CRA73 A CASE SERIES OF ENDOBRONCHIAL STENTING IN MALIGNANT CENTRAL AIRWAY OBSTRUCTION OF STAGE 4 NON-SMALL CELL LUNG CANCER
See Qing Ang1, Larry Ellee Nyanti1 2, Nai- Chien Huan1, Rong Lih Ho1, Tharmaraj Kunaraj1, Shan Min Lo1, Hema Yamini Ramarmuty1, Kunji Kannan Sivaraman Kannan1
1 Department of Respiratory Medicine, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia.
2 Medical Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia.
Introduction
Malignant central airway obstruction can be caused by locally advanced lung cancer or metastatic disease. Endobronchial stenting can be used to relieve the obstruction to improve patient’s symptoms and quality of life.
Case Description
Case 1 was a 63-year-old female, ECOG 2 with right lung squamous cell carcinoma complicated by brain metastasis. CECT Thorax noted a large right upper lobe mass obstructing the right main bronchus. Rigid bronchoscopy demonstrated complete obliteration of the right main bronchus by the necrotic mass. Cryodebulking and straight silicone stent was performed. Post-stenting, the patients was discharged on room air and commenced systemic chemotherapy.
Case 2 is a 72-year-old gentleman, ECOG 1 with right lung adenocarcinoma complicated by brain metastasis. CECT Thorax noted a narrowed right main bronchus due to external compression. Bronchoscopy showed 80% stenosis of right airway and 50% stenosis of left airway. Y-stent was inserted and he was commenced on targeted therapy post-stenting.
Surveillance bronchoscopy up to one/two months for both patients demonstrated patent airway.
Discussion
Several factors to consider before deployment of stents in malignant central airway obstruction include the mechanism of airway obstruction, severity of obstruction, underlying comorbidities and goal of care. Post-stenting follow-up is crucial to monitor complications to maintain long-term airway patency. The goal for stenting is often to provide palliation of symptoms, but from the two cases above, stenting can serve as a bridge to curative treatment.
Conclusion
Endobronchial stenting is an effective and safe method which brings not only palliative but possible curative benefits in managing patients with malignant central airway obstruction in terms of symptom relief, pulmonary function, quality of life and clinical outcomes.