Restoration of Patency to Central Airways Occluded by Malignant Endobronchial Tumors Using Intratumoral Injection of Cisplatin

Abstract

Rationale: Malignant airway obstruction is commonly found in patients with lung cancer and is associated with significant morbidity and mortality. Relieving malignant obstruction may improve symptoms, quality of life, and life expectancy.Objectives: The objective of this study was to analyze our experience with bronchoscopic endobronchial intratumoral injection of cisplatin for malignant airway obstruction. Methods:We conducted a retrospective analysis of patients with malignant airway obstruction treated with bronchoscopic intratumoral injection of cisplatin. Patient characteristics, histology, degree of airway obstruction, procedural methods, treatment cycles, performance status, and therapeutic outcomes were evaluated. Tumor response was analyzed based on bronchoscopic measurements performed on completion the of final treatment session. Adverse events and overall survival were abstracted. Measurements and Main Results:Between January 2009 and September 2014, 22 patients (10 men, 12 women; mean age 6 SD, 64.4 6 9.5 yr) were treated with one to four injections of 40 mg of cisplatin mixed in 40 ml of 0.9% NaCl. Treatments were completed 1 week apart. The primary etiologies of airway obstruction included squamous cell carcinoma (n = 11), adenocarcinoma (n = 6), small cell carcinoma (n = 2), large cell undifferentiated carcinoma (n = 1), and metastatic endobronchial cancer (n = 2). Twenty-one of 22 patients were evaluable for response. The majority of patients (15/21, 71.4%) responded to therapy, defined as greater than 50% relative reduction in obstruction from baseline. Treatment response was obtained regardless of tumor histology, concurrent systemic therapy, number of treatment cycles administered, performance status, or use of additional ablative interventions. Responders had significantly improved overall survival as compared with nonresponders, although the difference was small. Severe treatment-related side effects or complications were not observed.Conclusions: Subject to the limitations of a single-center retrospective study and a subjective primary outcome measure, we have demonstrated the feasibility of improving the patency of central airways that are largely or completely occluded by endobronchial malignant tumor using intraluminal injection of cisplatin. Additional longer-term, larger-scale safety and comparative effectiveness studies of this palliative treatment modality are warranted.

The role of endobronchial ultrasound versus mediastinoscopy for non-small cell lung cancer

“…Sublobar resections may become standard of care for T1a tumors (112) and are the only surgical option for patients with significantly impaired lung function (40). In this setting, development of a TCP-EBUS scope opens up a possibility of not only reaching further into the airways and sampling the more distant and upper lobe N1 LNs, but also, personalized therapy where a tumor-specific treatment could be delivered to a metastatic LN or a primary lung tumor, using a real time ultrasound imaging (113,114).…”

Endobronchial drug delivery: Expanding techniques and possibilities in interventional pulmonology

“…This is in clear contrast to traditional mechanical debulking techniques (e.g. laser, cryo‐resection), where unresected tumour remains unaffected and improvements are frequently short‐lived …”

“…Bronchoscopic injection of cytotoxic agents directly into airway tumour, also termed endobronchial intratumoural chemotherapy (EITC), has been reported for management of central airway tumour. In NSCLC, this has previously been used both for palliation of bronchial obstruction, as well as with neoadjuvant intent in patients with Stage III disease . Convex probe endobronchial ultrasound‐guided transbronchial needle injection (EBUS‐TBNI) has also been utilized for direct injection of chemotherapeutic agents into extraluminal primary tumours or mediastinal lymph nodes …”

The technique of endoscopic airway tumor treatment

“…It is rather a distinct form of chemotherapy in affecting cytotoxic action on a large local tumor cell burden with accompanying tumor cell death and tumor tissue necrosis (105).…”