This document summarizes the use of endobronchial high dose rate brachytherapy (EHDR) on intubated lung cancer patients. It describes the EHDR procedure, which involves bronchoscopy, catheter placement across the tumor, imaging, planning, and treatment delivery. Three case studies are presented, where intubated patients with lung cancers received 2-4 fractions of EHDR over 1-2 weeks. All three patients achieved the endpoint of successful extubation after treatment, with average oxygen saturation levels maintained during treatment. The document concludes that EHDR is a safe option for intubated lung cancer patients with airway obstruction and can effectively lead to extubation.

1. Endobronchial High Dose Rate Brachytherapy
on Intubated Patients with Lung Cancer
Richard Singh BSc MRTT
Clinical Education Leader/ Radiation Therapist
Juravinski Cancer Centre
Hamilton, Ontario
Canada

3. Themes
Multidisciplinary team, equipment,
I.
adaptation, challenges
II. Endobronchial High Dose Rate (EHDR)
Brachytherapy procedure
III. Three case reviews

4. HDR-Brachytherapy

5. People

6. EHDR Procedure
1.Bronchoscopy
Distal diameter = 5.5mm

7. 2. Placement of treatment
catheter across tumour
0.08cmX 150cm Teflon transfer catheter

8. 3. Imaging

9. 4. Planning

10. 5. Treatment

11. Airway challenges
Occlusion of airflow with scope
Positive End- Expiratory Pressure (PEEP)
–
Sealed airflow with catheter in place
tape+ tooth pick at scope port maintains
perfect seal

12. Case 1
Ventilated 66 year old male
Bronchial carcinoid with liver mets
– Had previous 20Gy/5 fraction to right chest
with EBRT
x

13. Treatment summary
Total
Treatment
Fraction Tumour Treatment
procedure
length
time
location
time
(cm)
(min)
(min)
1 RUL 4 4 15
7 Gy @ 1.5 cm

14. Case 1 continued…
Lost to follow-up report successfully extubated

15. Case 2
Ventilated 58 year old female NSCLC
x x
x
x

16. Rt. Bronchus intermedius
Carina
Lt main stem bronchus

17. Case 2 continued….
14Gy in 2 fractions @ 1 cm to each
lobe
Average SPO2
– Fraction 1= 96.7% on ventilator
– Fraction 2= 98% on ventilator

18. Treatment summary
Total
Treatment
Fraction Tumour Treatment
procedure
length
time
location
time
(cm)
(min)
(min)
1 RMS+RLL 3.5 4 44
LMS+LLL 5.5 7
2 RMS+RLL 6.2 8 75
LMS+LLL 5.1 6
Endpoint: Successfully extubated

19. Case 3
Ventilated 68 year old female SCLC
History atrial fibrillation+ congestive
cardiac failure
x
x
x

20. Case 3 treatment
2 fractions given one week apart on
ventilator
Average SPO2
– Fraction 1= 96.4% on ventilator
– Fraction 2= 98.2% on ventilator

22. Treatment summary
Total
Treatment
Fraction Tumour Treatment
procedure
length
time
location
time
(cm)
(min)
(min)
1 RMS+ C 3 6 50
LMS+ C 3 4
2 RMS+ C 4 8 50
LMS+ C 4 6

23. End point of EHDR to this patient
Extubated 48 hours after last fraction
Carboplatin +etoposide chemotherapy 12
days after extubation
Completed Chemotherapy+ EBRT with
PCI

24. Conclusions
Endobronchial High Dose Rate
1.
Brachytherapy (EHDR) is a safe option for
intubated lung cancer patients with lumen
obstructive disease.
In the three cases presented, an effective
2.
end point of extubation was achieved.

25. Thank You for your attention