Author of

• 17728

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  P2.04 - Poster Session with Presenters Present (ID 466)

  • Event: WCLC 2016
  • Type: Poster Presenters Present
  • Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
  • Presentations: 1
  • Moderators:
  • Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)

  • 17758

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    P2.04-030 - Airway Intervention in the Management of Low Grade Malignant Bronchogenic Neoplasms (ID 3676)

    14:30 - 14:30  |  Author(s): A.A.L. Hsu
    • Abstract

    Background:
    Patients with low grade malignant bronchogenic neoplasms present with insidious airway symptoms as these are rare indolent tumors occurring in young to middle aged adults. There is paucity of data on the role of airway intervention in the management of low grade neoplasm of the major airway as its prevalence amongst all primary bronchogenic malignancy is low.
    
    Methods:
    Study inclusion criteria were: 1) low grade malignant bronchogenic neoplasm confirmed on histology and 2) tumor present in the tracheobronchial tree requiring airway intervention as part of the therapeutic management.
    
    Results:
    There were 13 patients (8 females) with a mean age of 40.7 (range 30-66) years. Histological types include 8 adenoid cystic carcinomas, 4 carcinoids and 1 mucoepidermoid carcinoma. Insidious symptoms often treated for benign bstructive airway diseases and respiratory infections, over a mean of 15 (range 3-31) months. About half had normal CXR as the tumor was distributed most frequently in the trachea (46.2% of 13) followed by the main bronchi (30.8%), lobar bronchi (23%). Six (46.2%) patients, all with adenoid cystic carcinoma, underwent emergent bronchoscopic intervention to secure greater airway patency before definitive therapy with surgery or/and radiotherapy. All airway interventions were performed via the rigid bronchoscope under deep intravenous sedation with assisted ventilation. The types of intervention included: NdYAG laser resection (all 13), rigid tube or forceps resection (13), balloon dilatation (7) and silicone stenting (3). There were no procedural complications. Two patients, both with typical carcinoid, had bronchoscopic curative resection and the majority (9 out of 13) of the patients underwent surgery. External beam radiotherapy was administered to 5 (38.5%) of the patients when surgical resection was deemed not feasible (2) or with positive margins (3). None received systemic therapy. Prolonged good palliation was achieved for 4 (30.8%) patients with surgically unresectable lesions or recurrences via endoscopic therapy with or without radiation, including brachytherapy. The mean follow up duration was 64 months (range 28-100) months.
    
    Conclusion:
    Airway intervention for low grade malignant bronchogenic neoplasm is an important part of the therapeutic armamentarium. Its role may be 1) emergent for critical airway obstruction where establishment of adequate airway patency is necessary prior to definitive therapy with surgery and/or radiotherapy, or 2) curative for lesions limited to within the tracheobronchial wall, or 3) palliative to relief the suffocating distressing symptom in those with no or limited oncologic/surgical options.