endobronchial high dose rate brachytherapy
TRANSCRIPT
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
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