Ablative Procedures and Additional Anticancer Therapy Prolong the Survival in Patients With Endoluminal or Mixed-type Malignant Central Airway Obstruction: A Single-institution Retrospective Study

Abstract BackgroundIn patients with malignant central airway obstruction (MCAO) receiving transbronchial interventions (TBIs), it remains unclear if the prognosis after the intervention might differ according to the bronchoscopic appearance of the airway obstruction. MethodsTBIs were undertaken in MCAO patients with endoluminal obstruction (TM group, n = 19), extraluminal obstruction (EX group, n = 19) and mixed-type obstruction (MX group, n = 23), under moderate sedation and high fractions of inspired oxygen (FiO2). We evaluated the differences in the overall survival period (OS) after the TBIs among the 3 groups. ResultsRegarding the TBIs, the initial procedure was transbronchial microwave ablation (TMA) in the TM group and MX group and stent placement in the EX group. However, 7 patients in the MX group received stent placement as the second-line procedure, after failure of TMA. The OS tended to be longer in the TM/MX group as compared to that in the EX group, both in the subgroups of patients who received post-TBI anticancer therapy (27.2 months/32.9 months vs. 6.0 months, p = 0.011) and in the subgroups of patients who received best supportive care alone (3.2 months/3.1 months vs. 1.4 months, p = 0.072). Multivariate analysis identified adoption of TMA as the initial procedure, successful airway patency restoration following the TBI, and post-TBI anticancer therapy as independent factors associated with a reduced risk of death in patients with MCAO. ConclusionIt is beneficial to administer post-TBI anticancer therapy to MCAO patients with endoluminal or mixed-type obstruction following ablative procedures.

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Clinical and radiographic predictors of successful therapeutic bronchoscopy for the relief of malignant central airway obstruction

BMC Pulmonary Medicine ◽

10.1186/s12890-019-0987-3 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Coral X. Giovacchini ◽

Edward R. Kessler ◽

Christopher M. Merrick ◽

Junheng Gao ◽

Xiaofei Wang ◽

...

Keyword(s):

Airway Obstruction ◽

Smoking Status ◽

Univariate Analysis ◽

Radiographic Finding ◽

Ct Imaging ◽

Therapeutic Success ◽

Airway Patency ◽

Central Airway Obstruction ◽

Distal Airway ◽

Central Airway

Abstract Background Malignant central airway obstruction (CAO) occurs in approximately 20–30% of patients with lung cancer and is associated with debilitating symptoms and poor prognosis. Multimodality therapeutic bronchoscopy can relieve malignant CAO, though carries risk. Evidence to guide clinicians regarding which patients may benefit from such interventions is sparse. We aimed to assess the clinical and radiographic predictors associated with therapeutic bronchoscopy success in relieving malignant CAO. Methods We reviewed all cases of therapeutic bronchoscopy performed for malignant CAO at our institution from January 2010–February 2017. Therapeutic bronchoscopy success was defined as establishing airway patency of > 50%. Patient demographics and baseline characteristics, oncology history, degree of airway obstruction, procedural interventions, and complications were compared between successful and unsuccessful groups. Univariate and multivariate logistic regression identified the significant clinical and radiographic predictors for therapeutic success. The corresponding simple and conditional odds ratio were calculated. A time-to-event analysis with Kaplan–Meier plots was performed to estimate overall survival. Results During the study period, 301 therapeutic bronchoscopies were performed; 44 (14.6%) were considered unsuccessful. Factors associated with success included never vs current smoking status (OR 5.36, 95% CI:1.45–19.74, p = 0.010), patent distal airway on CT imaging (OR 15.11, 95% CI:2.98–45.83, p < 0.0001) and patent distal airway visualized during bronchoscopy (OR 10.77, 95% CI:3.63–31.95, p < 0.001) in univariate analysis. Along with patent distal airway on CT imaging, increased time from radiographic finding to therapeutic bronchoscopy was associated with lower odds of success in multivariate analysis (OR 0.96, 95% CI:0.92–1.00, p = 0.048). Median survival was longer in the successful group (10.2 months, 95% CI:4.8–20.2) compared to the unsuccessful group (6.1 months, 95% CI:2.1–10.8, log rank p = 0.015). Conclusions Predictors associated with successful therapeutic bronchoscopy for malignant CAO include distal patent airway visualized on CT scan and during bronchoscopy. Odds of success are higher in non-smokers, and with decreased time from radiographic finding of CAO to intervention.

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