Endoscopic treatment of lung cancer invading the airway before induction chemotherapy and surgical resection.
OBJECTIVE
Many patients with advanced lung cancer invading the airway require only palliation; however, induction chemotherapy and surgery may sometimes be considered. Preliminary endoscopic palliation may improve quality of life and functional status, allows better evaluation of tumor extension and contributes to prevent infectious complications. We reviewed our experience with preliminary laser treatment, induction chemotherapy and surgical resection in patients with lung cancer invading the airway.


METHODS
Twenty-one patients with stage IIIA and IIIB lung cancer presenting with an 80% unilateral airway obstruction were treated with laser resection, induction chemotherapy and surgery. Spirometry, arterial blood gas analysis, quality of life (QLQ-C30 score) and performance status were recorded before and after laser treatment and after chemotherapy. Complications during chemotherapy, surgical morbidity and mortality, and survival were also recorded.


RESULTS
No complications were observed after endoscopic treatment. FEV(1) significantly improved from 1.4+/-0.4 l/s to 2.2+/-0.7 l/s, as well as FVC (from 2+/-0.5 to 3.1+/-0.8 l), and remained stable after chemotherapy. The QLQ-C30 score significantly improved after laser treatment (from 45+/-4.8 to 31+/-2.5) as well as the Karnofsky status (from 76+/-5 to 90). One patient developed pneumonia during induction chemotherapy. Three patients were not operated on. We performed five pneumonectomies (one right tracheal sleeve pneumonectomy) and 13 lobectomies (five associated to a bronchial sleeve resection). One patient (5.5%) died after the operation. Four patients experienced minor postoperative complications. Three-year survival after the operation was 52%.


CONCLUSIONS
Preliminary endoscopic palliation of lung cancer invading the airway is feasible, improves evaluation and staging, helps to reduce the incidence of complications during induction chemotherapy without increasing surgical morbidity and mortality.
Venuta
F
F
Department of Thoracic Surgery, University of Rome La Sapienza, Rome, Italy. sofed@libero.it
Rendina
E A
EA
De Giacomo
T
T
Mercadante
E
E
Ciccone
A M
AM
Aratari
M T
MT
Moretti
M
M
Coloni
G F
GF
D000230:Adenocarcinoma / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001980:Bronchi / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D004724:Endoscopy; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D053685:Laser Therapy; D008175:Lung Neoplasms / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010166:Palliative Care; D011013:Pneumonectomy; D015996:Survival Rate
D000970:Antineoplastic Agents