In the early years of endobronchial brachytherapy low dose rate treatment was given. This is defined as less than 1Gy per hour at the point of reference. This approach requires a long indwell time of the radioactive wire, ranging from 30 to 96 hours.

The brachytherapy can be achieved by inserting a 2 mm polythene cathetertransnasally into the effected part of the tracheobronchial tree via a flexible fibre optic bronchoscope.This catherter called the afterload catheter is positioned under xray control and then loaded with the radioactive source. Manual manipulation of the radionucleotide is required. Most patients can tolerate the catheter although there were some irritations..

A different approach is by inserting the catheter through the cricothyroid membrane via a mini-trach device. This means that there is no catheter in the oropharynx to cause irritation. This approach has been very well tolerated.

The usual goal for brachytherapy is palliation of symptoms caused by airway obstruction from tumour. It has also been used to treat symptoms of cough and haemoptysis.

The major complications from brachytherapy are massive haemotysis and fistula formation. The risk of severe complications from endobronchial bratherapy may be caused by the location of the tumour as well as the therapeutic regimen. Brachytherapy should probably not be used where radiographic imaging indicates possible tumour invasion of pulmonary arteries or considerable destruction of the bronchial wall.

Generally, endobronchial brachytherapy may be used when further external beam radiotherapy cannot be given.