Outcome of advanced lung cancer with central airway obstruction versus without central airway obstruction

Abstract

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.

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

“…The median survival of patients with CAO in our audit was 3 months; but 25% of patients lived >8 months. A recent study of patients with and without CAO, found no difference in the proportion that died or median survival time in the two groups 21. However, this study only included patients with advanced stage cancer (stage ≥IIIa), who had treatment, and ~80% of those without CAO had stage IV disease, with this proportion being lower (~60%) in those with CAO; this is likely to explain these results 21.…”

“…A recent study of patients with and without CAO, found no difference in the proportion that died or median survival time in the two groups 21. However, this study only included patients with advanced stage cancer (stage ≥IIIa), who had treatment, and ~80% of those without CAO had stage IV disease, with this proportion being lower (~60%) in those with CAO; this is likely to explain these results 21. Chhajed et al , found retrospectively that patients with NSCLC with CAO treated with therapeutic bronchoscopy and chemotherapy do as well as those without CAO treated with chemotherapy 22.…”

In Silico Ventilation Within the Dose-Volume is Predictive of Lung Function Post-radiation Therapy in Patients with Lung Cancer

“…Over 50% of advanced-stage lung cancer patients have narrowed central airways, and terminal airways can be blocked by the tumour as well. 35 To incorporate this effect in our ventilation model, patient-based tumour volumes were mapped onto each model and any airways within the GTV were constricted. Proximal airways (radius > 2 mm) 22 were constricted to 50% of their ‘normal’ radius value and distal airways were constricted to 30% of their initial, normal radius value to represent an intermediate amount of occlusion.…”

Review of a 10-year experience of rigid bronchoscopy at a tertiary centre in Singapore

“…From a clinical standpoint, the value of rigid bronchoscopy (RB) in prolonging survival in patients with malignant central airway obstruction (MCAO) has been well established [1][2][3]. As the median survival in patients with untreated advanced lung cancer is only 6 months, re-canalizing their airway, and giving them a chance to undergo cancer target therapy prolongs their survival identical to those who do not have MCAO and are able to undergo chemotherapy without difficulty [2,4]. Its role as an alternative to surgery in establishing airway patency in benign diseases such as TB stricture and post-intubation tracheal stenosis (PITS) is also adequately de-Rigid bronchoscopy in Singapore scribed [5,6].…”