Brachytherapy in lung cancer: A review

Metastatic non-small cell lung cancer (NSCLC) remains the leading cause of cancer death worldwide. Intraluminal brachytherapy (ILBT) has been shown to improve patients' symptoms in some studies. However, its role in the palliation of these patients amidst the other local treatment modalities such as external beam radiotherapy (EBRT), laser and photodynamic therapy (PDT) remains unclear. We have completed a systematic review of the literature to evaluate outcomes of patients with lung cancer treated with ILBT alone and/or in combination with other treatment modalities. We have reviewed tumour and symptom response, overall survival (OS) and toxicities of patients treated with diverse fractionation schemes and those treated with a curative intent. Overall, ILBT is associated with improvement of patients' symptoms in most cases. Its toxicity profile is generally low with small risk of fatal hemoptysis. Further studies are needed to establish an optimal fractionation schedule, although it appears that fractionated treatments (3 fractions) were associated with less toxicity yet similar symptom relief when compared to single fraction treatments. Caution must be taken when prescribing the dose to avoid necrosis and or fistula that may be lead to fatal hemoptysis.