Role of palliative radiotherapy (PRT) in patients with malignant airway obstruction (MAO) in the intensive care unit (ICU).

Abstract

143 Background: MAO is a challenging sequela of advanced cancer, leading to significant morbidity and mortality. A number of patients with MAO present with significant airway compromise necessitating intubation and mechanical ventilation. PRT for MAO patients in the ICU is complex, requiring high levels of coordination and support. The role and efficacy of PRT in intubated patients is not well defined. We performed a retrospective review of intubated patients with MAO receiving PRT to understand efficacy of treatment and patient outcomes. Methods: After obtaining IRB approval, a retrospective query was performed to identify all patients who received PRT and required mechanical ventilation at some point during the course of RT at the Hospital of the University of Pennsylvania from 2008 to 2016. Data was analyzed looking at demographics, reason for intubation, PRT dose and fractionation, length of intubation, extubation success and overall survival. Data was subsequently entered into a database using the secure online application, REDCap. Results: 22 (M:13; F:9) patients with different histologies (most common: lung (11) and lymphoma (3)) were studied. 14 patients had stage IV and 8 had stage II-III disease. All patients had KPS ≤ 50 (ECOG ≤3) at the time PRT initiation. Two patients received PRT and then completed definitive course when became medically stable. The median RT dose was 2000cGy (300 - 7000cGy) given over 1 – 35 (median: 6) fractions. 13 (59%) patients received a full course of initially planned RT. Successful extubation was achieved in 13 (59%) cases but only 11 (50%) patients were survived to hospital discharge. 11 (50%) patients died despite PRT. The average ICU stay was 41.4 days (1 – 75 days). The median overall survival measured from the time of intubation to death or the last follow-up was 23.5 days (1 day - 5.3 year). Favorable histology and lower stage were associated with better outcome following PRT. Conclusions: We found that, in carefully selected patients, PRT can yield successful extubation and potentially improve survival in patients with MAO intubated in ICU. PRT should be considered early in the management of these patients, particularly when it is the treatment of last resort.