ABSTRACT FINAL ID: 127;
Randomized Prospective Study on the Role of High Dose Rate Intraluminal Brachytherapy (HDRILBT) in
Palliation of Symptoms in Advanced Non Small Cell Lung Cancer (NSCLC) Treated With Radiation
AUTHORS (ALL): Sur, Ranjan 1, 2; Donde, Bernard 2; Mohuiddin, Mohamed 2; Ahmed, Nisar 2; Pacella,
Juan 3; Mohamed, Goolam 2; Morar, Raj 2; Feldman, Charles 2.
INSTITUTIONS (ALL): 1. Radiation Oncology, McMaster University, Hamilton, ON, Canada.
2. Radiation Oncology, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
3. Radiation Oncology, Allan Blair Cancer Centre, Regina, SK, Canada.
Purpose/Objective: To analyze the effectiveness of HDRILBT boost when compared to external beam
radiotherapy (EBRT) boost in palliation of symptoms of advanced NSCLC treated with palliative
Materials/Methods: 65 patients with advanced inoperable stage III NSCLC who were not suited for/
refused chemoradiotherapy treatment and who had luminal disease demonstrable on bronchscopy were
treated with palliative EBRT of either 30 Gy in 10 fractions, 36 Gy in 18 fractions or 40 Gy in 20 fractions
using antero posterior fields. Thereafter patients were randomized to receive either HDRILT boost (Group
A) of 12 Gy in 2 fractions over 2 weeks, 6 Gy per fraction weekly or EBRT of 20 Gy in 10 fractions over 2
weeks (Group B) using planned fields. The biologically effective doses (ID2) for both the groups were
similar for acute and late effects. The patients were followed up and relief of symptomatology (cough,
shortness of breath, chest pain and hemoptysis) was recorded at each follow up.
Results: The median duration of symptom free survival following treatment was 77 days in Group A and
129 days in Group B (p= 0.0090). EBRT boost was therefore more effective than HDRILBT boost in
palliating symptoms of advanced NSCLC for a longer period of time. When each of the symptoms was
examined separately, there was no difference in the hemoptysis free survival duration (the median survival
was not reached in both groups, p= 0.2994), chest pain free survival duration (median Group A 127, Group
B 113 days p= 0.2768) and dyspnoea free survival duration (median Group A 311, Group B 336 days, p=
0.9158) amongst the two groups. Only the cough free survival was improved amongst patients who
received EBRT boost (Group A 133 days, Group B 141 days, p= 0.0464). On univariate and multivariate
analysis none of the prognostic factors evaluated had an impact on overall survival which was similar in the
two groups at one year (Group A 29.7%, Group B 29.4%, p> 0.05). No complications of treatment were
recorded in either group.
Conclusions: In our experience EBRT boost provided longer symptom palliation than HDRILBT boost in
patients with NSCLC treated with radiotherapy for palliation. HDRILBT is a safe modality of treatment
and further studies in combination with EBRT are warranted in a randomized prospective setting.
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