Bronchial Intervention for Advanced Lung Cancer with Central Airway Obstruction

Patients with central airway obstruction (CAO) from advanced lung cancer present with significant morbidity and are assumed to have lower survival. Hence, they are offered only palliative support. We asked if patients who have advanced lung cancer with CAO (recanalised and treated) will behave similarly to those with advanced lung cancer without CAO.This study was a retrospective review of the medical records of the patients managed for advanced lung cancer during 2010 and 2015 at our institution.85 patients were studied. Median survival and 1-, 2- and 5-year survival were 5.8 months, 30.3%, 11.7% and 2.3% versus 9.3 months, 35.7%, 9.6% and 4.7%, respectively, in the CAO and no CAO groups (p=0.30). More patients presented with respiratory failure (15 (35%) versus none; p=0.0001) and required assisted mechanical ventilation (10 (23.3%) versus none; p=0.001) in the CAO group compared with the no CAO group. Fewer patients received chemotherapy in the CAO group (11 (25.5%)) compared with the no CAO group (23 (54.7%); p=0.008).There was no difference in survival among patients with advanced lung cancer whether they presented with CAO or without CAO. Survival was similar to those without CAO in patients with recanalised CAO despite greater morbidity and lesser use of chemotherapy, strongly advocating bronchoscopic recanalisation of CAO. These findings dispel the nihilism associated with such cases.

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Successful Treatment with a Combination of Electrocautery Using Wire Snares and Gefitinib in Patients with EGFR-mutant Lung Cancer and Central Airway Obstruction

Internal Medicine ◽

10.2169/internalmedicine.52.0557 ◽

2013 ◽

Vol 52 (20) ◽

pp. 2331-2335 ◽

Cited By ~ 1

Author(s):

Tomoyuki Araya ◽

Yoshiki Demura ◽

Kazuo Kasahara ◽

Hiroki Matsuoka ◽

Masaru Nishitsuji ◽

...

Keyword(s):

Lung Cancer ◽

Airway Obstruction ◽

Successful Treatment ◽

Central Airway Obstruction ◽

Egfr Mutant ◽

Central Airway

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Prevalence and outcome of central airway obstruction in patients with lung cancer

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2019-000429 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000429 ◽

Cited By ~ 7

Author(s):

Cyrus Daneshvar ◽

William Euan Falconer ◽

Mohammed Ahmed ◽

Abdul Sibly ◽

Madeleine Hindle ◽

...

Keyword(s):

Lung Cancer ◽

Airway Obstruction ◽

Ct Scan ◽

Performance Status ◽

Service Planning ◽

Disease Stage ◽

Central Airway Obstruction ◽

Lung Cancer Patients ◽

Central Airway

IntroductionCentral airway obstruction (CAO) is a life-threatening complication of lung cancer. The prevalence of CAO in lung cancer patients is unknown. We audited CAO burden to inform our local cancer service.MethodsThis is a cohort review of all new lung cancer diagnoses between 1 November 2014 and 30 November 2015. CAO was defined by CT appearance. CT scans and routine patient records were followed up to 30 November 2018 to determine the prevalence of CAO at diagnosis; the characteristics of patients with prevalent CAO; mortality (using survival analysis); and incident CAO over follow-up.ResultsOf 342 new lung cancer diagnoses, CAO prevalence was 13% (95% CI 10% to 17%; n=45/342). Dedicated CT scan review identified missed CAO in 14/45 (31%) cases. In patients with prevalent CAO, 27/44 (61%) had a performance status of ≤2, 23/45 (51%) were diagnosed during an acute admission and 36/44 (82%) reported symptoms. Treatments were offered to 32/45 (71%); therapeutic bronchoscopy was performed in only 8/31 (26%) eligible patients. Median survival of patients with prevalent CAO was 94 (IQR 33–274) days. Multivariate analysis, adjusting for age, gender and disease stage, found CAO on index CT scan was independently associated with an increased hazard of death (adjusted HR 1.78 (95% CI 1.27 to 2.48); p=0.001). In total, 15/297 (5%) developed CAO during follow-up (median onset 340 (IQR 114–551) days). Over the audit period, 60/342 (18%; 95% CI 14% to 22%) had or developed CAO.DiscussionsThis is the first description of CAO prevalence in 40 years. Patients with prevalent CAO had a higher mortality. Our data provide a benchmark for service planning.

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Etiologies of delayed diagnosis and characteristics of patients with newly diagnosed advanced lung cancer initially presented with respiratory failure

10.21203/rs.3.rs-20712/v1 ◽

2020 ◽

Author(s):

Tseng How-Yang ◽

Yi-Cheng Shen ◽

Yen-Sung Lin ◽

Chih-Yeh Tu ◽

Hung-Jen Chen

Keyword(s):

Lung Cancer ◽

Targeted Therapy ◽

Respiratory Failure ◽

Cancer Patients ◽

Diagnostic Error ◽

Advanced Lung Cancer ◽

Newly Diagnosed ◽

Central Airway Obstruction ◽

Lung Cancer Patients ◽

Central Airway

Abstract Objective This study aimed to evaluate the characteristics of patients with newly diagnosed advanced lung cancer who initially presented with respiratory failure. Methods A retrospective study analyzed the outcome of patients in the intensive care unit (ICU) with newly diagnosed advanced lung cancer placed on mechanical ventilation (MV). We defined newly-diagnosed lung cancer as pathological or molecular results for treatment decisions not being out when the patient was admitted to ICU. Results During the 14-year inclusion period, 845 lung cancer patients requiring MV were screened. 56 newly diagnosed extensive lung cancer patients were analyzed. Cancer-related to central airway obstruction (n=29, 51.8%) was the leading cause of respiratory failure. The significant etiologies of delay in the diagnosis of lung cancer were diagnostic error, mistaking the cancer for tuberculosis, and missed hilar lesion. The 6-month survival was only 7.1% (n=4). SOFA score was significantly associated with mortality (HR = 1.144, 95% CI = 1.014-1.291, p = 0.028). The 6-month survival rate in patients receiving suitable targeted therapy and accepting chemotherapy and best supportive care was 40%(2/5), 0%(0/7), and 4.5%(2/44), respectively. Conclusions Patients with newly diagnosed advanced lung cancer with acute life-threatening respiratory failure have poor outcomes. Cancer-related to central airway obstruction is a leading cause of respiratory failure. Diagnostic error as tuberculosis and missed hilar lesions are two main etiologies of delay in the diagnosis. The SOFA score is correlated with mortality. For patients with oncogenic mutation adenocarcinoma, after survival from critical condition, targeted therapy can raise their six month survival rates.

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