How do you approach the management of an early stage non-small cell lung cancer limited to an endobronchial location (non-obstructing) in a patient that is not considered operable due to medical comorbidities?
What dose/fractionation would you recommend for an endobronchial Stage I NSCLC?
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The use of SBRT is predicated on CT based imaging so that a physical and visible target can be delineated and for which a radiotherapy plan can be generated. For patients where no such imaging-definable lesion has been identified, as with for example, an endobronchial-only lesion noted at the time of bronchoscopy, our institutional practice then for medically inoperable lesions has been not to employ SBRT as definitive management. This would extend to conventionally fractionated RT also. There i...
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Generally, favor concurrent chemoradiation to 60 Gy in 30 fractions in these cases particularly if we are talking about the involvement of proximal bronchial tree due to concern for bronchial necrosis and hemorrhage as detailed by Dr. @Dr. First Last above. I do frequently utilize SBRT-like hypofractionated regimens including 60 Gy/8 fractions and 70 Gy/10 fractions to central and ultra-central lesions, however, true endobronchial lesions give me pause. The Nordic HILUS trial (Lindberg et al., P...
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We are all aware of the enthusiasm for SBRT in early stage lung cancer. But, if it's because we think it is more likely to help our patients live a long time, then we must always be mindful about the risks of late effects. Once the cartilaginous structures of the bronchus necrose, bad things can happen - including lobar/sublobar collapse, or even hemorrhage. As such, many thought leaders in our field increasingly agree that it might be best to turn down the daily dose rate for tumors abutting an...
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We have implanted many tracheal and paratracheal malignant lesions with ct-guided permanent seed brachytherapy and have not seen necrosis even in patients who had salvage implant following failed external beam, documented by repeated bronchoscopies.
CT-guided permanent seed brachytherapy is a simple and effective outpatient technique not requiring extensive resources and demonstrates a very low toxicity profile.
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