Safety and efficacy of thoracic external beam radiotherapy after airway stenting in malignant airway obstruction

Int J Radiat Oncol Biol Phys. 2012 May 1;83(1):e129-35. doi: 10.1016/j.ijrobp.2011.11.055.


Purpose: We retrospectively evaluated the outcome and toxicity of external beam radiotherapy (EBRT) after airway stents were placed in patients treated for malignant airway obstruction.

Methods and materials: Between 2004 and 2009, we performed airway stenting followed by EBRT in 43 patients for symptomatic primary lung cancer (n = 31) or other thoracic malignancies (n = 12). The median time interval between stent placement and first irradiation was 14 days. A median total dose of 50 Gy was delivered. Sixty-seven percent of the patients had reduced performance status (Karnofsky performance score, ≤70).

Results: EBRT had to be stopped prematurely in 16 patients (37%), at a median total dose of 17 Gy, for various reasons. In this group of patients, the survival was poor, with a median overall survival (OS) of only 21 days. Twenty-seven patients (63%) completed radiotherapy as planned, with a median OS of 8.4 months. Fourteen of 43 patients (33%) developed at least one Common Terminology Criteria for Adverse Event of grade 3 to 5. The most common event was a malignant restenosis of the stent leading to asphyxia (n = 7), followed by fistula formation (n = 4), necrosis (n = 3), mediastinitis with abscess (n = 1), secondary nonmalignant airway stenosis (n = 1), and hemoptysis (n = 1). With the exception of one event, all events were associated with a local progression of the tumor.

Conclusions: Although the long-term prognosis for patients with malignant airway obstruction is poor, airway stenting combined with EBRT offers a possible therapeutic option, achieving fast relief of acute respiratory distress with an associated antitumor effect, resulting in a potential survival benefit. However, due to local advanced tumor growth, increased rates of adverse events are to be expected, necessitating careful monitoring.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Airway Obstruction / etiology
  • Airway Obstruction / mortality
  • Airway Obstruction / radiotherapy*
  • Airway Obstruction / surgery
  • Asphyxia / etiology
  • Bronchoscopy
  • Combined Modality Therapy / adverse effects
  • Combined Modality Therapy / methods
  • Combined Modality Therapy / mortality
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Karnofsky Performance Status
  • Lung Neoplasms / complications
  • Lung Neoplasms / mortality
  • Lung Neoplasms / radiotherapy*
  • Lung Neoplasms / surgery
  • Male
  • Mediastinal Neoplasms / complications
  • Mediastinitis / etiology
  • Middle Aged
  • Necrosis / etiology
  • Radiation Injuries / complications*
  • Radiation Injuries / mortality
  • Recurrence
  • Retrospective Studies
  • Stents / adverse effects*
  • Survival Analysis
  • Treatment Outcome