Endobronchial brachytherapy]

Endobronchial brachytherapy was developed following the miniaturization of radio-active sources enabling the use of fiberoptic techniques to deliver treatment at high dose yet substantially reducing the duration of treatment. Endobronchial brachytherapy has been used in patients presenting with symptomatic obstruction of the proximal bronchial tree in association with laser therapy. The level of responses in these palliative indications is around 80 per cent. Currently, other investigations are undergoing evaluation to test the method in association with conventional treatment to determine whether brachytherapy can augment local control. In the treatment of small tumours when other conventional treatments are not possible brachytherapy employed alone has shown undoubted efficacy. However there remain numerous problems to resolve: what is the ideal protocol in terms of total dose, dose per fraction, the order of dosing and fractions? How can secondary complications to endoluminal irradiation be limited in particular for curative therapy. An answer should be found for all these questions before this technique is eventually integrated into the primary treatment regimes for bronchial cancer.