Ninety percent of the patients who develop primary bronchogenic carcinoma die of their primary disease. Only 25 percent of cases are surgically resectable at the time of diagnosis, the median five-year survival in this group being approximately 60 percent. The median five-year survival in inoperable patients treated with irradiation is approximately 5 to 10 percent. The most common site for failure of inoperable nonsmall cell lung cancer (NSCLC) is within the thorax, and complications of the intrathoracic tumor are often the most common cause of death. In the past, treatment of unresectable malignant tracheobronchial obstruction was limited to radiation therapy or chemotherapy and, rarely, to cryotherapy or biopsy resection. Radiation therapy can relieve cough, chest pain, and dyspnea in 60 to 80 percent of patients but successfully relieves atelectasis in only 25 percent of patients. In recent years, the use of laser technology has offered a more reliable, definitive, and immediate palliation of the symptoms of local recurrence of lung carcinoma. Few authors, to our knowledge, have studied the effects of laser photoresection on survival in patients with primary bronchogenic carcinoma. read
Nd.YAG laser photoresection (YPR) has been available at the Cleveland Clinic Foundation since Septem-her 1983 and is used for palliation of symptoms in inoperable patients with dyspnea, hemoptysis, asphyxiation, atelectasis, or postobstructive pneumonitis. The course of 47 consecutive patients who underwent palliative YPR between September 1983 and September 1986 for airway obstruction caused by inoperable primary bronchogenic carcinoma was followed up to investigate the possible effects of YPR on survival. These patients had either been treated with conventional radiation therapy (XRT), were undergoing XRT, or had received no prior therapy at the time of referral for YPR treatment We thought that randomization of these obviously symptomatic inoperable patients, who could benefit immediately from palliative YPR, to other modalities of palliation would be unethical. A reference group (control group) was therefore established to examine retrospectively the survival experience of 58 patients seen from 1981 to 1983 with symptomatic inoperable primary bronchogenic carcinoma who underwent only palliative XRT. During that time, YPR was not yet available at this institution.
Category: Bronchogenic Carcinoma
Tags: bronchogenic carcinoma, metastatic disease, radiation therapy