Survival Experience Following Nd:YAG Laser Photoresection for Primary Bronchogenic Carcinoma: Results

Between September 1983 and September 1986, 47 patients (29 men, 18 women; squamous = 28, large cell = 10, adenocarcinoma =7, small cell = 2) with inoperable symptomatic primary bronchogenic carcinoma underwent palliative YPR for major airway obstruction at the Cleveland Clinic Foundation. A mean dose of 8,385 joules of energy was delivered (median dose, 6,944 joules; range, 1,622 to 22,492 joules). They were subsequently followed up as outpatients for a mean period of 192.7 days (median follow-up period, 136 days; range, 1 to 1,002 days), and 11 patients required repeated YPR for palliation. As of January 1987, eight patients were still alive. The survival characteristics for the whole group from time of treatment by cell type are shown in Table 1. buy glucotrol online

Of the 47 patients undergoing YPR, five did not receive XRT (squamous = 1, large cell— l, adenocarcinoma =2, small cell = 1). One patient (small cell) received both XRT as well as chemotherapy. Six patients (squamous cell = 3, large cell = 2, adenocarcinoma = 1) received EB-XRT (3,000 rad) in addition to conventional XRT and YPR. The median survival of these six patients from zero time was 471 days compared with the 304 days’ median survival for 35 patients who underwent XRT and YPR (Fig 1). The log rank test for these two groups shows that the difference is not statistically significant (p = 0.22). Given the small size of EB-XRT group, this is not surprising.
After the above 12 patients were excluded, there remained 35 patients with NSCLC (squamous cell = 24, large cell = 7, adenocarcinoma = 4) who underwent conventional XRT (median dose of5,500 rads) in addition to YPR. Of these 35 patients, 20 had completed XRT or were undergoing XRT at the time of referral for YPR. The remaining 15 patients underwent emergency YPR as the initial therapeutic intervention. The survival experience of these 35 patients was compared with that of the 58 patients in the control group who had had conventional XRT alone (Table 2).
Table 1—Survival Estimates for AH Fatients Undergoing Laser Therapy From Time of Treatment by Cell Type

WholeCroup SquamousCell Adeno/Large SmallCell
No. of patients 47 28 17 2
No. of deaths 39 23 14 2
4 mo % surv (±SE) 55.3 (4.3) 60.7 (9.2) 47.1 (12.1) 50 (35.4)
6 mo % surv (± SE) 42.2 (7.3) 46.4 (9.4) 33.6 (11.8) 50 (35.4)
1 yr % surv (± SE) 20.8 (6.4) 22.6 (8.3) 11.2 (10.0) 50 (35.4)
Median sun; days 143 157 122 318
Mean sun; days 208 210 146 318

Table 2—Survival Estimates by Treatment Groups in Patients with Non-Small Cell Primary Bronchogenic Carcinoma

TimeSince

Diagnosis

XRT Alone (Control Group) XRT+YPR
No. Surv Est, % SE,% No. Surv Est, % SE,%
0 58 100.0 35 100.0 _
4 mo 44 75.9 6.0 27 77.1 7.0
6 mo 35 60.3 6.0 24 68.6 8.0
lyr 18 31.0 6.0 13 39.8 8.0
2 yr 9 15.5 6.0 5 21.5 8.0
Median survival, days 253.0 304.0
Mean survival, days 355.4 463.2
Log rank test p-value = 0.17

 

Figure 1. Survival estimates for patients undergoing XRT + YPR with and without EX-XRT in patients with non-small cell primary bronchogenic carcinoma (see text for all abbreviations).

Figure 1. Survival estimates for patients undergoing XRT + YPR with and without EX-XRT in patients with non-small cell primary bronchogenic carcinoma (see text for all abbreviations).


Category: Bronchogenic Carcinoma

Tags: bronchogenic carcinoma, metastatic disease, radiation therapy