Palliative management of malignant airway obstruction.
BACKGROUND
Obstruction of the airway due to unresectable malignant disease is a frightening condition that portends a poor prognosis. Endobronchial treatment modalities were reviewed to determine the most effective management strategy.


METHODS
A 12-year retrospective review (1988 to 1999) of 121 consecutive patients with inoperable malignant airway obstruction (MAO) was performed. Sixty-five patients received high-dose-rate brachytherapy (HDR) alone, 32 received HDR plus neodymium:yttrium-aluminum garnet laser (YAG) therapy, 16 received YAG only, 4 patients were stented, and 4 received photodynamic therapy (PDT). Follow-up was obtained by chart review and contact.


RESULTS
Seventy-seven men and 44 women, median age 62 years (range 30 to 86 years), underwent 378 endobronchial procedures for relief of MAO. Good to excellent results were achieved in 77% (93/121) of patients. Seventy-two percent (23/32) of patients undergoing HDR plus YAG received a good to excellent result. All 8 patients receiving either stents or PDT had good to excellent palliation. There were no intraoperative deaths, but there were two in-hospital deaths. Complications occurred in 4% (5/121) of patients. Forty-four percent (53/121) of our patients were lost to follow-up. Mean survival was 6.7 months after the last treatment.


CONCLUSIONS
Temporary relief of inoperable MAO can be accomplished with a number of endobronchial treatments used either singularly or in combination. The majority of patients managed with HDR, YAG, or HDR plus YAG received good to excellent short-term palliation.
Morris
Cullen D
CD
Joseph Brown Whitehead Department of Surgery, Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Budde
Jason M
JM
Godette
Karen D
KD
Kerwin
Timothy L
TL
Miller
Joseph I
JI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D001918:Brachytherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010778:Photochemotherapy; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate