Palliative management of malignant airway obstruction

Ann Thorac Surg. 2002 Dec;74(6):1928-32; discussion 1932-3. doi: 10.1016/s0003-4975(02)04085-7.


Background: Obstruction of the airway due to unresectable malignant disease is a frightening condition that portends a poor prognosis. Endobronchial treatment modalities were reviewed to determine the most effective management strategy.

Methods: A 12-year retrospective review (1988 to 1999) of 121 consecutive patients with inoperable malignant airway obstruction (MAO) was performed. Sixty-five patients received high-dose-rate brachytherapy (HDR) alone, 32 received HDR plus neodymium:yttrium-aluminum garnet laser (YAG) therapy, 16 received YAG only, 4 patients were stented, and 4 received photodynamic therapy (PDT). Follow-up was obtained by chart review and contact.

Results: Seventy-seven men and 44 women, median age 62 years (range 30 to 86 years), underwent 378 endobronchial procedures for relief of MAO. Good to excellent results were achieved in 77% (93/121) of patients. Seventy-two percent (23/32) of patients undergoing HDR plus YAG received a good to excellent result. All 8 patients receiving either stents or PDT had good to excellent palliation. There were no intraoperative deaths, but there were two in-hospital deaths. Complications occurred in 4% (5/121) of patients. Forty-four percent (53/121) of our patients were lost to follow-up. Mean survival was 6.7 months after the last treatment.

Conclusions: Temporary relief of inoperable MAO can be accomplished with a number of endobronchial treatments used either singularly or in combination. The majority of patients managed with HDR, YAG, or HDR plus YAG received good to excellent short-term palliation.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Airway Obstruction / etiology
  • Airway Obstruction / mortality
  • Airway Obstruction / therapy*
  • Brachytherapy
  • Female
  • Follow-Up Studies
  • Humans
  • Laser Therapy
  • Lung Neoplasms / complications*
  • Male
  • Middle Aged
  • Palliative Care / methods*
  • Photochemotherapy
  • Retrospective Studies
  • Stents
  • Survival Rate