases brachytherapy is a treatment of choice. Because of uncontrolled local or recurrent disease, patients may have significant symptoms such as: cough, dyspnea, haemoptysis, obstructive pneumonia or atelectasis. Efforts to relieve this obstructive process are worthwhile, because patients may experience improved quality of their life. Brachytherapy plays a limited but specific role in definitive treatment with curative intent in selected cases of early endobronchial disease as well as in the postoperative treatment of small residual peribronchial disease. Various methods of palliation have been used in an attempt to improve patients' quality of life and to provide near normal, if not normal, swallowing until death occurs because of progressive esophageal cancer. Endoesophageal brachytherapy makes it possible to use high doses of radiation to the tumor itself with concurrent protection of adjoining healthy tissues due to the rapid fall in the dose with the square of the distance from the center of the dose. The above treatment also leads to a smaller proportion of late radiation complications. The aim of palliative brachytherapy is to reduce dysphagia, diminish pain and bleeding, and to improve the patient's well-being. Palliative treatment options for bile duct cancer or pancreas cancer remain limited due to the large number of patients with advanced disease at the time of diagnosis. Radical surgery is possible in less than 10-15% of these cases. Unrespectable bile duct or pancreas cancers are very difficult to treat with external beam therapy alone due to the proximity of adjacent normal organs and the high doses required to effectively irradiating these neoplasms. Although the results available in the literature are somewhat contradictory as regards the possible use of intraluminal brachytherapy in a curative setting, some evidence indicates that intraluminal brachytherapy can add something to the treatment of unresectabbe extrahepatic bile duct and pancreatic cancers if a proper subset of patients is identifled and a rational and aggressive scheme of mubtimodality treatment is designed. High rate of advanced cases affects the enrollment of brachytherapy (BT) into treatment of bile duct cancers. Indications for brachytherapy include all malignant strictures of the bile duct which can be cannulated. Intraluminal brachytherapy (ILBT) is an important component in the multimodality approach to bile duct cancers. The objective of this treatment is to deliver a high local dose of radiation to the tumor while sparing surrounding healthy tissues. The treatment can be safely adapted for right and left hepatic duct as well as for common bile duct lesions. The standard of care in rectal cancer is still surgery. For limited size rectal cancer (T1, small T2), brachytherapy alone offers an alternative to radical surgery and leads to excellent results without major morbidity. In advanced rectal cancer, a proportion of patients can achieve complete clinical response after external beam chemoradiotherapy (EBCRT) that can be demonstrated on MRI after neoadjuvant treatment. Chosen summarized indications, treatment schedules, results and complications are discussed in the following presentation.