Brachytherapy at the Carina
I have a patient status post chemotherapy and radiation therapy for non-small cell (squamous) carcinoma of the right upper lung. He now has a recurrence confirmed by biopsy in his carina, and brachytherapy has been suggested. Is there any literature out there on brachytherapy at the carina? I understand that this is a rare place for a recurrence and brachytherapy may not have been tried at this anatomical site.
Stephen M. Hahn, MD, Professor of Radiation Oncology at Penn Medicine, responds:
The local insertion of radioactive seeds, or brachytherapy, might be a reasonable option for this recurrence. There are data for using brachytherapy in the airway. After prior external beam radiation therapy, there are some increased risks of toxicities from the cumulative radiation dose to normal tissues. There may also be a somewhat higher risk of side effects with brachytherapy to the carina, as opposed to a site lower down in the airway on just one side or the other. However, in general it is a good treatment option, especially if there is no current evidence for cancer spread to lymph nodes or distant sites. Also, if the recurrence is superficial, photodynamic therapy or other endobronchial laser therapy could also be considered. Thoracic reirradiation is also being studied to determine if treating the same region in the chest a second time with external radiation therapy is safe and effective.