Radical endobronchial brachytherapy: a therapeutic alternative in selected cases

A 75-year-old male, former smoker (50 pack-years), with a history of squamous cell lung carcinoma treated with right lower lobectomy 20 years earlier, presented with progressive dyspnea at rest (mMRC IV) and hypoxemic respiratory failure. Chest computed tomography revealed a 14 mm nodular lesion in the left main bronchus. Bronchoscopy showed a lesion at the carina between the left upper and lower lobes, causing near-complete obstruction. Biopsy and partial endoscopic resection were performed, but follow-up demonstrated slight progression. Histopathology confirmed squamous cell carcinoma. Due to prior lobectomy, surgery was ruled out, and radical high-dose-rate endobronchial brachytherapy with Iridium-192 (30 Gy in six weekly fractions) was administered. Complete endobronchial resolution was achieved and maintained at six months. Endobronchial brachytherapy is a well-tolerated technique that delivers high radiation doses with minimal damage to surrounding tissue and may represent a radical therapeutic option in selected patients with localized endobronchial tumors not eligible for surgery or external radiotherapy.