Elsevier

The Annals of Thoracic Surgery

Volume 74, Issue 6, December 2002, Pages 1928-1933
The Annals of Thoracic Surgery

Original article: general thoracic
Palliative management of malignant airway obstruction

Presented at the Forty-eighth Annual Meeting of the Southern Thoracic Surgical Association, San Antonio, TX, Nov 8–10, 2001.
https://doi.org/10.1016/S0003-4975(02)04085-7Get rights and content

Abstract

Background

Obstruction of the airway due to unresectable malignant disease is a frightening condition that portends a poor prognosis. Endobronchial treatment modalities were reviewed to determine the most effective management strategy.

Methods

A 12-year retrospective review (1988 to 1999) of 121 consecutive patients with inoperable malignant airway obstruction (MAO) was performed. Sixty-five patients received high-dose-rate brachytherapy (HDR) alone, 32 received HDR plus neodymium:yttrium-aluminum garnet laser (YAG) therapy, 16 received YAG only, 4 patients were stented, and 4 received photodynamic therapy (PDT). Follow-up was obtained by chart review and contact.

Results

Seventy-seven men and 44 women, median age 62 years (range 30 to 86 years), underwent 378 endobronchial procedures for relief of MAO. Good to excellent results were achieved in 77% (93/121) of patients. Seventy-two percent (23/32) of patients undergoing HDR plus YAG received a good to excellent result. All 8 patients receiving either stents or PDT had good to excellent palliation. There were no intraoperative deaths, but there were two in-hospital deaths. Complications occurred in 4% (5/121) of patients. Forty-four percent (53/121) of our patients were lost to follow-up. Mean survival was 6.7 months after the last treatment.

Conclusions

Temporary relief of inoperable MAO can be accomplished with a number of endobronchial treatments used either singularly or in combination. The majority of patients managed with HDR, YAG, or HDR plus YAG received good to excellent short-term palliation.

Section snippets

Material and methods

From January 1988 to December 1999, we completed a retrospective review of 121 patients who underwent 378 endoscopic procedures for inoperable, high-grade, malignant airway obstruction. The records of all patients were reviewed for demographics, location and etiology of tumor, method of treatment, immediate results of treatment, long-term survival, and complications. When follow-up or results were in question, living patients and their families were contacted by telephone.

The age of the

Results

Seventy-seven percent (93/121) of patients received either a good or excellent result from their therapy (Table 3). Seventy-two percent (23/32) of patients who received both YAG laser therapy and high-dose radiation received a good to excellent result. The majority of these patients underwent laser therapy first for an exophytic lesion to relieve either dyspnea or hemoptysis, followed by HDR when residual disease was present. The classifications given in this table are those attributed to the

Comment

When a patient with non-small cell bronchogenic carcinoma is initially unresectable, is medically inoperable, or presents with recurrent disease after resection, frequently the most common symptoms are those of major endobronchial obstruction of the trachea or major airways. At other times, symptoms may result from obstructive phenomena at the lobar level. Management of patients with malignant airway obstruction represents a significant therapeutic challenge for all physicians engaged in caring

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