Abstract
BackgroundInterventional bronchoscopy is considered an effective treatment option for malignant central airway obstruction (MCAO). However, there are few reports of interventional bronchoscopy in patients with MCAOs due to extra-pulmonary malignancy. Therefore, the objective of this study was to investigate treatment outcomes and prognostic factors for bronchoscopic intervention in patients with MCAO due to extra-pulmonary malignancy.MethodsWe retrospectively analyzed consecutive 98 patients with MCAO due to extra-pulmonary malignancy who underwent interventional bronchoscopy between 2004 and 2014 at Samsung Medical Center (Seoul, Korea).ResultsThe most common primary site of malignancy was esophageal cancer (37.9%), followed by thyroid cancer (16.3%) and head & neck cancer (10.2%). Bronchoscopic interventions were usually performed using a combination of mechanical debulking (84.7%), stent insertion (70.4%), and laser cauterization (37.8%). Of 98 patients, 76 (77.6%) patients had MCAO due to progression of malignancy, and 42 (42.9%) patients had exhausted all other anti-cancer treatment at the time of bronchoscopic intervention. Technical success was achieved in 89.9% of patients, and acute complications and procedure-related deaths occurred in 20.4% and 3.1% of patients, respectively. Reduced survival was associated with MCAO due to cancer other than thyroid cancer or lymphoma, mixed lesions, and not receiving adjuvant treatment after bronchoscopic intervention.ConclusionsBronchoscopic intervention could be a safe and effective procedure for MCAO due to end-stage extra-pulmonary malignancies. In addition, we identified possible prognostic factors for poor survival after intervention, which could guide clinicians select candidates that will benefit from bronchoscopic intervention.
Highlights
Interventional bronchoscopy is considered an effective treatment option for malignant central airway obstruction (MCAO)
Patients We retrospectively reviewed all interventional bronchoscopy reports from January 2004 to December 2014 at Samsung Medical Center (a 1979-bed, tertiary care referral hospital in Seoul, South Korea) and identified 98 patients with MCAO due to extra-pulmonary malignancy
This study revealed that bronchoscopic interventions such as mechanical debulking, laser, and stent insertion could be performed safely and successfully in most patients with MCAO due to extra-pulmonary malignancy
Summary
Interventional bronchoscopy is considered an effective treatment option for malignant central airway obstruction (MCAO). There are few reports of interventional bronchoscopy in patients with MCAOs due to extra-pulmonary malignancy. The objective of this study was to investigate treatment outcomes and prognostic factors for bronchoscopic intervention in patients with MCAO due to extra-pulmonary malignancy. Malignant central airway obstruction (MCAO) is clinically significant and is usually considered as a criterion for intervention; it is usually defined as ≥50% occlusion of the cross-sectional area of the trachea, mainstem bronchi, bronchus intermedius, or lobar bronchus [1]. 20–50% of patients with extra-pulmonary malignancy will have lung metastasis during their clinical course [8]. Extra-pulmonary malignancy comprises 8–40% of all MCAO cases [1, 11, 12]. Most studies have conducted analyses without classification based on primary malignancy sites, such as
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