Lung cancer is the leading cause of cancer associated deaths in the United States and Europe [1, 2] with the majority of patients presenting with metastatic disease . Although substantial improvements in terms of survival time and quality of life have been achieved over the last decades [4, 5], palliation of local and systemic cancer associated symptoms remains one main objective in the treatment of these patients. Local symptoms including dyspnea due to airway obstruction, cough and hemoptysis respond to chemotherapy  and external beam radiotherapy . Nonetheless, in a substantial number of patients, local symptoms may not be treated sufficiently  with more than 50% of the patients still suffering from cough, dyspnea and hemoptysis  stressing the need for further therapeutic strategies.
In this context brachytherapy is highly effective in palliating local symptoms like bleeding, cough and airway obstruction, yielding improvements in the majority of patients [9–16].
Although randomized data demonstrated a more sustained palliative effect of external beam radiotherapy (EBRT) when compared to a single dose brachytherapy, this was achieved at the expense of more acute side effects in the EBRT group and a substantially longer treatment time (10 – 12 days for EBRT versus a single treatment session for brachytherapy) .
Thus, especially in patients with limited prognosis presenting with local symptoms, high dose rate brachytherapy (HDR-BT) offers a number of advantages including short treatment time, a relatively fast onset of treatment response and less acute side effects, probably by limiting irradiated volumes of normal tissue.
Brachytherapy has also been proven to be clinically useful in order to prolong the effect of laser recanalization and prevent stent obstruction by tumor overgrowth .
With curative intent, brachytherapy has been utilized with some success as a boost to conventional external beam radiotherapy [19, 20] or as definitive treatment for stage I lung cancer . However, in some series with longer follow up, relatively high rates of bronchial obstruction and fatal bleedings had been observed [19, 21, 22]. One non-randomized study compared different radiation doses (single dose of 20 Gy or 15 Gy at 1 cm from the central axis of the radiation source). In this study, multivariate analysis identified high single dose as a risk factor for fatal hemoptysis .
Although the effectiveness of HDR-BT in a palliative context is proven, no randomized data were available concerning the questions of optimal treatment dose and fractionation. Therefore we initiated a prospective randomized trial comparing two fractionation schedules in palliative lung cancer treatment. Interim results of this study obtained up to November 1993 were presented in 1995 . Here we present retrospective a analysis with more patients and longer follow-up.