The prognostic predictors of patients with airway involvement due to advanced esophageal cancer after metallic airway stenting using flexible bronchoscopy

The Prognostic Predictors of Airway Stenting in Malignant Airway Involvement From Esophageal Carcinoma

BACKGROUND

In locoregional esophageal carcinoma (EC), airway involvement is the most common route of extraesophageal metastasis. The prognosis remains poor even with a multimodality approach. Although airway stenting is well known for restoration of the airway, the survival benefit is still lacking.

METHODS

A total of 37 of patients with airway involvement from EC who underwent airway stenting at a single institution from 2015 to 2020 were retrospectively reviewed. Survival curves after stent placement among different groups were analyzed using Kaplan-Meier method.

RESULTS

Of 37 patients, 34 were male, and the mean age was 58.9 years (42 to 80). EC was commonly located at midesophagus (51.4%). The site of airway involvement was left main bronchus (48.6%), trachea (32.4%), multiple sites (16.2%), and right main bronchus (2.7%). The nature of airway involvement was tumor invasion (91.9%), compression (62.2%), and fistula (37.8%). Twenty-three patients (62.2%) had airway involvement at the time of esophageal cancer diagnosis. Only 4 patients underwent esophageal stenting. The median survival time after stent placement was 97 days (5 to 539). Chemotherapy and/or radiotherapy were given before stent placement in 18 patients (48.6%). Treatment-naive before airway stenting and diagnosis of airway involvement at the same time of EC diagnosis were independent predictors for the increased survival after stent placement ( P <0.05). Poststent treatment was associated with improved survival ( P =0.002).

CONCLUSION

In patients with malignant airway involvement from EC who underwent airway stenting, the prognostic predictors for improved survival were treatment-naive status, receiving treatment after airway stenting, and early-onset of airway involvement.

Central airway stenting in oncology

Introduction. Malignant central airway obstruction and malignant tracheoesophageal fistula in the context of tumor development are potentially life-threatening conditions which usually require immediate intervention. Airway stenting is one of the safest and most effective methods of airway patency restoration in patients with malignant obstruction of the central airways and restoration of continuity in patients with malignant tracheoesophageal fistula.

Aim. To evaluate the significance of self-expandable metal stents in palliative treatment of patients with malignant central airway obstruction and malignant tracheoesophageal fistula.

Materials and methods. Between 2017 and 2021 at the N. N. Blokhin National Medical Research Center of Oncology, 55 patients were observed and treated and underwent trachea stenting per the results of bronchoscopy in combination with esophagogastroduodenoscopy. The 1st group included 25 patients with malignant tracheoesophageal fistulas, the 2nd group included 30 patients with malignant central airway obstruction.

Results. In the 1st group, stenting was successful in 25 (100 %) cases which allowed to adequately seal the fistula. Stent migration was observed in 1 (4 %) patient with tracheoesophageal fistula in the context of stenosing cancer of the thoracic esophagus. In the 2nd group, stenting was successful in 30 (100 %) cases. Stent migration was not observed in this patient group. In both groups, there were no complications after stent implantation. Installation of tracheal stent allowed to improve patients’ quality of life and provide a possibility for successful special treatment through low-trauma manipulation.

Conclusion. According to the obtained data, endoscopic trachea stenting is the most important method of palliative treatment of tumor-related trachea lesions with development of tracheoesophageal fistulas, malignant central airway obstructions and associated sub- and decompensated pulmonary insufficiency.

Clinical outcomes and survival following placement of self-expandable metallic stents for central airway stenosis and fistula

Background

Self‐expandable metallic stent (SEMS) placement is an urgent procedure for patients with malignant central airway stenoses (CASs) and central airway fistulas (CAFs). The aim of this study was to determine the outcome and survival after SEMS placement in patients with malignant CASs and CAFs.

Methods

SEMSs were inserted into 20 patients with malignant CASs and four with malignant CAFs. Hospital records, the modified Medical Research Council dyspnea scale (mMRC) grade, performance status (PS), symptoms, procedure‐related complications and survival after placement were retrospectively reviewed.

Results

Spiral Z stents were inserted in nine patients, covered Ultraflex stents in 14, and a bare Ultraflex in one patient. After SEMS placement, 20 patients (83.3%) showed improvement in mMRC grade, 19 (79.2%) showed improvement in PS, and 21 (87.5%) showed improvement in symptoms. There were three patients whose stents migrated out of place, but there were no patients with obstructive granulation, infection, or mucous plugs. Median survival days after stent insertion was 98 days for CAS and 103 days for CAF, and mean survival days was 383 ± 707 days for CAS and 93 ± 33 days for CAF. Two patients with CAS by malignant lymphoma and thymic cancer survived more than six years because they were also treated with efficient therapies. The five‐year survival rate after stent insertion was 7.7%.

Conclusions

SEMS placement for CAS and CAF is associated with improvement in mMRC grade, PS and symptoms in 87.5% of patients. Patients with a malignant CAS are usually terminal, but the possibility of increasing survival rate will become a reality with new efficient therapies.

Key points

Significant findings of the study

Reasonable clinical outcomes and improved survival of patients following SEMS placement for thoracic malignancy with central airway stenosis and fistula.

What this study adds

The possibility of increasing survival rate will become a reality with new efficient therapies.

Therapeutic effects of Co-Venenum Bufonis Oral Liquid on radiation-induced esophagitis in rats

To investigate the effects of Co-Venenum Bufonis Oral Liquid (cVBOL) on radiation-induced esophagitis in rats. Irradiation (30 Gy) with X-RAD 225 x-ray was applied to induce esophagitis in 64 Wistar rats and treated by different methods. The body weight of rats either in RT group, cVBOL+RT, or EM+RT group was significantly decreased when compared with that in normal group (P<0.0001). After irradiation, histopathological studies, immunohistochemistry, and MRI scanning on esophagus were performed. Serum TNF-α,IL-6 and IL-10 were also determined by ELISA at 7, 14, 21 and 28 days after radiation treatment. The results demonstrated that radiation caused esophageal injury and thickening of esophageal tissue layers. The esophageal tissues after radiation treatment showed typical pathological changes of esophagitis. Radiation also caused esophagus edema. Treatment of cVBOL reduced the severity of histological esophageal lesion, decreased the expression of bFGF and TGF-β1, and lowered serum levels of inflammatory cytokines including TNF-α, IL-6 and IL-10 over 28 days after radiation treatment. In conclusion, cVBOL treatment is effective to prevent radiation induced esophagitis and reduces radiation induced esophagitis may be mediated through its ant-inflammatory effects.