Bronchoscopic debulking for endobronchial malignancy: Predictors of recanalization and recurrence

Scott Chih Hsi Kuo, Yu Lun Lo, Chun Liang Chou, Fu Tsai Chung, Shu Min Lin, Chien Ying Liu, Han Pin Kuo

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Abstract

Background: Central airway obstruction related to endobronchial malignancy is one of the most difficult oncological complications and requires efficient palliative intervention. Methods: Fifty-three consecutive patients with unresectable endobronchial malignancy receiving bronchoscopic cryotherapy as palliative treatment were retrospectively reviewed. Efficiency was evaluated by the improvement of performance status (PS), and the best achievement of tumor removal was assessed as complete or partial removal. Result: Patients' PS after cryotherapeutic tumor removal improved from the baseline PS (P = 0.006). In multivariate logistic regression analysis, the compression part of the tumor (odds ratio [OR] 0.42; 95% confidence interval [CI] 0.23∼0.75, P = 0.004) and the thin tumor stalk (OR 87.86; 95% CI 2.31∼3337.37, P = 0.016) were independent predictors of complete tumor removal. Tumors larger than 9.3cm, including compression and invasion parts, had the highest odds of being only partially removed (positive predictive value [PPV]: 88.2%, likelihood ratio [LR]+: 10.49); tumors smaller than 9.3cm were likely to be completely removed (negative predictive value [NPV]: 80.6%, LR-: 0.34). After cryotherapy, re-obstruction was significantly associated with non-squamous cell carcinoma (65.7 vs. 16.7%, P = 0.001) and patients who had longer overall survival (11.7 vs. 1.5 months, P < 0.001). Odds of tumor re-obstruction increased 2.28-fold (PPV: 81.6%, LR+: 2.28) beyond two months; the odds decreased by 81% (NPV: 73.3%, LR-: 0.19) within two months. Conclusion: Debulking of a tumor using cryotherapy is a useful palliative treatment for endobronchial obstruction secondary to a variety of malignancies.

Original languageEnglish
Pages (from-to)722-730
Number of pages9
JournalThoracic Cancer
Volume6
Issue number6
DOIs
Publication statusPublished - Jan 1 2015
Externally publishedYes

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Keywords

  • Bronchoscopic
  • Cryotherapy
  • Endobronchial
  • Malignancy

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

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