Endobronchial High Dose Rate Brachytherapy Endobronchial High Dose Rate Brachytherapy on Intubated Patients with Lung Canceron Intubated Patients with Lung Cancer

Richard Singh BSc MRTTClinical Education Leader/ Radiation Therapist

Juravinski Cancer CentreHamilton, Ontario

Canada

http://www.flickr.com/photos/ohtheclevernessofme/66332983/

ThemesI.

Multidisciplinary team, equipment, adaptation, challenges

II. Endobronchial High Dose Rate (EHDR) Brachytherapy procedure

III.

Three case reviews

HDR-Brachytherapy

PeoplePeople

EHDR Procedure EHDR Procedure 1.Bronchoscopy1.Bronchoscopy

Distal diameter = 5.5mm

2. Placement of treatment 2. Placement of treatment catheter across tumourcatheter across tumour

0.08cmX 150cm Teflon transfer catheter

3. Imaging

4. Planning4. Planning

5. Treatment5. Treatment

Airway challengesAirway challengesOcclusion of airflow with scope

– Positive End- Expiratory Pressure (PEEP)

Sealed airflow with catheter in placetape+ tooth pick at scope port maintains perfect seal

Case 1Case 1Ventilated 66 year old maleBronchial carcinoid with liver mets–

Had previous 20Gy/5 fraction to right chest with EBRT

x

Treatment summaryTreatment summaryFraction Tumour

locationTreatment time(min)

Treatment length (cm)

Total procedure time(min)

1 RUL 4 4 15

7 Gy @ 1.5 cm

Case 1 continued…Case 1 continued…

Lost to follow-up report successfully extubated

Case 2Case 2

Ventilated 58 year old female NSCLC

xx

x

x

Lt main stem bronchus

Carina

Rt. Bronchus intermedius

Case 2 continued….Case 2 continued….

14Gy in 2 fractions @ 1 cm to each lobeAverage SPO2 –

Fraction 1= 96.7% on ventilator

–

Fraction 2= 98% on ventilator

Treatment summaryTreatment summaryFraction Tumour

locationTreatment time(min)

Treatment length (cm)

Total procedure time(min)

1 RMS+RLLLMS+LLL

3.55.5

47

44

2 RMS+RLLLMS+LLL

6.25.1

86

75

Endpoint: Successfully extubated

Case 3Case 3

Ventilated 68 year old female SCLCHistory atrial fibrillation+ congestive cardiac failure

xx

x

Case 3Case 3 treatmenttreatment

2 fractions given one week apart on ventilatorAverage SPO2

–

Fraction 1= 96.4% on ventilator–

Fraction 2= 98.2% on ventilator

Treatment summaryTreatment summaryFraction Tumour

locationTreatment time(min)

Treatment length (cm)

Total procedure time(min)

1 RMS+ CLMS+ C

33

64

50

2 RMS+ CLMS+ C

44

86

50

End point of EHDR to this patientEnd point of EHDR to this patient

Extubated 48 hours after last fractionCarboplatin +etoposide chemotherapy 12 days after extubationCompleted Chemotherapy+ EBRT with PCI

ConclusionsConclusions

1. Endobronchial High Dose Rate Brachytherapy (EHDR) is a safe option for intubated lung cancer patients with lumen obstructive disease.

2. In the three cases presented, an effective end point of extubation was achieved.

Thank You for your attention Thank You for your attention