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Ann Thorac Surg 2003;76:381-384
© 2003 The Society of Thoracic Surgeons

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Original article: general thoracic

High dose rate brachytherapy in the management of lung transplant airway stenosis

^a Division of Thoracic Surgery, Emory University Hospital and Emory Crawford W. Long Hospital, Emory University School of Medicine, Atlanta, Georgia, USA, Joseph Brown Whitehead Department of Surgery
^b Department of Radiation Oncology, Emory University Hospital and Emory Crawford W. Long Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
^c Andrew J. McKelvey Lung Transplantation Center, Emory University Hospital and Emory Crawford W. Long Hospital, Emory University School of Medicine, Atlanta, Georgia, USA

Accepted for publication February 27, 2003.

^* Address reprint requests to Dr Miller, Section of General Thoracic Surgery, The Emory Clinic, 1365 Clifton Rd, Building A, Atlanta, GA 30322, USA.
e-mail: jmille6331{at}aol.com

BACKGROUND: Airway complications after lung transplantation remain a major cause of postoperative morbidity and mortality. Interventional bronchoscopic management continues to be the main modality in the management of these problems.

METHODS: Four patients with airway stenoses after lung transplantation received high dose rate brachytherapy for management of recurrent stenosis. All 4 patients had been treated with various bronchoscopic interventions, including dilation and stenting, electrocautery ablation, and neodymium:yttrium-aluminum-garnet laser therapy. High dose rate endobronchial brachytherapy was subsequently used in all 4 patients for management of recurrent airway obstruction. The radiation dose for all 4 patients was 3 Gy at a distance of 1 cm from the center of the catheter.

RESULTS: All four patients have had routine follow-up after endobronchial brachytherapy treatments. Of the 4 patients, 2 treated with this modality showed a significant response to therapy in that the bronchus remained free of obstruction after treatment; 1 patient had partial improvement, and 1 patient failed to show significant improvement and expired from the sequelae of persistent airway obstruction.

CONCLUSIONS: Endobronchial brachytherapy can be an effective modality for managing recurrent stenoses caused by hyperplastic granulation tissue at the bronchial anastomosis. The optimal timing and ideal candidate for intraluminal radiation therapy for this problem remains a challenge and warrants further investigation.

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				A. Ernst, D. Feller-Kopman, H. D. Becker, and A. C. Mehta Central Airway Obstruction Am. J. Respir. Crit. Care Med., June 15, 2004; 169(12): 1278 - 1297. [Abstract] [Full Text] [PDF]