High dose rate brachytherapy in the management of lung transplant airway stenosis

Background Airway complications after lung transplantation remain a major cause of postoperative morbidity and mortality. Interventional bronchoscopic management continues to be the main modality in the management of these problems. Methods Four patients with airway stenoses after lung transplantation received high dose rate brachytherapy for management of recurrent stenosis. All 4 patients had been treated with various bronchoscopic interventions, including dilation and stenting, electrocautery ablation, and neodymium:yttrium-aluminum-garnet laser therapy. High dose rate endobronchial brachytherapy was subsequently used in all 4 patients for management of recurrent airway obstruction. The radiation dose for all 4 patients was 3 Gy at a distance of 1 cm from the center of the catheter. Results All four patients have had routine follow-up after endobronchial brachytherapy treatments. Of the 4 patients, 2 treated with this modality showed a significant response to therapy in that the bronchus remained free of obstruction after treatment; 1 patient had partial improvement, and 1 patient failed to show significant improvement and expired from the sequelae of persistent airway obstruction. Conclusions Endobronchial brachytherapy can be an effective modality for managing recurrent stenoses caused by hyperplastic granulation tissue at the bronchial anastomosis. The optimal timing and ideal candidate for intraluminal radiation therapy for this problem remains a challenge and warrants further investigation.