Bronchoscopic palliation of primary lung cancer: single or multimodality therapy?
| Autor: | Ricardo S. Santos, Y. Raftopoulos, A. Halal, Richard H. Maley, Robert J. Keenan, Rodney J. Landreneau |
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| Rok vydání: | 2003 |
| Předmět: |
Male
medicine.medical_specialty Hemoptysis Lung Neoplasms medicine.medical_treatment Brachytherapy Multimodality Therapy Pneumonectomy Bronchoscopy Carcinoma Non-Small-Cell Lung medicine Combined Modality Therapy Humans Life Tables Lung cancer Survival rate Aged Retrospective Studies medicine.diagnostic_test business.industry Bronchial Neoplasms Palliative Care Stent Airway obstruction Middle Aged medicine.disease Survival Analysis Surgery Airway Obstruction Survival Rate Treatment Outcome Photochemotherapy Carcinoma Squamous Cell Female Stents Tracheal Neoplasms Radiology Laser Therapy business |
| Zdroj: | Surgical endoscopy. 18(6) |
| ISSN: | 1432-2218 |
| Popis: | An obstructing primary lung cancer is a challenging disease frequently requiring endobronchial interventional therapy. A variety of interventional modalities, including Nd:YAG laser, stenting, photodynamic therapy (PDT), and endoluminal brachytherapy, are utilized to relieve airway obstruction and bleeding. The aim of this study is to compare the effect on patient survival of bronchoscopic palliation for lung cancer utilizing one interventional modality compared to the use of combination of modalities to relieve the airway problem. METHODS. We reviewed our longitudinal experience with interventional bronchoscopy in 75 patients who underwent 176 procedures for the management of endobronchial lung cancer between 1994 and 2002. Indication for intervention was hemoptysis in 24 patients (32%) and airway obstruction in the remaining. Six patients died within 30 days from the first intervention and were excluded. Forty of the surviving 69 patients (58%) were treated with a single interventional modality (group A). In 29 patients (42%) a multimodality endoscopic treatment was utilized (group B). Single-modality treatment in group A included Nd-YAG laser in 60%, stent in 17%, brachytherapy in 20%, and PDT in 3%. A variety of combinations of the aforementioned modalities were used in group B to enhance airway patency. Patient data were compared with the Student's t-test and chi-square test. Survival analysis and the log rank test were used to compare difference in survival between the two groups. A p-value of 0.05 was considered significant.There were 46 males and 23 females, with a mean age of 67 years. The tumor was located in the trachea 9%, in the carina in 7%, and primary bronchial in 84%. Two patients had complications due to stent malposition. There was no significant difference between the two groups in relation to age, gender, tumor location, histology, and type of previous cancer therapy. There was a significant improvement in survival for the multimodality group (p = 0.04). The 1- and 3-year cumulative survival rate for groups A and B was 51.3% versus 50% and 2.3% versus 22%, respectively.Improvement in survival can be seen with diligent airway surveillance after interventional bronchoscopy and liberal use of a variety of endobronchial treatment modalities for airway obstruction or bleeding. Physicians involved in the management of this difficult problem should be versed in the use of all available treatment modalities to enhance therapeutic outcome. |
| Databáze: | OpenAIRE |
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