Combined Nd-YAG laser/HDR brachytherapy versus Nd-YAG laser only in malignant central airway involvement: a prospective randomized study

Background: Laser debulking and prosthetic stents are useful modalities in the palliative treatment of initial inoperable or recurrent lung cancer. Recently. endobrochial brachytherapy was introduced to extend the duration of palliation and reduce the number of endoscopic treatments. This trial compares Nd-YAG laser alone and associated to high dose rated (HDR)-brachytherapy. Patients and Methods: From 1995 to 1998, 29 consecutive patients, with non-small cell lung cancer (NSCLC) and central airway involvement, were randomized in two groups: group 1 (15 patients) received Nd-YAG laser only: group 2 (14 patients) underwent a combined Nd-YAG laser HDR brachytherapy treatment. Results: There was no mortality or morbidity related to the treatment. The period free from symptoms was 2.8 months for group 1 and increased to 8.5 months in group 2 (P < 0.05). The disease's progression free period grew from 2.2 months of group 1 to 7.5 months of group 2 (P < 0.05) and the number of further endoscopic treatment reduced from 15 to 3 (P < 0.05). Conclusion: The results confirm the potential of brachytherapy to prolong relief from symptoms. lessen disease progression and reduce costs of treatment. A detailed analysis is presented of both groups. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.