Radiotherapy for Intubated Patients with Malignant Airway Obstruction: Futile or Facilitating Extubation?

Abstract

A significant minority of patients receiving RT were successfully extubated. Higher radiation doses were predictive of improved OS and showed a trend for increased ES. Survival beyond 6 months was uncommon, however, the majority of patients with ES were able to be discharged home.

A population-based analysis of outcomes after radiotherapy in intensive care unit patients with lung cancer

“…Within these, episodes of RT delivery were rare (n=133, 0.9%; across n=131 patients). The RT group tended to be younger (median age 65 vs. 68, P<0.001), but with worse baseline characteristics, including being on some form of supportive ventilation in the ICU (79.8% vs. 38.2%, P<0.001), and longer ventilation duration {median (IQR): 6 [1][2][3][4][5][6][7][8][9][10][11] vs. 0 [0-2] days, P<0.001}. Pre-ICU disposition in RT patients was more likely to be from the ER (28.6% vs. 21.9%) or via transfer from a different institution (35.3% vs. 9.7%) (P<0.001).…”

“…Although RT is a cornerstone in the palliative management of lung cancer (8), its use for patients in the ICU is poorly described. To our knowledge, a single study of 26 patients, evaluating the extreme scenario of RT for malignant airway obstruction necessitating mechanical ventilation (9,10), represents the only literature focusing on the use of RT for intrathoracic malignancy in the ICU.…”

Airway stenting in patients requiring intubation due to malignant airway stenosis: a 10-year experience

“…External beam radiotherapy has been widely used for palliation of malignant airway obstruction (2,3); however, its role seems to be quite limited for intubated patients. Louie et al (13) retrospectively evaluated the efficacy of external beam radiotherapy for 26 intubated patients with malignant airway obstruction. The median overall survival duration was only 0.36 months, and the extubation success rate was only 27%; extubation occurred a median of 8 days between initiating radiation therapy and extubation.…”

Intensive care in thoracic oncology

“…Some indications for radiotherapy during ICU stay resulted from small series suggesting that irradiation for intubated patients could be beneficial. In a series of 26 patients (21 NSCLC, four SCLC), seven patients were extubated and six were discharged alive from the hospital [99].…”