Endobronchial Metastases from Colorectal Cancers: Natural History and Role of Interventional Bronchoscopy

Abstract

Background: Endobronchial metastases are rare. The most frequent primary tumors associated with endobronchial involvement are breast, colon and renal cell carcinomas. Metastases from colorectal cancers can be treated either surgically or with chemotherapy in order to improve survival. Objectives: This paper aims to report the potential role of interventional bronchoscopy in patients with endobronchial metastases from colorectal cancer. Methods: This retrospective study included 24 patients who underwent an interventional bronchoscopy procedure between 1988 and 2006. All patients had verified tracheobronchial metastases and were treated to relieve their obstruction. Assessment of the natural history of metastatic colorectal carcinoma, therapeutic options and survival associated with endobronchial metastases are reported. Results: Endobronchial metastases occurred at a median of 53 months (range 18–144) following the diagnosis of the primary tumor. Fifty-seven percent of patients had other proven metastases when the endobronchial involvement was diagnosed. All patients had known synchronous pulmonary metastases upon the discovery of tracheobronchial secondary lesions. The most frequently observed symptoms were dyspnea, cough and hemoptysis. Atelectasis was a common radiological finding. In 67% of patients, an interventional bronchoscopy was possible with the primary intent of relieving the obstruction. An endoscopic intervention provided symptomatic relief and an improvement in forced expiratory volume in 1 s. The median overall survival was 70 months (range 23–245) and 14 months once the endobronchial metastase(s) had been diagnosed. Conclusion: Endobronchial metastases occur relatively late in patients with a metastatic colorectal neoplasm. Palliative treatment with interventional bronchoscopy to prevent asphyxia is a safe and effective method that may improve the quality of life in these patients.