Most patients with malignant disease of the lungs will, at some time in their course, require palliative therapy. Previously, this has centered on radiotherapy for non-small cell and chemotherapy and/or radiotherapy for small cell tumors. The prospects for those who remain symptomatic or whose symptoms recur after maximum tolerated radiotherapy are bleak. Symptomatic therapy with increasing doses of narcotics or cough suppressants are all that can usually be offered.
Bronchoscopic placement of radiation sources was first reported by Ormerod in 1937. He implanted radon seeds into 67 patients via the rigid bronchoscope. Without quoting specific response rate, he noted a number of successful implantations. Pool reported on 44 patients who underwent similar implantations. Two of his patients died during the procedure, but he was impressed with the techniques utility for treating tracheal lesions or bronchial stump recurrence. More recently, Hilaris et al, also using a rigid bronchoscope, implanted Radon or 1 into 62 patients. Local control was achieved in 52 to 54 percent of his patients. All patients with hemoptysis responded. In a small series of six patients, Mendiondo et al successfully palliated local recurrence of tumor using endobronchial radiation delivered by a variety of techniques. We believe that ours is the first report of the use of the fiberoptic bronchoscope for implantation of radiation sources specifically to palliate endobronchial neoplasm.