Braquiterapia endoluminal HDR no tratamento de tumores primários ou recidivas na árvore traqueobrônquica

 

Maria Fortunato 1

Salvato Feijó 3

Telma Almeida 1

Vera Mendonça 1

Margarida Aguiar 3

Marília Jorge 1

Isabel Monteiro Grillo 1,2

 

 

Resumo

Introdução: Tumores localmente avançados como forma de apresentação inicial dos tumores localizados na árvore traqueobrônquica não são um fenómeno raro. A recidiva brônquica é um acontecimento frequente na história natural de algumas neoplasias. As opções terapêuticas são múltiplas, sendo no entanto dependentes de variáveis, como a terapêutica inicial utilizada, o local da recorrência, a sintomatologia e as condições físicas do doente.

Objectivos: Demonstrar as principais vantagens terapêuticas da braquiterapia endoluminal (BTE) com alta taxa de dose (HDR) em tumores primários e na recidiva tumoral localizada na árvore traqueobrônquica.

Material e métodos: Avaliámos retrospectivamente sete doentes (dts) com tumor primário do cólon, traqueia e pulmão. A recidiva traqueobrônquica (dois dts na traqueia e cinco dts no brônquio) ocorreu entre Março de 2003 e Setembro de 2004, os dts foram submetidos a BT HDR como terapêutica primária ou na recidiva, em associação com RTE, laserterapia e quimioterapia (QT), com intuito paliativo/ curativo. Na BTE HDR foram utilizadas doses de 5 a 7 Gy em duas a quatro fracções, prescritas a 1 cm do eixo da fonte. O tratamento consistiu na aplicação endoluminal de Ir192, utilizando um cateter 6 French.

Resultados: Verificámos o rápido alívio sintomático associado à redução da massa tumoral em seis dos sete doentes submetidos a esta técnica. Em um dos seis doentes estudados observou-se uma progressão da doença local entre a 2.ª e a 3.ª fracções de tratamento (obstrução da traqueia). Com um follow-up mediano entre a terapêutica com BT e a avaliação do presente estudo de 17 meses (2 -40), três doentes estão vivos, um sem evidência de doença e dois apresentam uma recidiva brônquica; quatro faleceram, um após hemoptise maciça e três por progressão da doença.

Discussão e conclusões Os dts submetidos a BT após recidiva tumoral endobrônquica ou com tumores primários sintomáticos apresentam uma boa tolerância e um alívio sintomático associado a uma boa qualidade de vida. Apesar da reduzida amostra, os resultados demonstram as eventuais vantagens da BTE de HDR no tratamento paliativo/ curativo destes doentes

Palavras-chave: Braquiterapia de alta taxa de dose, carcinoma do pulmão, obstrução da árvore traqueobrônquica

 

 

Endoluminal high dose rate brachytherapy in the treatment of primary and recurrent bronchogenic tree malignancies

Abstract

Introduction: Locally advanced tumours as the initial form of presentation of tumours in the bronchial tree are not a rare event. Bronchogenic recurrence is frequent in the natural history of some tumours. The choice of therapeutic options from the raft available depends on such variables as initial therapy, place of recurrence, symptoms and patient’s physical status.

Aim: To demonstrate the advantages of endoluminal brachytherapy (EBT) with high dose rate (HDR) in primary and recurrent tumour of the bronchial tree.

Material and methods: A retrospective study of seven patients (pts) with primary tumours of the colon, trachea and lung. Tracheobronchial recurrence (trachea, two pts, bronchus, five pts) occurred between March 2003 and September 2004. Patients under-went EBT with HDR for primary or recurrent therapy in association with external radiotherapy, laser therapy and chemotherapy with palliative or curative intention. EBT with HDR doses of 5 to 7 Gy in 2 to 4 fractions at 1 cm from the source axis were given. Treatment included endoluminal application of Ir192 with a French 6 catheter.

Results: There was symptomatic relief related to reduction of tumour in six of the seven patients treated.

In one of the six patients studied, there was progression of the local disease between the second and third fractions of the treatment (obstruction of the trachea). In a mean follow up of 17 (2-40) months between EBT and this study, three patients are alive, one has no evidence of disease while two have had bronchial recurrence, four patients have died, one after massive haemoptysis and three due to disease progression.

Discussion and conclusions: Patients undergoing brachytherapy for symptomatic primary tumours or endobronchial recurrence show good tolerance, important symptom relief and improved quality of life.

Despite the small size of our sample, it is clear that EBT with HDR plays an important role in the palliative/curative treatment of these patients.

Key-words: High dose brachytherapy, lung cancer, tracheobronchial obstruction.

 

 

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1 Hospital de Santa Maria, Serviço de Radioterapia

2 Instituto de Medicina Molecular, Faculdade de Medicina – Universidade de Lisboa

3 Hospital de Santa Maria, Serviço de Pneumologia

 

Correspondência/Correspondence to:

Maria Fortunato

Serviço de Radioterapia do Hospital de Santa Maria, CHLN

Avenida Professor Egas Moniz, Lisboa, Portugal

E-mail: mfortunatoruivo@hotmail.com

 

Recebido para publicação/received for publication: 08.08.01

Aceite para publicação/accepted for publication: 08.11.06