External beam radiation therapy (EBRT) provides objective and symptomatic improvement for patients with tracheobronchial amyloidosis, according to a report in the July issue of Chest.

"Tracheobronchial amyloidosis is a rare disease," Dr. Robert L. Foote from the Mayo Clinic College of Medicine, Rochester, Minnesota told Reuters Health. "It is probably best for the patient, as well as for advancing our understanding of such diseases, that such patients be referred to tertiary centers for evaluation and management."

Dr. Foote and colleagues describe the results, side effects, and complications of EBRT in their seven patients with tracheobronchial amyloidosis who were treated between 1999 and 2004.

All patients received 20 Gy in ten fractions of 2 Gy, the authors report, and the fields included the entire trachea beginning just inferior to the vocal cords down to and including both mainstem bronchi.

All seven patients experienced symptomatic improvement or stabilization of symptoms a median of four months after EBRT.

Objective improvement was noted in two of three patients who had serial bronchoscopy, the investigators say, but objective improvement did not always correlate with symptoms.

Five patients developed acute esophagitis, which resolved in all patients, and one patient had grade 2 pneumonitis three weeks after EBRT. The pneumonitis resolved after ten days of antibiotic and corticosteroid treatment.

Summing up, Dr. Foote noted that "we plan to continue to treat patients with tracheobronchial amyloidosis refractory to medical therapy or whose disease is not amenable to local therapy such as laser therapy or placement of stents, with 20 Gy of radiation therapy and follow them long term with serial symptom review, pulmonary function testing, CT imaging, and bronchoscopic evaluation to document response to radiation therapy."

"If we see late progression of disease," he concluded, "we will study re-treatment with another 20 Gy of radiation therapy and increasing the initial treatment dose to 30 or 40 Gy.

TrackBack URI for this entry

Comments (0)

Subscribe to this comment's feed