Author of

• 20161

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  P1.12 - Pulmonology/Endoscopy (ID 698)

  • Event: WCLC 2017
  • Type: Poster Session with Presenters Present
  • Track: Pulmonology/Endoscopy
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)

  • 22754

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    P1.12-007 - Outcomes of Radiotherapy and Endoscopic Airway Stenting for Central Airway Obstruction in Non-Small Cell Lung Cancer (ID 9910)

    09:30 - 09:30  |  Author(s): V. Mehta
    • Abstract

    Background:
    Lung cancer is the leading cause of death from malignancy within the United States, exceeding that from breast, colon, and prostate combined. A common complication and challenge of advanced stage lung cancer is central airway obstruction (CAO). CAO can present with minimal symptoms, but often associated with hemoptysis, progressive dyspnea, and even respiratory failure. Interventions such airway stenting and radiation therapy are offered to palliate symptoms, potentially prevent future complications, and prolong survival. However, to date, very little data exists on the comparison of external beam radiotherapy (EBRT) to endoscopic airway stenting in patients with CAO related to non-small cell lung cancer (NSCLC).
    
    Method:
    Patients with NSCLC treated for CAO within the Division of Thoracic Surgery and Interventional Pulmonology from 2010-2013 were identified from diagnosis and billing codes. Patient demographics and interventions were obtained from chart review. Using the Kaplan-Meier method and log rank test, overall survival was calculated from the time to intervention; time from initial intervention to treatment failure (requiring second intervention) and/or death; ECOG status at presentation to death.
    
    Result:
    A total of 34 patients were identified that underwent palliative interventions, including initial treatment with stenting (21/34, 62%) and EBRT (13/34, 38%). No difference was identified in overall survival calculated by the Kaplan-Meier method, p=0.583. However, median overall survival tended to be longer for EBRT at 135 days (interquartile range, IQR: 83-263) compared to stenting at 44 days (IQR: 23-301), p=0.228. In addition, comparative Kaplan-Meier times to failure (second intervention/death) were significantly different, p=0.049; with a similar trend in median time to failure for EBRT at 135 days (IQR: 23-263) versus 27 days (IQR: 6-82) for stenting, p=0.063. Median survival by ECOG status was ECOG 1 – 263 days (IQR:197-463), ECOG 2 – 69 days (IQR:26-147), ECOG 3 – 107 days (IQR:51-209), ECOG 4 – 6 days (IQR:4-23), p=0.003; with sustained separation in Kaplan-Meier survival, p<0.001.
    
    Conclusion:
    NSCLC patients developing CAO represent a challenging population. Overall median survival times are poor, but appeared improved in patients receiving EBRT compared to those receiving airway stenting. From a physiologic standpoint, airway stenting often provides immediate relief of airway obstruction and respiratory embarrassment; however, our current results may question the role of airway stenting in NSCLC patients with CAO. Alternatively, additional outcomes such as quality of life and utilization of healthcare resources may also need to be explored to evaluate the full impact that EBRT and/or airway stenting may have on CAO.