Radiologic and clinical outcomes with special reference to tumor involvement pattern after stent placement for malignant bronchial obstructions

Abstract

Location of tumor within the tracheobronchial tree as well as its severity can affect the clinical outcome of patients who undergo airway stent placement. To evaluate radiologic and clinical outcome, including survival data, with special reference to proposed tumor involvement pattern, in patients with malignant bronchial strictures. A total of 35 patients who underwent stent placement for malignant bronchial strictures were enrolled over a 9-year period. Tumor involvement pattern was divided into three types based on computed tomography (CT) scans and selective bronchography. Type I was defined as tumor involving only the main stem bronchus; type II, tumor involving the bronchus intermedius and/or the lower lobar bronchus without involvement of the lower-lobe segmental bronchus; and type III, tumor involving the lower lobar bronchus with involvement of the lower-lobe segmental bronchus. Tumor stage, lung collapse/infiltration, radiologic improvement, clinical improvement, and survival were compared according to the tumor involvement pattern. Tumor involvement pattern was of type I, II, and III in 14, 13, and eight patients, respectively. When comparisons were made between types I/II and type III to evaluate the influence of lower-lobe segmental bronchial involvement, radiologic and clinical improvement was significantly lower in type III than in types I/II, while advanced stage, lung collapse/infiltration, and median overall survival were not significantly different between types I/II and type III. In patients with malignant bronchial obstructions involving the lower-lobe segmental bronchus, clinicians must be aware of the possibility of less radiologic and clinical improvement following stent placement.