Endobronchial brachytherapy as palliative care for people with inoperable non-small cell lung cancer

Cardona Zorrilla AF, Reveiz L, Ospina EG, Yepes A

Published Online:

January 21, 2009

Patients with inoperable non-small cell lung cancer (NSCLC) have a poor prognosis and the therapeutic options are limited to controlling their symptoms and maintaining their quality of life. Palliative endobronchial brachytherapy (EBB) is used as a treatment option to improve local control of the tumor, the patient's symptoms and quality of life. We were not able to provide conclusive evidence from randomized controlled trials to support the use of EBB in combination with external beam radiation therapy (EBRT), chemotherapy or Nd-YAG laser. EBRT alone was more effective for palliation of the symptoms of NSCLC than EBB alone in the present trials. For patients previously treated with EBRT and who are symptomatic from recurrent disease because of central endobronchial obstruction, EBB may be considered in selected cases.

Abstract (click to read)

Background:

Non-small cell lung cancers (NSCLC) constitutes about 80% of all lung cancer cases. Although surgery is the only curative treatment of NSCLC, fewer than 20% of tumors can be radically resected. Radiotherapy is one of the main treatment modalities in lung cancer, contributing to both its cure and palliation. Endobronchial brachytherapy (EBB) has been used as one approach to improve local control either alone or in combination with other treatments.

Objectives:

To assess the effectiveness of palliative EBB in increasing survival and to control thoracic symptoms in patients with advanced NSCLC compared with external beam radiation therapy (EBRT) or other alternative endoluminal treatments.

Search strategy:

The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and other databases were searched, as were reference lists and handsearching of selected journals and conference proceedings.

Selection criteria:

Randomized controlled trials (RCTs) comparing different regimens of palliative EBB with EBRT or other endobronchial interventions in patients with advanced NSCLC.

Data collection and analysis:

Thirteen RCTs were included. There were important differences in the doses of radiotherapy investigated, patient characteristics and the outcomes measured. Because of this heterogeneity no meta-analysis was attempted.

Main results:

We found trials comparing EBB to EBRT alone, EBB plus EBRT to EBRT alone, EBB plus chemotherapy to EBB alone, EBB to Nd-YAG laser and comparisons between diverse fractionation schedules of high dose rate EBB. From the heterogeneous information obtained from several small RCTs, we concluded that EBRT alone is more effective for palliation of NSCLC symptoms than EBB alone. Our findings did not provide conclusive evidence to recommend EBB plus EBRT to relieve symptoms compared to EBRT alone. Overall, for the primary endpoint of survival there was no evidence of benefit for EBB compared to EBRT and Nd-YAG laser or for the combination of EBB with chemotherapy. Additionally, findings from one trial suggested that twice 7.4 Gy was superior to the four times per week 3.8 Gy schedule for mean time of local control and fatal haemoptysis. No significant differences were found for fatal haemoptysis as an adverse event of EBB.

Authors' conclusions:

The evidence did not provide conclusive results that EBB plus EBRT improved symptom relief over EBRT alone. We were not able to provide conclusive evidence to recommend EBB with EBRT, chemotherapy or Nd-YAG laser. For patients previously treated by EBRT who are symptomatic from recurrent endobronchial central obstruction, EBB may be considered in selected cases.

This record should be cited as:

Cardona Zorrilla AF, Reveiz L, Ospina EG, Yepes A. Palliative endobronchial brachytherapy for non-small cell lung cancer. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD004284. DOI: 10.1002/14651858.CD004284.pub2

Assessed as up to date:

December 20, 2007

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Primary Review Group:

Lung Cancer Group

Health topics:

Cancer > Lung > Non-small cell

Lungs & airways > Lung cancer > Non-small cell

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Endobronchial brachytherapy as palliative care for people with inoperable non-small cell lung cancer

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