Long-Term Follow-Up of High-Risk Patients in the National Emphysema Treatment Trial

Kaplan, Robert M.; Sun, Qiankun; Naunheim, Keith S.; Ries, Andrew L.

doi:10.1016/j.athoracsur.2014.06.031

Cited by 15 publications

(11 citation statements)

References 10 publications

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“…All patients survived to discharge. Short-term complications were of lesser importance compared to the reported 16% 30-day mortality among high-risk patients following sLVR [5]. …”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, the procedure has relevant risks, and not all patients are suitable to undergo sLVR. The National Emphysema Treatment Trial (NETT) showed high mortality rates within the first 30 days for patients with a low forced expiratory volume in 1 s (FEV 1 ) and either homogeneous emphysema or a very low diffusing capacity for carbon monoxide (D LCO ) [4,5]. Nevertheless, long-term follow-up of the high-risk patients of the NETT ultimately showed a benefit even in this subgroup [5].…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Lung Volume Reduction Using Endobronchial Valves in Patients with Severe Emphysema and Very Low FEV<sub>1</sub>

Trudzinski¹,

Höink

Leppert

et al. 2016

Respiration

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Background: Patients with a forced expiratory volume in 1 s (FEV₁) below 20% of the predicted normal values (pred.) and either homogeneous emphysema or low diffusing capacity for carbon monoxide (DLCO) have a high risk for adverse events including death when undergoing surgical lung volume reduction. Objectives: We hypothesized that selected patients can benefit from endoscopic lung volume reduction (eLVR) despite a very low FEV₁. Methods: This study is a retrospective analysis of consecutive patients with severe airflow obstruction, an FEV₁ ≤20% of pred., and low DLCO who were treated by eLVR with endobronchial valves (EBV) between June 2012 and January 2015. Pre- and postinterventional lung function parameters, the 6-min walking test (6-MWT) distance, adverse events, and follow-up were recorded. Results: In 20 patients, there was an overall improvement in lung function with an increase in FEV₁ (16.97-21.03% of pred.) and a decrease in residual volume (322-270% of pred.) and total lung capacity (144-129.06% of pred.). The 6-MWT distance improved (from 239 ± 77 to 267± 97 m overall, and from 184 ± 50 to 237 ± 101 m if patients developed an atelectasis of the target lobe). Pneumothorax occurred in 5 of the 20 patients (25%). 30-day mortality was 0%, and all patients survived to discharge. Conclusions: The patients benefitted moderately from EBV treatment despite an initially low FEV₁. Some patients improved remarkably. EBV treatment in patients with an FEV₁ ≤20% of pred. is generally feasible and safe. The greatest risk is pneumothorax with prolonged chest tube duration.

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“…All patients survived to discharge. Short-term complications were of lesser importance compared to the reported 16% 30-day mortality among high-risk patients following sLVR [5]. …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic Lung Volume Reduction Using Endobronchial Valves in Patients with Severe Emphysema and Very Low FEV<sub>1</sub>

Trudzinski¹,

Höink

Leppert

et al. 2016

Respiration

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“…Again, these benefits were most pronounced in the upper lobe predominant/low baseline exercise capacity subgroup, but longer term follow-up of the high-risk participants revealed comparable outcomes (survival, dyspnoea, and QoL). 21 The initial higher mortality rate was offset by a later lower one. However, the figures did not achieve statistical significance: Early termination of recruitment of this subgroup led to underpowering.…”

Section: Clinical Datamentioning

confidence: 99%

Lung Volume Reduction in Pulmonary Emphysema

Garner

Shah

2020

Semin Respir Crit Care Med

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Severe emphysema with hyperinflation presents a therapeutic challenge. Inhaled medication has limited efficacy in individuals with mechanical constraints to the respiratory pump and impaired gas exchange. Lung volume reduction surgery (LVRS) reestablishes some semblance of normal physiology, resecting grossly expanded severely diseased tissue to restore the function of compromised relatively healthy lung, and has been shown to significantly improve exercise capacity, quality of life, and survival, especially in individuals with upper-lobe predominant emphysema and low-baseline exercise capacity, albeit with higher early morbidity and mortality. Bronchoscopic lung volume reduction achieved by deflating nonfunctioning parts of the lung is promoted as a less invasive and safer approach. Endobronchial valve implantation has demonstrated comparable outcomes to LVRS in selected individuals and has recently received approvals by the National Institute of Clinical Excellence in the United Kingdom and the Food and Drug Administration in the United States of America. Endobronchial coils are proving a viable treatment option in severe hyperinflation in the presence of collateral ventilation in selected cases of homogeneous disease. Modalities including vapor and sealant are delivered using a segmental strategy preserving healthier tissue within the same target lobe-efficacy and safety-data are, however, limited. This article will review the data supporting these novel technologies.

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“…However, many patients with severe emphysema are not surgical candidates, as they may have excessive comorbidities or exhibit features associated with a striking 16 % 90-day mortality rate in the NETT and are classified as high-risk [ 1 , 3 ]. Importantly, at 6-year follow up of 140 high-risk NETT patients, those receiving LVRS demonstrated equivalent long-term overall survival with significantly improved quality of life compared with those medically managed [ 4 ]. Thus, investigation of less invasive LVRS alternatives for lung volume reduction is warranted for high-risk emphysema patients.…”

Section: Introductionmentioning

confidence: 99%

Time course and predictive factors for lung volume reduction following stereotactic ablative radiotherapy (SABR) of lung tumors

et al. 2016

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BackgroundStereotactic ablative volume reduction (SAVR) is a potential alternative to lung-volume reduction surgery in patients with severe emphysema and excessive surgical risk. Having previously observed a dose-volume response for localized lobar volume reduction after stereotactic ablative radiotherapy (SABR) for lung tumors, we investigated the time course and factors associated with volume reduction.MethodsWe retrospectively identified 70 eligible patients receiving lung tumor SABR during 2007-2013. We correlated lobar volume reduction (relative to total, bilateral lung volume [TLV]) with volume receiving high biologically effective doses (VXXBED3) and other pre-treatment factors in all patients, and measured the time course of volume changes on 3-month interval CT scans in patients with large V60BED3 (n = 21, V60BED3 ≥4.1 % TLV).ResultsMedian CT follow-up was 15 months. Median volume reduction of treated lobes was 4.5 % of TLV (range 0.01–13.0 %), or ~9 % of ipsilateral lung volume (ILV); median expansion of non-target adjacent lobes was 2.2 % TLV (−4.6–9.9 %; ~4 % ILV). Treated lobe volume reduction was significantly greater with larger VXXBED3 (XX = 20–100 Gy, R2 = 0.52–0.55, p < 0.0001) and smaller with lower pre-treatment FEV1% (R2 = 0.11, p = 0.005) in a multivariable linear model. Maximum volume reduction was reached by ~12 months and persisted.ConclusionsWe identified a multivariable model for lobar volume reduction after SABR incorporating dose-volume and pre-treatment FEV1% and characterized its time course.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-016-0616-8) contains supplementary material, which is available to authorized users.

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Long-Term Follow-Up of High-Risk Patients in the National Emphysema Treatment Trial

Cited by 15 publications

References 10 publications

Endoscopic Lung Volume Reduction Using Endobronchial Valves in Patients with Severe Emphysema and Very Low FEV<sub>1</sub>

Endoscopic Lung Volume Reduction Using Endobronchial Valves in Patients with Severe Emphysema and Very Low FEV<sub>1</sub>

Lung Volume Reduction in Pulmonary Emphysema

Time course and predictive factors for lung volume reduction following stereotactic ablative radiotherapy (SABR) of lung tumors

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