Radiotherapy for intubated patients with malignant airway obstruction: Futile, or facilitating extubation?

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e19120 Background: There is uncertainty as to the appropriate management of intubated patients with malignant airway obstruction (MAO). Radiotherapy (RT) may be delivered but requires substantial resources in this patient population. In the absence of evidence, it is unknown if radiotherapy facilitates extubation or prolongs ICU stays, resulting in a delay in the appropriate transition to end-of-life care. Methods: We performed a 10-year retrospective review of patients in the ICU treated with RT for MAO. Primary study endpoints were overall survival (OS) and extubation success (ES) defined as ≥48 hours without reintubation or death. Secondary endpoints included rates of discharge from the ICU and to home. Logistic regression and Cox regression analyses were performed to identify factors associated with ES and OS. Results: Twenty-six patients were eligible for analysis. Patients waited an average of 2.9 days (±4.5) from intubation and MV until receiving RT. Seven patients (27%) achieved ES, occurring between days 4 and 22 after RT initiation. All of these patients were discharged from the ICU, and most (n=6) were discharged home. There was a trend for a higher chance of ES in patients who received higher radiation doses (OR per 5 Gy increase: 0.63, p = 0.080). Median OS was only 0.36 months (range 0–113 months), and 6-months OS was 11%. On Cox regression analysis, increased radiation dose was predictive of improved OS (HR per 5 Gy increase: 0.74, p = 0.016). Conclusions: Although median survival is short, in a minority of intubated patients with MAO, RT is associated with ES. Survival beyond six months is uncommon, although improved OS is associated with higher delivered doses of RT.