Malignant Airway Obstruction Research Articles

Clinical effects of cisplatin plus recombinant human endostatin (rh-endostatin) intratumoral injection on malignant central airway obstruction: a retrospective analysis of 319 cases.

BackgroundPrimary lung cancer with severe central airway obstruction (CAO) is often life-threatening. In this study, we investigated the clinical efficacy and safety of cisplatin plus recombinant human endostatin (rh-endostatin) intratumoral injection in treatment of malignant central airway obstruction (MCAO) caused by primary squamous cell lung cancer.MethodsWe retrospectively analyzed patients with MCAO caused by primary squamous cell lung cancer treated with and without bronchoscopic intratumoral injection of cisplatin plus rh-endostatin between January 2007 and June 2016.ResultsA total of 206 patients received cisplatin plus rh-endostatin intratumoral injection, and 113 without injection. Dyspnea grade, degree of stenosis, quality of life and lung function of all patients were significantly improved at 1 week after treatment compared with baseline. Both groups achieved good airway patency (97.1% vs. 93.8%, P=0.156). Followed up at 2 months, all parameters were improved in the injection group compared with baseline, while no statistical differences were observed in the non-injection group (P>0.05). The injection group achieved airway patency in 155 (75.2%) of 206 patients, which was significantly superior to the non-injection group [20 (17.7%) of 113, P<0.001]. In addition, the restenosis rate of the injection group was lower compared with the non-injection group (22.5% vs. 81.1%, P<0.001, respectively). No serious complications were observed in two groups.ConclusionsCisplatin plus rh-endostatin intratumoral injection is effective and safe for the therapy of MCAO caused by primary squamous cell lung cancer.

Unique technique of rescue ventilation in malignant critical airway obstruction during airway stenting.

Unique technique of rescue ventilation in malignant critical airway obstruction during airway stenting.

Contributions of Airway Stent for Long-term Outcome in Patients With Malignant Central Airway Stenosis or Obstruction.

Although an airway stent is used for malignant central airway stenosis or obstruction, long-term outcomes are unknown. In this study, we retrospectively analyzed the clinical features of patients who required stenting for malignant central airway stenosis or obstruction. We retrospectively analyzed clinical data from 116 patients with stenting for central airway stenosis or obstruction who underwent treatment at Toho University Hospital from 1998 to 2018. We evaluated the clinical features, prognoses, and complications for stenting in these patients. The distribution of the 116 patients was as follows: lung cancer, 53; esophageal cancer, 40; thyroid cancer, 8; and others, 15. Patients with thyroid cancer had a significantly higher rate of complications after stenting than patients with lung cancer (P=0.0062), esophageal cancer (P=0.0029), and others (P=0.0062). Patients with esophageal cancer had a significantly worse prognosis than patients with lung and thyroid cancer. In patients with lung cancer the prognosis was significantly different between patients who underwent additional treatment for lung cancer after stenting and patients with no treatment (P=0.0398), and patients who received chemoradiotherapy for lung cancer after stenting had a significantly better prognosis than patients with no treatment (P=0.0306). Stenting for airway stenosis/obstruction may improve prognosis in patients with lung or thyroid cancer, especially if patients with lung cancer undergo additional treatments after stenting, although airway stenting for patients with esophageal cancer was palliative. New treatment strategies may be necessary for patients with esophageal cancer after stenting to improve prognosis.

Survival and prognostic factors for patients with malignant central airway obstruction following airway metallic stent placement.

BackgroundThere have been many studies on the effectiveness and complications of airway stent, but few had focused on factors that affect survival after stent placement. This study intended to assess the factors associated with the survival in patients with malignant central airway obstruction (MCAO) after airway metallic stent placement.MethodsThe clinical data of adult MCAO patients who underwent stent placement form February 2003 to June 2017 in the First Affiliated Hospital of Soochow University in China were retrospectively analyzed. The survival rates were compared using Log-rank tests. Potential prognostic factors were identified using multivariate Cox hazard regression models.ResultsTotal 102 MCAO patients were included in this study. The median survival time of these patients after airway metallic stent placement was 4.1 months. Multivariate analysis showed that MCAO patients receiving radiotherapy [hazard ratio (HR) 0.554; 95% confidence interval (CI): 0.308–0.999] or chemoradiotherapy (HR 0.251; 95% CI: 0.126–0.499) after stenting had better prognosis. However, ECOG PS ≥3 score prior to the stenting (HR 2.193; 95% CI: 1.364–3.526) and stents placed in both trachea and main bronchus (HR 2.458; 95% CI: 1.384–4.366) were associated with worse survival.ConclusionsIn our results, survival of MCAO patients after airway metallic stenting was related to ECOG PS score prior to the stenting, the site of stent placement and we have hereby proposed for the first time that having opportunity to receive radiotherapy or chemoradiotherapy after stenting contribute to better prognosis.

Bronchoscopic intratumoral injections of cisplatin and endostar as concomitants of standard chemotherapy to treat malignant central airway obstruction

Study PurposeMalignant central airway obstruction (CAO) in non-small cell lung cancer (NSCLC) is associated with high morbidity and requires endobronchial palliative treatment to re-establish a free air passage. We investigate...

A REVIEW OF PALLIATIVE ENDOBRONCHIAL INTERVENTIONS PERFORMED IN PATIENTS WITH MALIGNANT AIRWAY OBSTRUCTION

SESSION TITLE: Cardiothoracic Surgery Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Malignant Airway Obstruction (MAO) results from various processes including direct invasion due to bronchogenic carcinoma, metastatic deposits with endobronchial obstructions, and extrinsic compression by mediastinal tumors and lymphadenopathies. Despite an overall poor prognosis, some patients may benefit from a palliative intervention with advanced endoluminal therapies. The ultimate goal is to restore airway patency, avoid hospital readmissions, and improve respiratory symptoms. Here, we present our experience in treating patients with MAO with endoluminal therapies including YAG laser, balloon tracho-bronchoplasties, and airway stenting. METHODS: From January 2018 to July 2020, we retrospectively reviewed 57 patients with inoperable malignant airway disease who underwent endoluminal airway interventions. Characteristics such as smoking history, type of procedure, necessity for re-intervention, and mortality within thirty days of intervention associated with the procedure were analyzed. Successful palliation was defined as decreased dyspnea and radiologic evidence of improved aeration of lung parenchyma. Categorical variables are descriptively summarized using percentages and continuous variables using mean and standard deviation. All statistical analyses were performed using SAS software, version 9.4 (SAS Institute Inc., Cary, NC). RESULTS: 57 patients underwent a total of 121 endoluminal interventions for MAO. 51% were females, with a mean age ± std of 66±14.7. 57% were prior or active smokers. The most common malignancies were squamous cell carcinoma (28%) and metastatic disease (19%). Endobronchial tumor debulking was performed in 60% of the patients with yag laser therapy. Airway stenting was performed in 63% of patients and balloon dilatation was performed in 40% of patients. Planned re-intervention within 12 weeks from index procedure was performed in 65 % of the patients. 75% of the patients experienced significant clinical improvement. Mortality at thirty days was 2%. CONCLUSIONS: Palliative endobronchial intervention remains an important tool in patients with advanced non resectable MAO as it can provide relief of respiratory symptoms and improve quality of life with a low risk of thirty day mortality. CLINICAL IMPLICATIONS: Palliative endobronchial interventions may be considered in patients with inoperable MAO as it provides palliation, reducing dyspnea and recurrent post obstructive atelectasis. DISCLOSURES: No relevant relationships by Angel Porras, source=Web Response no disclosure on file for Fernando Safdie; No relevant relationships by Anita Singh, source=Web Response No relevant relationships by Francico Ujueta, source=Web Response

Bronchoscopic procedures during COVID-19 pandemic: Experiences in Turkey.

BackgroundGlobally, coronavirus disease‐2019 (COVID‐19) is a new, highly contagious, and life‐threatening virus. We aimed to demonstrate how we proceeded with bronchoscopic procedures without published guidelines at the inception of the pandemic period.Materials and MethodsAll bronchoscopic procedures applied from the first case seen in Turkey (11 March‐15 May) were evaluated retrospectively. Patient data on indications, diagnosis, types of procedures, and the results of COVID‐19 tests were recorded.ResultsThis study included 126 patients; 36 required interventional bronchoscopic techniques (28.6%), 74 required endobronchial ultrasonography (EBUS; 58.7%), and 16 required flexible fiberoptic bronchoscopy (12.7%). All interventional rigid bronchoscopic techniques were performed for emergent indications: malignant airway obstruction (66.7%), tracheal stenosis (25%), and bronchopleural fistula (8.3%). Malignancy was diagnosed in 59 (79.7%), 12 (50%), and 4 (25%) patients who underwent EBUS, interventional procedures, and fibreoptic bronchoscopy, respectively. All personnel wore personal protective equipment and patients wore a surgical mask, cap, and disposable gown. Of the patients, 31 (24.6%) were tested for COVID‐19 and all the results were negative. COVID‐19 was not detected in any of the patients after a 14‐day follow‐up period.ConclusionThis study was based on our experiences and demonstrated that EBUS and/or bronchoscopy should not be postponed in patients with known or suspected lung cancer.

Integrated intErventional bronchoscopy in the treatment of locally adVanced non-small lung cancER with central Malignant airway Obstructions: a multicentric REtrospective study (EVERMORE)

ObjectivesDespite new therapeutic perspectives, the presence of central airways occlusion (CAO) in patients with locally advanced non-small cell lung cancer (NSCLC) is associated with poor survival. There is no clear evidence on the clinical impact of interventional bronchoscopy as a part of an integrated treatment to cure these patients. Materials and methodsThis retrospective cohort study was conducted in two teaching hospitals over a 10 years period (January 2010-January 2020) comparing patients with NSCLC at stage IIIB and CAO at disease onset treated with chemotherapy/radiotherapy (standard therapy-ST) with those receiving interventional bronchoscopy plus ST (integrated treatment-IT). Primary outcome was 1-year survival. The onset of respiratory events, symptoms-free interval, hospitalization, need for palliation, and overall mortality served as secondary outcomes. ResultsA total of 100 patients were included, 60 in the IT and 40 in the ST group. Unadjusted Kaplan-Meier estimates showed greater effect of IT compared to ST on 1-year survival (HR = 2.1 95%CI[1.1-4.8], p = 0.003). IT showed a significantly higher survival gain over ST in those patients showing KRAS mutation (7.6 VS 0.8 months,<0.0001), a lumen occlusion >65% (6.6 VS 2.9 months,<0.001), and lacking the involvement of left bronchus (7 VS 2.3 months,<0.0001). Compared to ST, IT also showed a favorable difference in terms of new hospitalizations (p = 0.03), symptom-free interval (p = 0.02), and onset of atelectasis (p = 0.01). ConclusionsIn patients with NSCLC stage IIIB and CAO, additional interventional bronchoscopy might impact on 1-year survival. Genetic and anatomic phenotyping might allow identifying those patients who may gain life expectancy from the endoscopic intervention.

Management of malignant central airway obstruction

Malignant central airway obstructions (MCAOs) generally consist of lesions occupying a large percentage of the luminal wall within the trachea, mainstem bronchi, bronchus intermedius, or lobar bronchus. These obstructions can often be dangerous and debilitating, causing serious hemodynamic instability and severe reduction in quality of life. Advanced bronchoscopic techniques offer an ability to tackle these lesions in an attempt to restore airway patency while simultaneously improving hemodynamic stability and alleviating symptoms. A large number of bronchoscopic therapies are available to date. Choice of a modality is widely dependent on the clinical picture and type of obstruction at hand. Therefore, this review focuses on the developments made in the field of interventional pulmonology, providing insight into possible advanced bronchoscopic therapies to combat these MCAOs.

Silicone Stent Versus Fully Covered Metallic Stent in Malignant Central Airway Stenosis

Airway stenting to restore airway patency in cases of malignant central airway obstruction is an effective palliation treatment. Our goal was to compare the efficacy after deployment and complications of a fully covered self-expandable metal stent (SEMS) (Aerstent) and a silicone stent (Dumon). This was a retrospective cohort of 2 similar groups of patients with malignant central airway obstruction treated with stents between August 2012 and July 2017. Complications were assessed bronchoscopically. A competing risk for death analysis was performed to adjust the probability of developing a complication. Seventy patients (29 with silicone stents and 41 with SEMS) were included. Stent insertion was successful in all cases. Mucus retention was the most frequent complication (75.9% with silicone stents and 84.8% with SEMS; P= .51), followed by granulation tissue (51.7% with silicone stents and 41.3% with SEMS; P= .52) and migration (6.9% with silicone stents and 13.0% with SEMS; P= .47). In the first month, the cumulative incidence of a complication was 36.7% for silicone stents and 41.3% for SEMS and increased to 90.0% and 97.8% after 6 months, respectively (hazard ratio= 1.66; P= .04). A competing risk for death analysis showed an adjusted hazard ratio of 1.41 (P= .49) indicating no differences in overall complications between stents. Both stents were equally successful and safe. The incidence of complications increased over time to 90% at 6 months for both stents. The risk of overall complications was higher for SEMS; nevertheless, when mortality was measured in a competitive risk analysis, no differences were found between SEMS and silicone stents.

Role of radiotherapy in the management of malignant airway obstruction.

BackgroundA significant proportion of lung cancer patients suffer from malignant airway obstruction (MAO). Palliative external beam radiotherapy (EBRT) is often used to control the symptoms caused by MAO. In this study, we report the effect of palliative EBRT on lung cancer with MAO and analyze the factors that influence it.MethodsThis study included 75 patients with MAO in lung cancer who underwent palliative EBRT, between 2009 and 2018 and were analyzed retrospectively. Change of dyspnea, tumor response, and overall survival (OS) were recorded. Univariate and multivariate analyses were performed to determine the prognostic factors for treatment outcomes.ResultsThe median follow‐up duration was 2.5 months, and median OS was 2.3 months. Out of 75 patients, dyspnea was improved in 46 patients (61.3%), and tumor was partially decreased in 39 patients (52%). Symptoms improved in all tumor responding patients. The symptom improvement was significantly affected by radiation dose and time to EBRT. The tumor response was significantly affected by pathology, radiation dose, and time to EBRT.ConclusionsPalliative EBRT is an effective and safe treatment option for patients with MAO in lung cancer. In particular, high‐dose irradiation and prompt treatment can improve treatment results.Key pointsSignificant findings of the studyIn MAO patients, tumor response is an important factor for resolving dyspnea and improving survival rate. In order to increase the tumor response, high‐dose irradiation and prompt treatment after symptoms occur are necessary.What this study addsOur study reported the effects of EBRT and prognostic factors in MAO patients. We emphasize that palliative EBRT is a relatively safe and effective treatment in MAO patients, which is a complement to previous studies.

Outcomes of Airway Stents in the Palliative Care of Patients With Cancer.

A significant proportion of patients with advanced primary or metastatic intrathoracic malignancy will eventually develop central airway obstruction. The morbidity associated with malignant airway obstruction (MAO) is considerable and the management is difficult. Our aim was to evaluate the outcomes of tracheobronchial stenting in patients with MAO and its role in palliative care. This retrospective study involved a consecutive case series of patients with advanced cancer with MAO who underwent tracheobronchial stenting between August 2014 and August 2019. The European Cooperative Oncology Group (ECOG) scale was used to evaluate patient functional status before and after tracheobronchial stenting. Univariate survival analysis included Kaplan-Meier curves with Log-Rank test, while Cox regression was used as a multivariate analysis. We included 28 patients with median age of 55.0 years (interquartile range = 49.3-66.5) and 89.3% male. The most frequent primary tumour was the esophagus followed by lungs. The majority of the patients (75%) expressed immediate symptom relief after stenting and there was a significant improvement in the mean ECOG performance status (PS; P = .005). There was no intraprocedure mortality and complications were observed in 6 patients. The median survival after airway stenting was 39.0 days (95% CI = 32.2-45.8) with poorer PS after stent insertion associated with lower overall survival (hazard ratio = 2.3 [95% CI = 1.1-4.9], P = .030) on multivariate analysis. Airway stent is a safe and effective procedure that offers rapid palliation of symptoms with no major complications. Therefore, stent placement should be considered as part of the treatment of patients with terminal cancer.

Self-expanding metallic Y-stent compared to silicone Y-stent for malignant lesions of the main carina: A single center retrospective study

BackgroundBifurcation stents are often required in patients with malignant airway obstruction or fistulization involving the main carina. The silicone Y stent is the most used but remains challenging to place. The self-expanding metallic Y (SEM) stent appears easy to use. The objective is to report the feasibility, efficacy, and tolerance of SEM Y stent compared to silicone Y stent in patients with malignant tumors involving the main carina. Patients and methodsThis retrospective single center study was performed between May 2004 and May 2017. All patients with malignant carina involvement treated with a bronchial Y stent were included. ResultsForty silicone Y stents and 38 SEM Y stents were placed. Seven stenting placements failed in the silicone Y group but none in the SEM Y stent group (P=0.008). The median duration of the procedure was 80min (25–210) in the silicone Y group and.50min (25–110min) in the SEM Y group (P=0.001). There was no significant difference in terms of early or late complications between the 2 groups. Nine silicone Y stents (26.5%) and 7 SEM Y stents (18.4%) were removed (P=0.4). The median survival time following stent insertion was 171 days (Interquartile range (IQR): 53–379) in the silicone Y group and 104 days (IQR: 53–230) in the SEM Y group. ConclusionIf silicone Y stent remains the best solution for benign obstruction, SEM Y stent seems to be an easy alternative with no difference in terms of complication or ablation for malignant lesions involving the main carina.

Impact of Silicone Stent Placement in Symptomatic Airway Obstruction due to Non-Small Cell Lung Cancer – A French Multicenter Randomized Controlled Study: The SPOC Trial

Background: Therapeutic bronchoscopy (TB) is an accepted strategy for the symptomatic management of central airway malignant obstruction. Stent insertion is recommended in case of extrinsic compression, but its value in preventing airway re-obstruction after endobronchial treatment without extrinsic compression is unknown. Objective: Silicone stent Placement in symptomatic airway Obstruction due to non-small cell lung Cancer (SPOC) is the first randomized controlled trial investigating the potential benefit of silicone stent insertion after successful TB in symptomatic malignant airway obstruction without extrinsic compression. Method: We planned an inclusion of 170 patients in each group (stent or no stent) over a period of 3 years with 1-year follow-up. The 1-year survival rate without symptomatic local recurrence was the main endpoint. Recurrence rate, survival, quality of life, and stent tolerance were secondary endpoints. During 1-year follow-up, clinical events were monitored by flexible bronchoscopies and were evaluated by an independent expert committee. Results: Seventy-eight patients (mean age 65 years) were randomized into 2 arms: stents (n = 40) or no stents (n = 38) after IB. Consequently, our main endpoint could not be statistically answered. Improvement of dyspnea symptoms is noticeable in each group but lasts longer in the stent group. Stents do not change the survival curve but reduce unattended bronchoscopies. In the no stent group, 19 new TB were performed with 16 stents inserted contrasting with 10 rigid bronchoscopies and 3 stents placed in the stent group. In a subgroup analysis according to the oncologic management protocol following TB (first-line treatment and other lines or palliation), the beneficial effect of stenting on obstruction recurrence was highly significant (p < 0.002), but was not observed in the naïve group, free from first-line chemotherapy. Conclusion: Silicone stent placement maintains the benefit of TB after 1 year on dyspnea score, obstruction’s recurrence, and the need for new TB. Stenting does not affect the quality of life and is suggested for patients after failure of first-line chemotherapy. It is not suggested in patients without previous oncologic treatment.

Malignant Melanoma Metastasis to the Thyroid Gland Causing Severe Central Airway Obstruction.

Metastasis of malignant melanoma to the thyroid gland causing airway obstruction is an extremely rare condition. In an 80-year-old woman who presented with painless swelling of the neck, a diagnosis of malignant melanoma metastasis to the thyroid gland with an unknown source was established. She received multiple radiotherapy sessions that resulted in occasional regression but not complete resolution. She was then referred for tracheal stenting owing to progressed dysphagia and dyspnea. Rigid bronchoscopy was performed, and a fully covered metal stent was placed to secure the open airway. Dyspnea improved immediately after stent insertion. The patient died at her residence because of a cerebrovascular event 2 weeks after the procedure. To the best of our knowledge, central airway obstruction due to malignant melanoma metastasis to the thyroid gland has been not reported in the literature. The approach for palliation of obstruction is similar to that of other malignant central airway obstructions.

Clinical outcomes of self-expandable metallic stents for malignant obstructive atelectasis

Self-expandable metallic stents (SEMSs) have been widely used in the treatment of malignant central airway obstruction. However, few reports focus on the treatment of atelectasis and how to estimate the prior probability of success via SEMSs placement, This current study aimed to study the safety and effectiveness of SEMSs for the treatment of obstructive atelectasis, and the value of preoperative CT enhancement for ventilation of atelectasis via SEMSs placement. A total of 35 patients with obstructive atelectasis (29 male and 6 female) was included from February 2012 to March 2018. The procedures were performed under fluoroscopic guidance, and bronchoscopic laser resection was performed for severe restenosis cases after SEMSs placement. Clinical and functional pulmonary data were recorded before and 3 months after the procedure. Follow-up involved clinical data and radiographic techniques at 48 h and at 1-, 3-, 6-, and 12-month intervals. Thirty-eight SEMSs were successfully implanted in 34 patients, included 29 Y type tracheal stents, 4 small y stents, and 5 straight airway stents. After stenting, 26 cases showed full ventilation, and 3 cases were partially ventilated. The technical success and clinical success was 97.1% and 82.9%, respectively. A higher maximum enhancement CT value was found in patients with full ventilation. Mean follow-up time was 18.8 ± 4.0 months. Eight cases showed restenosis and received endoscopic laser resection, included 1 case underwent removal and 3 cases received second stenting. There were 2 cases of perioperative non-operative death, and 11 cases of post-discharge death (2 cardiac deaths and 9 malignant tumors). The survival rates of 3 months, 1 year and 2 years were 78.6%, 58.5% and 58.5%, respectively. In conclusion, SEMSs placement is safe and effective for obstructive atelectasis, and the preoperative CT enhancement played an important role in estimating the prior probability of success in the treatment of atelectasis via SEMSs placement.

Clinical and radiographic predictors of successful therapeutic bronchoscopy for the relief of malignant central airway obstruction

BackgroundMalignant central airway obstruction (CAO) occurs in approximately 20–30% of patients with lung cancer and is associated with debilitating symptoms and poor prognosis. Multimodality therapeutic bronchoscopy can relieve malignant CAO, though carries risk. Evidence to guide clinicians regarding which patients may benefit from such interventions is sparse. We aimed to assess the clinical and radiographic predictors associated with therapeutic bronchoscopy success in relieving malignant CAO.MethodsWe reviewed all cases of therapeutic bronchoscopy performed for malignant CAO at our institution from January 2010–February 2017. Therapeutic bronchoscopy success was defined as establishing airway patency of > 50%. Patient demographics and baseline characteristics, oncology history, degree of airway obstruction, procedural interventions, and complications were compared between successful and unsuccessful groups. Univariate and multivariate logistic regression identified the significant clinical and radiographic predictors for therapeutic success. The corresponding simple and conditional odds ratio were calculated. A time-to-event analysis with Kaplan–Meier plots was performed to estimate overall survival.ResultsDuring the study period, 301 therapeutic bronchoscopies were performed; 44 (14.6%) were considered unsuccessful. Factors associated with success included never vs current smoking status (OR 5.36, 95% CI:1.45–19.74, p = 0.010), patent distal airway on CT imaging (OR 15.11, 95% CI:2.98–45.83, p < 0.0001) and patent distal airway visualized during bronchoscopy (OR 10.77, 95% CI:3.63–31.95, p < 0.001) in univariate analysis. Along with patent distal airway on CT imaging, increased time from radiographic finding to therapeutic bronchoscopy was associated with lower odds of success in multivariate analysis (OR 0.96, 95% CI:0.92–1.00, p = 0.048). Median survival was longer in the successful group (10.2 months, 95% CI:4.8–20.2) compared to the unsuccessful group (6.1 months, 95% CI:2.1–10.8, log rank p = 0.015).ConclusionsPredictors associated with successful therapeutic bronchoscopy for malignant CAO include distal patent airway visualized on CT scan and during bronchoscopy. Odds of success are higher in non-smokers, and with decreased time from radiographic finding of CAO to intervention.

EP1.16-10 Differentiation of Performance Status After Tumor Debulking in Malignant Central Airway Tumor via Rigid Bronchoscopy

Bronchogenic carcinoma patients have been suffered from cancer and its complications. The aim of cancer treatment is for prolonged survival and symptomatic control. Novel multimodality treatment can be relieving symptoms and improve patients’ performance status (PS). Malignant central airway obstruction is the most harmful complication that increases morbidity, mortality and decreases PS. Rigid bronchoscopy with tumor resection plays pivotal roles for resolve these problems Retrospective Observational study enrolled cancer patients who had been suffered from malignant central airway obstruction that undergo Rigid bronchoscopy with tumor debulking in Phramongkutklao Hospital during January 2014 – October 2018 64 cancer patients were included in this study. 37(60.7%) were older than sixty. 36 (59%) were male and 38 (62.3%) had primary lung cancer in origin. 30 (49.2%) had left main bronchial obstruction 24(39.3%) had right main bronchial obstruction and 15(24.6%) had the tracheal obstruction. Most of patients 43(70.5%) had intraluminal obstruction and degree of obstruction were grade 4 39(63.9%). Pre-intervention ECOG 2-4 group were 23(37.7%), 24(39.3%) and 14(23%) respectively. Mean pre- intervention ECOG was 2.9±0.8 After rigid bronchoscopy with tumor debulking mean ECOG was decreased to 1.8 ±1.0. 46 of 64 (90.2%) had clinical improvement after successful procedure. 37 (72.5%) had 6-month survival and 33(64.7%) had 1-year survival after successful procedure, compared with 2(20%) and 1(10%) in unsuccessful procedure. 43(95.6%) had opportunity to received other treatment such as chemotherapy, targeted therapy, etc. after ECOG status was improveView Large Image Figure ViewerDownload Hi-res image Download (PPT) Rigid bronchoscopy with tumor debulking improves performance status, increases survival and increases opportunity for other new multimodality treatment in cancer patients who had malignant central airway obstruction.

Bronchoscopic Ablative Therapies for Malignant Central Airway Obstruction and Peripheral Lung Tumors.

Bronchoscopic ablative therapies have been applied safely and successfully for the palliation of malignant central airway obstruction and have the potential for treating inoperable peripheral lung tumors. Proper understanding of technology-tissue interaction allows clinicians to optimize tissue effects, avoid intraoperative complications, and predict response to therapy and potential adverse events. This article reviews the basic mechanisms of action and clinical data on bronchoscopic ablation using laser, electrosurgery, photodynamic therapy, cryotherapy, radiofrequency ablation, microwave ablation, and thermal vapor ablation for malignant central airway obstruction and peripheral lung tumors.

SQUAMOUS CELL CARCINOMA PRESENTING WITH OBSTRUCTION OF THE SUPERIOR VENA CAVA AND CENTRAL AIRWAYS

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: One mechanism by which cancer causes morbidity/mortality is by mass effect with distortion, compression, or occlusion of nearby anatomical structures. Within the chest, tumors can exert these effects on the airways and vascular structures. This case illustrates the need for urgent intervention in a patient presenting with severe compression of multiple intrathoracic structures. CASE PRESENTATION: A 54 year-old man with chronic tobacco use and limited exposure to healthcare presented to the hospital with gradually progressive shortness of breath over several months, followed by facial swelling, severe wheezing, and recurrent syncope over the past few days. Exam was remarkable for facial flushing and diffuse inspiratory/expiratory wheezing. Laryngoscopy was performed, which did not suggest critical airway edema. Computed tomography (CT) of the chest demonstrated a large right-sided suprahilar mass, with severe compression of the superior vena cava (SVC) and right mainstem bronchus (RMB) and bronchus intermedius, narrowing of the right pulmonary artery and vein, and complete collapse of the right upper lobe. The patient underwent urgent placement of an 11x59mm balloon-expandable covered stent within the SVC, after which the patient reported improvement in facial swelling but minimal improvement in dyspnea. Next, he underwent bronchoscopy, which demonstrated significant extrinsic compression within the right mainstem bronchus; transbronchial needle aspirates of lymph nodes from Stations 4R and 7 were obtained, from which pathology results were consistent with squamous cell carcinoma (SCC). Because of the degree of bronchial compression, and the need for chemotherapy and radiation therapy which could temporarily cause tumoral inflammation and worsen compression/collapse of the right lung, bronchoscopy was repeated, and this time a 12x40mm self-expandable partially-covered stent was placed within the right mainstem bronchus. After this, the patient reported significant improvement in dyspnea, and was discharged to home in stable condition. DISCUSSION: This case describes pulmonary SCC presenting with symptoms of acute SVC syndrome and central airway compression. Lung cancer associated with either of these conditions has dramatically increased morbidity/mortality. In malignant SVC syndrome, stent placement has been shown to reduce SVC pressure and improve symptoms; there is moderate risk of stent re-obstruction. Though not free of risks, endobronchial stent placement can prevent the impending occlusion of a central airway, when surgical or endobronchial resection/debulking is not possible. In recent years, there have been numerous advances in the technology and variety of endobronchial stents for multiple indications. CONCLUSIONS: Malignant extrinsic compression of the SVC and central airways is associated with high morbidity/mortality and can be managed urgently and safely with stent placement. Reference #1: Avasarala SK, Freitag L, & Mehta AC. Metallic endobronchial stents: A contemporary resurrection [published online ahead of print December 11, 2018]. CHEST. doi:10.101/j.chest.2018.12.001. Reference #2: Niu S, Xu YS, Cheng L, & Cao C. Stent insertion for malignant superior vena cava syndrome: Effectiveness and long-term survival. Vascular and Interventional Radiology 2017, 122: 633-638. Reference #3: Mudambi L, Miller R, & Eapen GA. Malignant central airway obstruction. Journal of Thoracic Disease 2017, 9(10): 1087-1110. DISCLOSURES: No relevant relationships by Gabriel Ryan, source=Web Response