Endobronchial metastases from colorectal adenocarcinomas: clinical and endoscopic characteristics and patient prognosis.
BACKGROUND
Endobronchial metastases (EBM) secondary to extrapulmonary solid malignant tumours are rare but may occur. The most common extrathoracic malignancies associated with EBM are breast, renal and colorectal carcinomas. This study aimed to evaluate the clinical and bronchoscopic aspects of EBM from colorectal carcinomas and the prognosis of the patients.


METHODS
EBM were diagnosed in 7 patients with colorectal carcinomas between 2004 and 2005. All patients underwent colorectal resection at the time of primary tumour diagnosis. Bronchial involvement was proved by bronchoscopy, and the metastatic nature of the lesions was confirmed histopathologically in all patients. EBM patients were compared with a control group of 7 patients with pulmonary metastases from colorectal cancer.


RESULTS
Median age at time of colorectal carcinoma was 55 years in EBM patients and 57 years in controls. Distressing airway symptoms caused by EBM were relieved by use of newer intrabronchial therapies: radiotherapy, brachytherapy and cryotherapy. One patient underwent metastasis resection. The median survival after diagnosis of EBM was 18.9 months. All patients had pulmonary metastases. The median survival after diagnosis of pulmonary metastasis from colorectal carcinoma was 55.7 months in EBM patients and 12.7 months in controls (p < 0.005).


CONCLUSIONS
EBM are generally underdiagnosed in patients with colorectal carcinoma. Bronchoscopy is not part of the standard evaluation of these patients. Physicians must be more attentive to pulmonary symptoms, even when patients' pulmonary metastases are known. Various management options are available for localized endobronchial tumours.


CONCLUSIONS
On average, EBM are diagnosed about 5 years after the diagnosis of the primary tumour, which is a relatively long lead time. Although this metastatic location usually implies a very negative prognosis regarding life expectancy, it did not seem to significantly reduce survival in our patients. Local treatments allow substantial improvement of pulmonary symptoms.
Coriat
Romain
R
Oncology Department, Centre Léon Bérard, Lyon, France. romain.coriat@laposte.net
Diaz
Olivia
O
de la Fouchardière
Christelle
C
Desseigne
Françoise
F
Négrier
Sylvie
S
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology*; D000368:Aged; D001984:Bronchial Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000556:secondary*; D002454:Cell Differentiation; D002648:Child; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed