Brachytherapy in the Treatment of Non-Small Cell Lung Cancer

Abstract

The literature review is dedicated to analysing the feasibility, efficacy and safety of using brachytherapy in non-small cell lung cancer. A small number of publications highlighting this issue attract attention. It is shown that the method can be implemented with different isotopes and radiation dose rate options from ultra-low to high. There are three main approaches to brachytherapy in thoracic oncology: intraoperative, interstitial and intraluminal. A number of clinical trials, prospective randomised trials and meta-analyses have shown that brachytherapy significantly increases objective response, local control and survival rates in both localised and widespread disease, with acceptable side effects. The focus is on the possibilities of using intraluminal endobronchial brachytherapy in central lung cancer with lesions of the large bronchi and trachea as part of radical, palliative and symptomatic treatment. It has been shown that it is preferable to use equipment with a high dose rate source in order to shorten the duration of the sessions and reduce patient pain. It is a reasonable method when the options of radiotherapy and chemotherapy have been exhausted. It is recommended that the appropriateness of endobronchial brachytherapy be determined on an individual basis. The own data show that median survival in the endobronchial brachytherapy group was 19 months versus 8 months in the no brachytherapy group, I-year overall survival was 68 % versus 33 %, and 2-year survival was 37 % versus 8 %. One of the indications for palliative use of the method is endobronchial obstruction, especially recurrent. It is recommended that new randomized controlled trials (RCTs) be conducted to evaluate the efficacy and safety of the method. Improvements in brachytherapy outcomes can be achieved through the use of modern hightech equipment, improved planning systems, radiation dose calculation methods, fractionation mode and optimization of combination with systemic treatment.