Massive haemoptysis death and other morbidity associated with high dose rate intraluminal radiotherapy for carcinoma of the bronchus

Brachytherapy in lung cancer

“…Other authors refer only to patients with stage IV disease or tumors recurrent after full-dose external beam [27]. Tumor stage and/or patient performance factors are difficult to determine from some large reports [28].…”

“…One of the largest reported series of patients treated with palliative brachytherapy alone is from the Christie Hospital in Manchester, England [28]. Three hundred and twenty-two patients with inoperable nonsmall cell lung cancers were treated with a single fraction of [15][16][17][18][19][20] Gy HDR intraluminal brachytherapy, with the dose prescribed 1 cm from the central axis of the catheter.…”

“…Although endobronchial brachytherapy is frequently utilized to palliate hemoptysis, it is ironic that one of the major concerns regarding lung brachytherapy has been the association between the treatment and subsequent fatal massive hemoptysis observed by several authors [27,28,38]. An unexpectedly high incidence of hemoptysis has not been reported in the majority of clinical studies involving endobronchial brachytherapy.…”

Indikationen für thoraxchirurgische Interventionen

“…Eine Röntgenaufnahme im Liegen mit anschließender flexibler Bronchoskopie über den liegenden Tubus kann zum einen den Atemweg wieder benutzbar machen und zum anderen die Quelle und das Ausmaß der Blutung eruieren. Gleichzeitig dient die flexible Bronchoskopie der Möglichkeit, den endotrachealen Tubus selektiv in den kontralateralen Atemweg zu platzieren, was zur Beatmung und damit zum Überleben des Patienten elementare Voraussetzung ist [8,12].…”

“…d. h., die technische Resektabilität muss sicher gegeben und die funktionelle Reserve des Patienten ausreichend sein [8,12,15,20,21].…”