Pulmonary lymphangitis and cancer: Prospective series of 37 patients in palliative care

Abstract

18600 Background: Lymphangitis of the lungs is an uncommon type of metastasis, mainly in breast, lung and gastric cancers, and has major impact in quality of life and an unfavorable prognosis. Survival is very poor: 50% in 3 and 15% in 6 months. Our objective was to evaluate prospectively quality of life in cancer patients with pulmonary lymphangitis, under palliative care. Methods: Patients with pulmonary lymphangitis, diagnosed either by lung biopsy (major criteria) or 3 minor criteria (cyto or histotologically proven cancer, clinical picture and image exam) were followed in 3 tertiary services, in a cohort series study. Primary end point was quality of life (QoL), measured with questionnaires in the beginning of the study and monthly afterwards (Saint George Respiratory Questionnaire -SGRQ- and Medical Outcomes Study 36-Item Short-Form Health Survey -SF36). Clinical and complementary aspects were also followed, in addition to treatment and outcome. Results: Thirty-seven patients were included from Aug/2004 to Jan/2006 - 23 female and 14 male; age from 41 to 84 (mean: 62) years. Primary tumors were: lung (20), breast (11), esophagus (2), pancreas, rectum and bone. Of those patients, 33 were able to respond QoL questionnaires in the beginning of follow-up and monthly thereafter. Median follow-up was of one month (range: 0–13); at the moment, 9 patients are still alive. Median survival was 2.5 months (range: 0,1–33), with 38% with a survival of at least 6 months. In general, QoL was poor, but improved after palliative care. Notice that values get higher as QoL improves in SF-36; however, they get lower as QoL improves in SGRQ - values were 61.5, 50.5, 61.7, and 47.5% for SGRQ and 38.1, 32.1, 32.8, 61.6 for SF36 in 0, 1, 3 and 6 months, respectively. Palliative care included: corticosteroids (65%), oxygen (51%), opioids (51%), diuretics (47%), inhalations with beta2-agonists and/or ipatropium (57%), chemo and/or hormonotherapy (51%), physical therapy (43%), antidepressants and benzodiazepines (37% each), thoracocentesis (35%), and blood transfusions. Conclusions: Even though QoL is poor and survival is short for patients with cancer lymphangitis in lungs, some improvement is possible with active palliative care. No significant financial relationships to disclose.

Successful Recovery of COVID-19 Associated With Cardiomyopathy in Advanced Breast Cancer Patient With Pulmonary Lymphangitis Carcinomatosis

“…11 Low-dose corticosteroids decrease mortality risk and improve respiratory conditions. 10 However, this does not lead to significant radiological improvement, as seen in this patient. A systematic review and meta-analysis of case reports on PLC from 1970 to 2018 showed that glucocorticoids, in addition to other supportive treatments (such as oxygen and morphine), helped relieve the respiratory symptoms without affecting the imaging findings of PLC.…”

“…9 Corticosteroids have been used to treat hypoxia in patients with PLC; however, the evidence to support this is limited. 10 Corticosteroids have been used to manage hypoxia in patients with PLC, although evidence to support their use is limited. In contrast, low doses of corticosteroids have been found effective in managing severe COVID-19 pneumonia, and dexamethasone has been reported to decrease mortality in ICU patients.…”

IASLC Lung Cancer Staging Project—A Radiologist Perspective

“…We agree that the issue of lymphangitis identified by Raj and colleagues is inadequately covered by the "optional descriptors" for lymphatic invasion presently offered in the 6th Edition of either the International Union Against Cancer (UICC) TNM Classification of Malignant Tumors 3 or the American Joint Committee on Cancer (AJCC) Manual of Cancer Staging. 4 We hope to study this in more detail in the prospective data base.…”

“…First, relating to T descriptor, Lymphangitis carcinomatosis (LC), although uncommon, is a distressing form of metastatic lung cancer and has major impact in quality of life with an unfavorable prognosis. 3 LC can occur from lymphatic invasion from the primary tumor or nodal spread. 4 In other tumors, particularly, spread is thought to be hematogenous.…”