Integrated intErventional bronchoscopy in the treatment of locally adVanced non-small lung cancER with central Malignant airway Obstructions: a multicentric REtrospective study (EVERMORE). (October 2020)

• Record Type: Journal Article
• Authors: Marchioni, Alessandro; Andrisani, Dario; Tonelli, Roberto; Piro, Roberto; Andreani, Alessandro; Cappiello, Gaia Francesca; Meschiari, Emmanuela; Dominici, Massimo; Bavieri, Mario; Barbieri, Fausto; Taddei, Sofia; Casalini, Eleonora; Falco, Francesco; Gozzi, Filippo; Bruzzi, Giulia; Fantini, Riccardo; Tabbì, Luca; Castaniere, Ivana; Facciolongo, Nicola; Clini, Enrico
• Is Part Of: Lung cancer. Volume 148(2020)
• Page Start: 40
• Page End: 47
• Publication Date: 2020-10
• Subjects: CAO central airway obstruction -- CT chemotherapy -- RT radiation therapy -- ST standard therapy -- IT integrated treatment -- NSCLC Non-Small Cell Lung Cancer -- IQR interquartile ranges -- EGFR epidermal growth factor receptor -- BRAF v-raf murine sarcoma viral oncogene homolog B1 -- KRAS Kirsten rat sarcoma -- ALK Anaplastic lymphoma kinase -- PDL1 programmed death-ligand 1 -- CHT chemotherap y -- RT radiotherapy -- TKI tyrosine kinase inhibitor; Non-small cell lung cancer -- central airway obstruction -- therapeutic bronchoscopy -- mechanical debulking -- airway stent -- KRAS-mutant tumors; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2020.07.032
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: In a cohort of patients with locally advanced Non-Small Cell Lung Cancer and associated Central Airways Obstruction interventional bronchoscopy as a part of an integrated treatment improved 1-year survival. Interventional bronchoscopy reduced new hospitalizations, increased symptom-free interval and prevented atelectasis. Genetic and anatomic phenotyping might identify patients who may gain life expectancy from the endoscopic intervention. Abstract: Objectives: Despite new therapeutic perspectives, the presence of central airways occlusion (CAO) in patients with locally advanced non-small cell lung cancer (NSCLC) is associated with poor survival. There is no clear evidence on the clinical impact of interventional bronchoscopy as a part of an integrated treatment to cure these patients. Materials and methods: This retrospective cohort study was conducted in two teaching hospitals over a 10 years period (January 2010-January 2020) comparing patients with NSCLC at stage IIIB and CAO at disease onset treated with chemotherapy/radiotherapy (standard therapy-ST) with those receiving interventional bronchoscopy plus ST (integrated treatment-IT). Primary outcome was 1-year survival. The onset of respiratory events, symptoms-free interval, hospitalization, need for palliation, and overall mortality served as secondary outcomes. Results: A total of 100 patients were included, 60 in the IT and 40 in the ST group. Unadjusted Kaplan-Meier estimates showed greater effect of IT compared to ST on 1-year survival (HR = 2.1 95%CI[1.1-4.8], p = 0.003). IT showed a significantly higher survival gain over ST in those patients showing KRAS mutation (7.6 VS 0.8 months, <0.0001), a lumen occlusion >65% (6.6 VS 2.9 months, <0.001), and lacking the involvement of left bronchus (7 VS 2.3 months, <0.0001). Compared to ST, IT also showed a favorable difference in terms of new hospitalizations (p = 0.03), symptom-free interval (p = 0.02), and onset of atelectasis (p = 0.01). Conclusions: In patients with NSCLC stage IIIB and CAO, additional interventional bronchoscopy might impact on 1-year survival. Genetic and anatomic phenotyping might allow identifying those patients who may gain life expectancy from the endoscopic intervention.