Palliative YPR was performed on symptomatic patients with unresectable exophytic primary bronchogenic carcinoma involving the trachea or major airways. In all cases, these lesions were symptomatic, producing hemoptysis, dyspnea, asphyxiation, postobstructive pneumonitis, or collapse of one or more lobes of the lung (or the entire lung) at time of referral for YPR. These indications were established by initial history and physical examination, chest roentgenography, and fiberoptic bronchoscopic study. Diagnosis of malignancy was established by examination of endobronchial biopsy specimen or of available pathology slides from previous procedures. Patients were considered to have unresectable disease because of either the extent of disease or surgical inoperability. YPR was performed only after an initial trial of XRT (n = 26) or chemotherapy (n = 1). In those cases where the patients life was thought to be in immediate danger (n = 20), YPR was performed before XRT (n = 19) or chemotherapy (n = 1). Photographic documentation of the lesion and airway patency before and after YPR were obtained in each case. Detailed informed consent was obtained from each patient undergoing YPR.
YPR was performed using either local or general anesthesia in the manner previously described. The Kaplan-Meier method was used to estimate the survival rates by cell type and by metastatic disease status both from zero time (date of histologic diagnosis of primary bronchogenic carcinoma) as well as from date of YPR. This method incorporates the time interval a patient was followed up as well as the survival status of the patient The survival distributions were compared using the log rank test Patients with adenocarcinoma and large cell carcinoma have been known to have similar survival patterns and so were pooled together for analysis. Twenty-six patients had undergone or were undergoing XRT at time of referral for YPR. Data on six of these patients who underwent additional endobronchial radiation therapy (EB-XRT) were analyzed separately The remaining 20 patients underwent conventional XRT alone.
Category: Bronchogenic Carcinoma
Tags: bronchogenic carcinoma, metastatic disease, radiation therapy