title: Restoration of Patency to Central Airways Occluded by Malignant Endobronchial Tumors Using Intratumoral Injection of Cisplatin.
abstract: BACKGROUND
  Malignant airway obstruction is commonly found in patients with lung cancer and is associated with significant morbidity and mortality. Relieving malignant obstruction may improve symptoms, quality of life, and life expectancy.
  
  
  OBJECTIVE
  The objective of this study was to analyze our experience with bronchoscopic endobronchial intratumoral injection of cisplatin for malignant airway obstruction.
  
  
  METHODS
  We conducted a retrospective analysis of patients with malignant airway obstruction treated with bronchoscopic intratumoral injection of cisplatin. Patient characteristics, histology, degree of airway obstruction, procedural methods, treatment cycles, performance status, and therapeutic outcomes were evaluated. Tumor response was analyzed based on bronchoscopic measurements performed on completion the of final treatment session. Adverse events and overall survival were abstracted.
  
  
  RESULTS
  Between January 2009 and September 2014, 22 patients (10 men, 12 women; mean age ± SD, 64.4 ± 9.5 yr) were treated with one to four injections of 40 mg of cisplatin mixed in 40 ml of 0.9% NaCl. Treatments were completed 1 week apart. The primary etiologies of airway obstruction included squamous cell carcinoma (n = 11), adenocarcinoma (n = 6), small cell carcinoma (n = 2), large cell undifferentiated carcinoma (n = 1), and metastatic endobronchial cancer (n = 2). Twenty-one of 22 patients were evaluable for response. The majority of patients (15/21, 71.4%) responded to therapy, defined as greater than 50% relative reduction in obstruction from baseline. Treatment response was obtained regardless of tumor histology, concurrent systemic therapy, number of treatment cycles administered, performance status, or use of additional ablative interventions. Responders had significantly improved overall survival as compared with nonresponders, although the difference was small. Severe treatment-related side effects or complications were not observed.
  
  
  CONCLUSIONS
  Subject to the limitations of a single-center retrospective study and a subjective primary outcome measure, we have demonstrated the feasibility of improving the patency of central airways that are largely or completely occluded by endobronchial malignant tumor using intraluminal injection of cisplatin. Additional longer-term, larger-scale safety and comparative effectiveness studies of this palliative treatment modality are warranted.
authors.affiliation: 1 Division of Pulmonary, Critical Care, and Sleep Medicine, and.
authors.forename: Hiren J
authors.identifier: http://orcid.org/0000-0001-7331-747X
authors.initials: HJ
authors.lastname: Mehta
authors.affiliation: 2 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota.
authors.forename: Abbie
authors.initials: A
authors.lastname: Begnaud
authors.affiliation: 1 Division of Pulmonary, Critical Care, and Sleep Medicine, and.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Penley
authors.affiliation: 1 Division of Pulmonary, Critical Care, and Sleep Medicine, and.
authors.forename: John
authors.initials: J
authors.lastname: Wynne
authors.affiliation: 3 Division of Pulmonary and Critical Care Medicine, West Virginia University Charleston Division, Charleston, West Virginia.
authors.forename: Paras
authors.initials: P
authors.lastname: Malhotra
authors.affiliation: 4 Interventional Pulmonology, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile; and.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Fernandez-Bussy
authors.affiliation: 5 University of Florida Health Shands Hospital, Department of Pharmacy, Gainesville, Florida.
authors.forename: Jessica
authors.initials: J
authors.lastname: Cope
authors.affiliation: 6 Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Shuster
authors.affiliation: 1 Division of Pulmonary, Critical Care, and Sleep Medicine, and.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Jantz
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology* / Q000628:therapy; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001999:Bronchoscopy / Q000379:methods; D002277:Carcinoma / Q000473:pathology / Q000628:therapy*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015552:Injections, Intralesional / Q000379:methods; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011788:Quality of Life; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: cisplatin; endobronchial injection of chemotherapy; malignant airway obstruction