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Mahmood K, Frazer-Green L, Gonzalez AV, Shofer SL, Argento AC, Welsby I, Hales R, Shojaee S, Gardner DD, Chang JY, Herth FJF, Yarmus L. Management of Central Airway Obstruction: An American College of Chest Physicians Clinical Practice Guideline. Chest 2024:S0012-3692(24)04614-2. [PMID: 39029785 DOI: 10.1016/j.chest.2024.06.3804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/26/2024] [Accepted: 06/29/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Central airway obstruction (CAO), seen in a variety of malignant and non-malignant airway disorders, is associated with a poor prognosis. The management of CAO is dependent on provider training and local resources, which may make the clinical approach and outcomes highly variable. We reviewed the current literature and provided evidence-based recommendations for the management of CAO. METHODS A multidisciplinary expert panel developed key questions using the PICO (Patient, Intervention, Comparator, and Outcomes) format and conducted a systematic literature search using MEDLINE (PubMed) and the Cochrane Library. The panel screened references for inclusion and used vetted evaluation tools to assess the quality of included studies and extract data, and graded the level of evidence supporting each recommendation. A modified Delphi technique was used to reach consensus on recommendations. RESULTS A total of 9,688 abstracts were reviewed, 150 full-text articles were assessed, and 31 studies were included in the analysis. One good practice statement and 10 graded recommendations were developed. The overall certainty of evidence was very low. CONCLUSIONS Therapeutic bronchoscopy can improve the symptoms, quality of life, and survival of patients with malignant and non-malignant CAO. Multi-modality therapeutic options, including rigid bronchoscopy with general anesthesia, tumor/tissue debridement, ablation, dilation, and stent placement, should be utilized when appropriate. Therapeutic options and outcomes are dependent on the underlying etiology of CAO. A multidisciplinary approach and shared decision-making with the patient are strongly encouraged.
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Affiliation(s)
- Kamran Mahmood
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Duke University, Durham, NC.
| | | | - Anne V Gonzalez
- Respiratory Division, McGill University Health Centre, Montréal, QC, Canada
| | - Scott L Shofer
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Duke University, Durham, NC
| | | | - Ian Welsby
- Department of Anesthesiology, Duke University, Durham, NC
| | - Russell Hales
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD
| | | | | | - Joe Y Chang
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, and Translational Lung Research Center (TLRCH), University of Heidelberg, Heidelberg, Germany
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Ivanick NM, Kunadharaju R, Bhura S, Mengiste H, Saeed M, Saradna A, Grover H, Kalvapudi S, Yendamuri S, Yu H, Shafirstein G, Reid M. Epidemiology and Survival of Malignant Central Airway Obstruction in Lung Cancer Identified on Cross-Sectional Imaging. J Bronchology Interv Pulmonol 2024; 31:e0970. [PMID: 38881337 DOI: 10.1097/lbr.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/17/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND The prevalence of malignant central airway obstruction at diagnosis and its 5-year incidence are largely unknown, as are basic epidemiological data pertaining to this serious condition. To address these data limitations, we retrospectively collected data from the cohort of patients diagnosed with lung cancer at our institution in 2015 and followed cohort patients 5 years forward, until 2020. METHODS We reviewed index PET/CT or CT scans at the time of lung cancer diagnosis to identify the presence, subtype, and severity of malignant central airway obstruction as well as progression/development over the next 5 years. RESULTS The prevalence of malignant central airway obstruction affecting the airway lumen by 25% or greater was 17%, and its 5-year incidence of development was 8.2%. Notable associations from the multivariate analysis included a younger age and a stepwise increase in obstruction with increasing stage of disease. Squamous cell carcinoma and small-cell lung cancer were the 2 histologic subtypes with the strongest association with obstruction. The presence of malignant central airway obstruction either at time of diagnosis or on follow-up imaging was associated with significantly shortened survival (multivariate Cox proportional HR for MCAO=1.702, P<0.001). CONCLUSION This study provides the first systematic characterization of fundamental epidemiological data on malignant central airway obstructions at a tertiary cancer center in the United States. This data is important to inform research directions and funding efforts of this serious complication. It also serves as a baseline value against which to compare for future studies.
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Affiliation(s)
| | - Rajesh Kunadharaju
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY
| | - Sajeer Bhura
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY
| | - Hiwot Mengiste
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY
| | - Musa Saeed
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY
| | - Arjun Saradna
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY
| | - Harshwant Grover
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY
| | | | | | - Han Yu
- Biostatistics and Bioinformatics
| | - Gal Shafirstein
- Department of Cell Stress Biology, Photodynamic Therapy Center
| | - Mary Reid
- Department of Medicine, Cancer Screening and Survivorship Section, Roswell Park Comprehensive Cancer Center
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3
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Zhou Z, Han B, Ren K, Li Y, Wu K, Wang J, Li Y, Li Z, Han X. External beam radiotherapy inhibits stent related granulation hyperplasia in rabbit trachea. Sci Rep 2023; 13:7219. [PMID: 37137968 PMCID: PMC10156667 DOI: 10.1038/s41598-023-34449-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/30/2023] [Indexed: 05/05/2023] Open
Abstract
Endobronchial stent exacerbates the formation of granulation tissue. Radiotherapy maybe a durable treatment option for granulation hyperplasia. In this study, we explore the results of external beam radiotherapy (EBRT) for granulation hyperplasia after airway stent placement. A total of 30 New Zealand rabbits were assigned in three groups, Control group (n = 12), low dosage (LD, 12 Gy in 4 fractions and twice a week) group (n = 9) and high dosage (HD, 20 Gy in 4 fractions and twice a week) group (n = 9). Post-stenting 1 week, LD and HD group started to receive EBRT. Bronchoscopy, Haematoxylin-eosin (HE), Masson's trichrome (MTS), Safranin O (SO) and immunohistochemical (IHC) staining protocols were performed to evaluate the histopathological changes of trachea. A total of 30 stents were successfully implanted in 30 rabbits. No procedure-related death and complications happened. Post-stenting 4 w, 8 w and 12 w, the ventilate area ratio (VAR) and qualitative histological scoring (QHS) in the LD group and HD group lower than the Control group. Post-stenting 12w, the immunohistochemical results revealed that the positive percentage of TGF-β and VEGF in the LD group and HD group were lower than the Control group. In conclusion, the present study investigated the efficacy of EBRT in reducing stent related granulation tissue formation in the rabbit trachea. Higher dosage EBRT with a better result in inhibiting granulation hyperplasia.
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Affiliation(s)
- Zihe Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Bin Han
- Department of Radiotherapy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China
| | - Kewei Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Yahua Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Kunpeng Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Janan Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Yifan Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Zongming Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China.
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China.
- Interventional Treatment and Clinical Research Center of Henan Province, Zhengzhou, 450052, Henan, People's Republic of China.
- Interventional Institute of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China.
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4
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Ivanick NM, Oakley ER, Kunadharaju R, Brackett C, Bellnier DA, Tworek LM, Kurenov SN, Gollnick SO, Hutson AD, Busch TM, Shafirstein G. First-In-Human Computer-Optimized Endobronchial Ultrasound-Guided Interstitial Photodynamic Therapy for Patients With Extrabronchial or Endobronchial Obstructing Malignancies. JTO Clin Res Rep 2022; 3:100372. [PMID: 36188632 PMCID: PMC9523383 DOI: 10.1016/j.jtocrr.2022.100372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Patients with inoperable extrabronchial or endobronchial tumors who are not candidates for curative radiotherapy have dire prognoses with no effective long-term treatment options. To reveal that our computer-optimized interstitial photodynamic therapy (I-PDT) is safe and potentially effective in the treatment of patients with inoperable extra or endobronchial malignancies inducing central airway obstructions. Methods High-spatial resolution computer simulations were used to personalize the light dose rate and dose for each tumor. Endobronchial ultrasound with a transbronchial needle was used to place the optical fibers within the tumor according to an individualized plan. The primary and secondary end points were safety and overall survival, respectively. An exploratory end point evaluated changes in immune markers. Results Eight patients received I-PDT with planning, and five of these received additional external beam PDT. Two additional patients received external beam PDT. The treatment was declared safe. Three of 10 patients are alive at 26.3, 12, and 8.3 months, respectively, after I-PDT. The treatments were able to deliver a prescribed light dose rate and dose to 87% to 100% and 18% to 92% of the tumor volumes, respectively. A marked increase in the proportion of monocytic myeloid-derived suppressor cells expressing programmed death-ligand 1 was measured in four of seven patients. Conclusions Image-guided light dosimetry for I-PDT with linear endobronchial ultrasound transbronchial needle is safe and potentially beneficial in increasing overall survival of patients. I-PDT has a positive effect on the immune response including an increase in the proportion of programmed death-ligand 1-expressing monocytic myeloid-derived suppressor cells.
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Affiliation(s)
- Nathaniel M. Ivanick
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Emily R. Oakley
- Department of Cell Stress Biology, Photodynamic Therapy Center, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Rajesh Kunadharaju
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Craig Brackett
- Department of Cell Stress Biology, Photodynamic Therapy Center, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - David A. Bellnier
- Department of Cell Stress Biology, Photodynamic Therapy Center, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Lawrence M. Tworek
- Department of Cell Stress Biology, Photodynamic Therapy Center, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Sergei N. Kurenov
- Department of Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Sandra O. Gollnick
- Department of Cell Stress Biology, Photodynamic Therapy Center, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Alan D. Hutson
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Theresa M. Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gal Shafirstein
- Department of Cell Stress Biology, Photodynamic Therapy Center, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Shaller BD, Filsoof D, Pineda JM, Gildea TR. Malignant Central Airway Obstruction: What's New? Semin Respir Crit Care Med 2022; 43:512-529. [PMID: 35654419 DOI: 10.1055/s-0042-1748187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Malignant central airway obstruction (MCAO) is a debilitating and life-limiting complication that occurs in an unfortunately large number of individuals with advanced intrathoracic cancer. Although the management of MCAO is multimodal and interdisciplinary, the task of providing patients with prompt palliation falls increasingly on the shoulders of interventional pulmonologists. While a variety of tools and techniques are available for the management of malignant obstructive lesions, advancements and evolution in this therapeutic venue have been somewhat sluggish and limited when compared with other branches of interventional pulmonary medicine (e.g., the early diagnosis of peripheral lung nodules). Indeed, one pragmatic, albeit somewhat uncharitable, reading of this article's title might suggest a wry smile and shug of the shoulders as to imply that relatively little has changed in recent years. That said, the spectrum of interventions for MCAO continues to expand, even if at a less impressive clip. Herein, we present on MCAO and its endoscopic and nonendoscopic management-that which is old, that which is new, and that which is still on the horizon.
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Affiliation(s)
- Brian D Shaller
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, California
| | - Darius Filsoof
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, California
| | - Jorge M Pineda
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, California
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6
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Xie P, Wang S, He W, Yin M, Li C, Li Z, Li X, Ma Y, Yang G, Wu G. Sequential treatment of severe airway stenosis caused by esophageal cancer by using airway stent implantation and arterial infusion chemotherapy. Sci Rep 2022; 12:6918. [PMID: 35484182 PMCID: PMC9050643 DOI: 10.1038/s41598-022-10888-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 03/30/2022] [Indexed: 11/11/2022] Open
Abstract
The purpose of this clinical study was to investigate the efficacy and safety of airway stent implantation and transarterial infusion chemotherapy in the sequential treatment of severe airway stenosis caused by esophageal cancer. Data of patients with advanced esophageal cancer complicated by severe airway stenosis treated with airway stent implantation and transarterial infusion chemotherapy were retrospectively analyzed. Furthermore, dyspnea, clinical efficacy, adverse reactions, and survival of patients were evaluated. 71 patients were included in this study. There were 28 patients with grade III dyspnea and 43 patients with grade IV dyspnea before airway stent implantation, and 34 patients with grade I dyspnea, 35 patients with grade II dyspnea and 2 patients with grade III dyspnea after airway stent implantation. After airway stent implantation and 1–3 courses of transarterial infusion chemotherapy, 11, 41 and 19 patients had complete response, partial response and stable response respectively. Total disease control rate (DCR) and objective response rate (ORR) were 100.0% and 73.2%, respectively. During the follow-up, 32 patients died of organ failure, 24 patients died of tumor-related respiratory failure, and 10 patients died of gastrointestinal bleeding. The median survival time of all patients was 8 months, and the 1-year survival rate was 40.8%. Airway stent implantation combined with arterial infusion chemotherapy is safe and effective for sequential treatment of esophageal cancer with severe airway stenosis.
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Affiliation(s)
- Pengfei Xie
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052, China
| | - Shuai Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052, China
| | - Wei He
- Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Meipan Yin
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052, China
| | - Chunxia Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052, China
| | - Zhen Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052, China
| | - Xiaobing Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052, China
| | - Yaozhen Ma
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052, China
| | - Guang Yang
- Department of Radiology, The Fourth Hospital of Hebei Medical University, No. 12, Jiankang Road, Shijiazhuang, 050000, Hebei, China
| | - Gang Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052, China.
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7
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Animal study of a newly designed metal airway brachytherapy stent loaded with radioactive 125I seeds. J Cancer Res Clin Oncol 2022; 148:3061-3069. [PMID: 34978618 DOI: 10.1007/s00432-021-03904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/24/2021] [Indexed: 10/19/2022]
Abstract
AIM To evaluate dynamic tissue changes after airway stenting (AS) with a newly designed metal brachytherapy stent (BS) loaded with radioactive 125I seeds in normal rabbits. METHODS Forty-five normal New Zealand white rabbits were divided into 3 groups (group A: stent without seeds; group B: stent with 0.4 mCi active seeds; group C: stent with 0.8 mCi active seeds) and underwent AS under C-arm guidance. Then, five rabbits were killed from each group at 2, 4, and 8 weeks for further examination. Laboratory tests (including routine blood tests, liver function, kidney function, and electrolytes), gross observations, and tissue changes of Masson/hematoxylin-eosin staining, plus immunohistochemistry of α-SMA, NOX4, and TGF-β were performed at each time point. RESULTS All animals underwent AS successfully without procedure-related death, but one animal died at 6 weeks due to severe pulmonary infection in group C. Apart from a transient increase in white blood cells (P < 0.05) and a gradual increase in ROS levels (P < 0.05), other blood test items showed no significant changes (P > 0.05). The brachytherapy injury score increased with irradiation dose accumulation (P < 0.05), but tissue hyperplasia at the stent end in group C was less severe than that in groups A and B (P < 0.05). Airway lateral fibrosis was observed in all groups by histopathologic analysis; however, fibrosis in group C was more severe than that in groups A and B (P < 0.05). CONCLUSION The brachytherapy injury score increased with irradiation dose accumulation, while granulation tissue hyperplasia at the stent end was inhibited by 125I brachytherapy within 8 weeks.
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8
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Johnson AG, Soike MH, Farris MK, Hughes RT. Efficacy and Survival after Palliative Radiotherapy for Malignant Pulmonary Obstruction. J Palliat Med 2021; 25:46-53. [PMID: 34255568 DOI: 10.1089/jpm.2021.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: The purpose of this study was to determine the efficacy of palliative radiotherapy (PRT) for patients with pulmonary obstruction from advanced malignancy and identify factors associated with lung re-expansion and survival. Materials and Methods: We reviewed all patients treated with PRT for malignant pulmonary obstruction (n = 108) at our institution between 2010 and 2018. Radiographic evidence of lung re-expansion was determined through review of follow-up CT or chest X-ray. Cumulative incidence of re-expansion and overall survival (OS) were estimated using competing risk methodology. Clinical characteristics were evaluated for association with re-expansion, OS, and early mortality. Treatment time to remaining life ratio (TT:RL) was evaluated as a novel metric for palliative treatment. Results: Eighty-one percent of patients had collapse of an entire lung lobe, 46% had Eastern Cooperative Oncology Group (ECOG) performance status 3-4, and 64% were inpatient at consultation. Eighty-four patients had follow-up imaging available, and 25 (23%) of all patients had lung re-expansion at median time of 35 days. Rates of death without re-expansion were 38% and 65% at 30 and 90 days, respectively. Median OS was 56 days. Death within 30 days of PRT occurred in 38%. Inpatients and larger tumors trended toward lower rates of re-expansion. Notable factors associated with OS were re-expansion, nonlung histology, tumor size, and performance status. Median TT:RL was 0.11 and significantly higher for subgroups: ECOG 3-4 (0.19), inpatients (0.16), patients with larger tumors (0.14), those unfit for systemic therapy (0.17), and with 10-fraction PRT (0.14). Conclusion: One-fourth of patients experienced re-expansion after PRT for malignant pulmonary obstruction. Survival is poor and a significant proportion of remaining life may be spent on treatment. Careful consideration of these clinical factors is recommended when considering PRT fractionation.
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Affiliation(s)
- Adam G Johnson
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael H Soike
- Hazelrig-Salter Radiation Oncology Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael K Farris
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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9
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Wu SY, Yee E, Chan JW, Chapman CH, Boreta L, Braunstein SE. Timing of Urgent Inpatient Palliative Radiation Therapy. Adv Radiat Oncol 2021; 6:100670. [PMID: 33817413 PMCID: PMC8005735 DOI: 10.1016/j.adro.2021.100670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/19/2021] [Accepted: 02/03/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Urgent indications for palliative radiation therapy (RT) include malignant spinal cord compression, symptomatic brain metastases, pain, airway obstruction, and bleeding. Data on the timing of palliative RT in the inpatient setting are limited. We report our experience with inpatient palliative RT at a tertiary academic center and evaluate the effect of a dedicated inpatient palliative RT nurse practitioner (NP) on treatment timelines. Methods and Materials We performed a retrospective, single-institution review of 219 inpatients consulted for RT to sites of metastatic disease between May 2012 and May 2018. We compared time-to-treatment intervals before and after integrating an NP for palliative RT in August 2017. Results The median age of the 219 patients receiving RT was 61 years (interquartile range [IQR], 51-69 years). The most frequent indications were symptomatic brain metastases (73 patients [33%]), pain (61 patients [28%]), and cord/cauda compression (48 patients [22%]). The median time from consultation request to consult was 1 day (IQR, 0-2 days), and the median time from consultation request to first RT fraction was 3 days (IQR, 2-6 days). The median time from consultation request to RT was shorter for cord compression (2 [IQR, 1-4] days) than for pain (5 [IQR, 2-7] days) (P = .001) or symptomatic brain metastases (3 [IQR, 1-6] days; P = .037). With an NP, patients were more likely to undergo same-day consultation and simulation (75% vs 60%; P = .045), which was associated with shorter median duration from consultation to initiation of RT (1 [IQR, 0-3] days vs 4 [IQR, 2-7] days; P <.001). After the integration of an NP for palliative RT, patients had a higher median Karnofsky Performance Score (70 [IQR, 60-80] vs 50 [IQR, 40-60]; P < .001) and were more likely to complete their prescribed RT course (93% vs 82%; P = .05) Conclusions Time from consultation request to RT is necessarily short for urgent inpatient palliative RT. Advanced practice providers may facilitate and potentially expedite treatment, with significantly shorter times to treatment among patients who undergo same-day consultation and simulation.
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Affiliation(s)
- Susan Y Wu
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emily Yee
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Jason W Chan
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Christopher H Chapman
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Lauren Boreta
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California, San Francisco, California
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10
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Zhou Y, Yu F, Zhao Y, Zeng Y, Yang X, Chu L, Chu X, Li Y, Zou L, Guo T, Zhu Z, Ni J. A narrative review of evolving roles of radiotherapy in advanced non-small cell lung cancer: from palliative care to active player. Transl Lung Cancer Res 2021; 9:2479-2493. [PMID: 33489808 PMCID: PMC7815368 DOI: 10.21037/tlcr-20-1145] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiotherapy, along with other loco-regional interventions, is conventionally utilized as a palliative approach to alleviate symptoms and mitigate oncological emergencies in advanced non-small cell lung cancer (NSCLC). Thanks to the ongoing improvement of medical treatments in the last decade, such as targeted therapy and immunotherapy, the survival of patients with advanced NSCLC has been considerably prolonged, making it feasible and clinically beneficial for radiotherapy to play a more active role in highly selected subpopulations. In this review, we will focus on the evolving roles of radiotherapy in advanced NSCLC. First of all, among patients who are initially unable to tolerate aggressive treatment due to severe symptoms caused by metastases and/or tumor emergencies, timely radiotherapy could significantly improve their performance status (PS) and general condition, thus giving them a chance for intensive treatment and prolonged survival. The efficacy, potential candidates, and optimal dose-fractionation regimens of radiotherapy in this clinical scenario will be discussed. Additionally, radiotherapy can play a curative role as a concurrent therapy, consolidation therapy, and salvage therapy for patients with oligo-metastatic, oligo-residual, and oligo-progressive disease, respectively. Accumulating evidence from recent clinical trials, basic research, and translational investigations regarding the potentially curative roles of radiotherapy in NSCLC patients with oligo-metastatic disease will be summarized. Moreover, with the advent of various small molecular tyrosine kinase inhibitors (TKIs), the treatment efficacy and overall survival of oncogene-addicted NSCLC with brain metastases have been significantly improved, and the clinical value and optimal timing of cranial radiotherapy have become topics of much debate. Finally, synergistic antitumor interactions between radiotherapy and immunotherapy have been repeatedly demonstrated. Thus, the immune sensitizing role of radiotherapy in advanced NSCLC is also highlighted in this review.
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Affiliation(s)
- Yue Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fan Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yang Zhao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ya Zeng
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Li Chu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiao Chu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yida Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Liqing Zou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tiantian Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China
| | - Jianjiao Ni
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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11
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Computed tomography-guided implantation of 125I radioactive seeds in patients with malignant airway compression induced by advanced lung cancer: effectiveness and safety in 40 patients. J Contemp Brachytherapy 2020; 12:343-350. [PMID: 33293973 PMCID: PMC7690234 DOI: 10.5114/jcb.2020.98113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/03/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose To evaluate the safety and efficacy of computed tomography (CT)-guided 125I radioactive seed implantation in patients with malignant airway compression induced by advanced lung cancer. Material and methods Between June 2015 and June 2018, 40 patients from three medical institutions with malignant airway compression induced by advanced lung cancer were treated with 125I seed implantation. The outcomes were measured in technical success and safety, objective response rate, complications, Karnofsky performance status (KPS) score, and survival time. Results All 40 patients successfully underwent implantation procedure. No procedure-associated death occurred. The most common complications were irritable cough, temporary hemoptysis, chest pain, fever, and pneumothorax, which occurred in 26 (65.0%), 31 (77.5%), 12 (30.0%), 15 (37.5%), and 11 (27.5%) patients, respectively. The objective response rates were 100%, 100%, 100%, 87.5%, and 83.3% at the 3rd, 6th, 12th, 24th, and 36th months post-procedure, respectively. The KPS score significantly improved at post-procedure. Median survival time was 25.1 months. Actuarial survival rates were 100%, 60%, and 15% at the 12th, 24th, and 36th months after the procedure, respectively. Conclusions For patients with malignant airway compression induced by advanced lung cancer, implantation with 125I seed is a safe and effective alternative treatment option.
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12
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Choi HS, Jeong BK, Jeong H, Ha IB, Kang KM. Role of radiotherapy in the management of malignant airway obstruction. Thorac Cancer 2020; 11:2163-2169. [PMID: 32530138 PMCID: PMC7396370 DOI: 10.1111/1759-7714.13523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/27/2022] Open
Abstract
Background A 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. Methods This 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. Results The 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. Conclusions Palliative 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 points Significant findings of the study In 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 adds Our 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.
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Affiliation(s)
- Hoon Sik Choi
- Radiation Oncology, Gyeongsang National University School of Medicine, and Gyeongsang National University Changwon Hospital, Changwon-si, South Korea.,Institute of Health Science, Gyeongsang National University, Jinju-si, South Korea
| | - Bae Kwon Jeong
- Radiation Oncology, Gyeongsang National University School of Medicine, and Gyeongsang National University Hospital, Jinju-si, South Korea.,Institute of Health Science, Gyeongsang National University, Jinju-si, South Korea
| | - Hojin Jeong
- Radiation Oncology, Gyeongsang National University School of Medicine, and Gyeongsang National University Hospital, Jinju-si, South Korea.,Institute of Health Science, Gyeongsang National University, Jinju-si, South Korea
| | - In Bong Ha
- Radiation Oncology, Gyeongsang National University School of Medicine, and Gyeongsang National University Hospital, Jinju-si, South Korea.,Institute of Health Science, Gyeongsang National University, Jinju-si, South Korea
| | - Ki Mun Kang
- Radiation Oncology, Gyeongsang National University School of Medicine, and Gyeongsang National University Changwon Hospital, Changwon-si, South Korea.,Institute of Health Science, Gyeongsang National University, Jinju-si, South Korea
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13
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A combination therapy of photodynamic therapy (PDT) and airway stent placement using a transparent silicone stent. Lasers Med Sci 2019; 35:1035-1040. [PMID: 31522282 DOI: 10.1007/s10103-019-02876-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/06/2019] [Indexed: 12/19/2022]
Abstract
The aim of this study was to evaluate the feasibility of a combination therapy of photodynamic therapy (PDT) and airway stent placement using a transparent silicone stent (gold studded stent [GSS]). Laser irradiation (664 nm, continuous wave) was performed through the GSS using a straight and cylindrical fiber 1.0 cm away from a power meter. There are two types of GSS: the TD type for the trachea and the BD type for the bronchus. Laser outputs were set to 150 mW, 180 mW, 210 mW, 240 mW, 270 mW, and 300 mW. The laser powers passing through the both types of GSS were measured three times for each outputs and the averages were calculated. Based on the results, animal experiment was performed using two female pigs. Under general anesthesia, a GSS (BD type) was inserted into trachea of pigs, and PDT using NPe6 as a photosensitizer was performed by 100 J/cm2 laser irradiation on parts of the trachea with and without a GSS. Immediately after and 1 week after PDT, pig tracheas were harvested and histological analysis was performed. Histological analysis of areas with or without the stent showed edematous changes between the cartilage and submucosal layer immediately after PDT, and necrotic changes 1 week later. The effectiveness of NPe6-PDT for pigs' trachea covered by the stent was same as trachea without the stent. The use of a GSS may enable PDT to be effective even in the area covered by the stent.
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14
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Wang Y, Lu J, Guo JH, Zhu GY, Zhu HD, Chen L, Wang C, Teng GJ. A Novel Tracheobronchial Stent Loaded with 125I Seeds in Patients with Malignant Airway Obstruction Compared to a Conventional Stent: A Prospective Randomized Controlled Study. EBioMedicine 2018; 33:269-275. [PMID: 29909977 PMCID: PMC6085500 DOI: 10.1016/j.ebiom.2018.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/31/2018] [Accepted: 06/06/2018] [Indexed: 12/13/2022] Open
Abstract
Background To evaluate the safety and efficacy of a novel radioactive bare metal stent (RBMS) compared with a conventional bare metal stent (CBMS) in patients with inoperable malignant airway obstruction. Methods This prospective study was approved by the Institutional Ethics Committee, and informed consent was obtained from each participant. Patients with malignant airway obstruction who had dyspnea were randomly assigned to receive RBMS or CBMS placement. The primary endpoint was stenosis grade, while the secondary endpoints were technical success, overall survival, and complications. A p value of <0·05 was considered statistically significant. Results Between September 2013 and July 2015, 66 patients with inoperable malignant airway obstruction received stent placement fluoroscopically (33 in either group). The median follow-up time was 154 days (range, 15–335 days). The baseline stenosis was immediately relieved in both groups after stent placement, and the stenosis grades in the RBMS group were significantly lower than that in the CBMS group since the second month (p < 0·05). The technical success rates of stent placement were 100% in both groups. The median survival in the RBMS group was significantly longer than that in the CBMS group (170 days vs. 123 days, p < 0·05). There was no significant difference in the incidence of complications between the two groups (p < 0·05). Conclusions The placement of RBMS in patients with inoperable malignant airway obstruction is feasible and safe, and it significantly reduces restenosis and improves overall survival compared with the placement of CBMS. The baseline stenosis was immediately relieved in both groups after stent placement. The stenosis grades in the RBMS group were significantly lower than that in the CBMS group since the second month. The technical success rates of stent placement were 100% in both groups. The median survival in the RBMS group was significantly longer than that in the CBMS group. There was no significant difference of the incidence of complications between the two groups.
Malignant airway obstruction (MAO) is a serious situation of 20-30% cases of lung cancer, resulting in dyspnea, decreased functional status, and asphyxiation risk. Conventional stent placement provides immediate palliation of dyspnea. However, stent restenosis occurs during the follow up. A novel radioactive bare metal stent (RBMS) loaded with 125I seed was developed for preventing such restenosis. Our study showed that placement of RBMS in patients with inoperable malignant airway obstruction is feasible and safe, and it significantly reduces the restenosis and improves overall survival compared with placement of conventional stent.
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Affiliation(s)
- Yong Wang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhong-Da Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Jian Lu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhong-Da Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Jin-He Guo
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhong-Da Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Guang-Yu Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhong-Da Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Hai-Dong Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhong-Da Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Li Chen
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhong-Da Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Chao Wang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhong-Da Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Gao-Jun Teng
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhong-Da Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China.
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15
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Mallow C, Thiboutot J, Semaan R, Hayes MM, Hales R, Ram A, Feller-Kopman D, Lee H, Yarmus L. External beam radiation therapy combined with airway stenting leads to better survival in patients with malignant airway obstruction. Respirology 2018; 23:10.1111/resp.13292. [PMID: 29532563 PMCID: PMC6135707 DOI: 10.1111/resp.13292] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/22/2018] [Accepted: 02/22/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Malignant airway obstruction (MAO), a common complication of patients with advanced lung cancer, causes debilitating dyspnoea and poor quality of life. Two common interventions used in the treatment of MAO include bronchoscopy with airway stenting and external beam radiotherapy (EBRT). Data are limited regarding their clinical effectiveness and overall effect on survival. METHODS A retrospective chart review of patients treated with airway stenting and/or EBRT at the Johns Hopkins Hospital for MAO between July 2010 and January 2017 was reviewed. Demographics, performance status, cancer histology, therapeutic intervention and date of death were recorded. Survival was calculated using cox regression analysis. RESULTS Of the 606 patients who were treated for MAO, 237 were identified as having MAO and included in the study. Sixty-eight patients underwent rigid bronchoscopy and stenting, 102 EBRT and 67 a combined approach. Patients who underwent stenting hand an increased hazard ratio (HR) of death in comparison to those who received combination therapy (HR: 2.12, 95% CI: 1.02, 4.39), while there was a trend towards significance in the EBRT alone group in comparison to the combination therapy group (HR: 1.62, 95% CI: 0.93, 2.83). CONCLUSION In this retrospective analysis, combination therapy with stenting and EBRT led to better survival in comparison to stenting or EBRT alone. Prospective cohort trials are needed to confirm these results.
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Affiliation(s)
- Christopher Mallow
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeffrey Thiboutot
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roy Semaan
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Margaret M. Hayes
- Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Pulmonary and Critical Care Medicine, Boston, MA
| | - Russell Hales
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ashwin Ram
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Feller-Kopman
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hans Lee
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lonny Yarmus
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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16
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Wang Y, Guo JH, Zhu GY, Zhu HD, Chen L, Lu J, Wang C, Teng GJ. A Novel Self-Expandable, Radioactive Airway Stent Loaded with 125I Seeds: A Feasibility and Safety Study in Healthy Beagle Dog. Cardiovasc Intervent Radiol 2017; 40:1086-1093. [DOI: 10.1007/s00270-017-1639-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/22/2017] [Indexed: 12/11/2022]
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17
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Guibert N, Mazieres J, Marquette CH, Rouviere D, Didier A, Hermant C. Integration of interventional bronchoscopy in the management of lung cancer. Eur Respir Rev 2016; 24:378-91. [PMID: 26324799 DOI: 10.1183/16000617.00010014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Tracheal or bronchial proximal stenoses occur as complications in 20-30% of lung cancers, resulting in a dramatic alteration in quality of life and poor prognosis. Bronchoscopic management of these obstructions is based on what are known as "thermal" techniques for intraluminal stenosis and/or placement of tracheal or bronchial prostheses for extrinsic compressions, leading to rapid symptom palliation in the vast majority of patients. This invasive treatment should only be used in cases of symptomatic obstructions and in the presence of viable bronchial tree and downstream parenchyma. This review aims to clarify 1) the available methods for assessing the characteristics of stenoses before treatment, 2) the various techniques available including their preferred indications, outcomes and complications, and 3) the integration of interventional bronchoscopy in the multidisciplinary management of proximal bronchial cancers and its synergistic effects with the other specific treatments (surgery, radiotherapy or chemotherapy).
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Affiliation(s)
- Nicolas Guibert
- Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France
| | - Julien Mazieres
- Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France
| | - Charles-Hugo Marquette
- Hospital Pasteur and Institute for Research on Cancer and Ageing (IRCAN) (Inserm U10181/UMR CNRS 7284) University Nice Sophia Antipolis, Nice, France
| | - Damien Rouviere
- Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France
| | - Alain Didier
- Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France
| | - Christophe Hermant
- Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France
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18
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McLaughlin RA, Noble PB, Sampson DD. Optical coherence tomography in respiratory science and medicine: from airways to alveoli. Physiology (Bethesda) 2015; 29:369-80. [PMID: 25180266 DOI: 10.1152/physiol.00002.2014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Optical coherence tomography is a rapidly maturing optical imaging technology, enabling study of the in vivo structure of lung tissue at a scale of tens of micrometers. It has been used to assess the layered structure of airway walls, quantify both airway lumen caliber and compliance, and image individual alveoli. This article provides an overview of the technology and reviews its capability to provide new insights into respiratory disease.
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Affiliation(s)
- Robert A McLaughlin
- Optical & Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, The University of Western Australia, Perth, Australia;
| | - Peter B Noble
- School of Anatomy, Physiology & Human Biology, and Centre for Neonatal Research & Education, School of Paediatrics and Child Health, The University of Western Australia, Crawley, Australia; and
| | - David D Sampson
- Optical & Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, The University of Western Australia, Perth, Australia; Centre for Microscopy, Characterisation & Analysis, The University of Western Australia, Perth, Australia
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19
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Guibert N, Mazieres J, Lepage B, Plat G, Didier A, Hermant C. Prognostic Factors Associated With Interventional Bronchoscopy in Lung Cancer. Ann Thorac Surg 2014; 97:253-9. [DOI: 10.1016/j.athoracsur.2013.07.118] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 07/03/2013] [Accepted: 07/16/2013] [Indexed: 12/17/2022]
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20
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Chao YK, Liu KS, Wang YC, Huang YL, Liu SJ. Biodegradable Cisplatin-Eluting Tracheal Stent for Malignant Airway Obstruction. Chest 2013; 144:193-199. [DOI: 10.1378/chest.12-2282] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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21
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Araya T, Demura Y, Kasahara K, Matsuoka H, Nishitsuji M, Nishi K. Successful treatment with a combination of electrocautery using wire snares and gefitinib in patients with EGFR-mutant lung cancer and central airway obstruction. Intern Med 2013; 52:2331-5. [PMID: 24126395 DOI: 10.2169/internalmedicine.52.0557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
One-third of lung cancer patients present with life-threatening central airway obstruction (CAO). Two elderly patients were referred to our institution with symptoms caused by CAO. In each case, thoracic computed tomography and a bronchoscopic examination revealed a tumor obstructing the central airway. The tumors were resected endoscopically, and the patients' respiratory and performance status remarkably improved. Both patients were diagnosed with an advanced stage of lung adenocarcinoma harboring epidermal growth factor receptor (EGFR) mutations. They received gefitinib monotherapy, with partial responses sustained for more than 12 months. Combination therapy with endoscopic tumor resection and gefitinib is beneficial in patients with EGFR-mutant lung cancer and CAO.
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Affiliation(s)
- Tomoyuki Araya
- Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, Japan
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