Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :400
Small font sizeDefault font sizeIncrease font size
Navigate here
  Search
 
  
Resource links
   Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
   Article in PDF (424 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   References
   Article Figures

 Article Access Statistics
    Viewed933    
    Printed44    
    Emailed0    
    PDF Downloaded137    
    Comments [Add]    

Recommend this journal

 


 
  Table of Contents  
LETTER TO THE EDITOR
Year : 2015  |  Volume : 52  |  Issue : 3  |  Page : 368-369
 

Chemotherapy for obstructive atelectasis in nonsmall cell lung cancer: Is this a treatment option?


Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India

Date of Web Publication18-Feb-2016

Correspondence Address:
K Prabhash
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.176756

Rights and Permissions



How to cite this article:
Naronha V, Pinninti R, Joshi A, Prabhash K. Chemotherapy for obstructive atelectasis in nonsmall cell lung cancer: Is this a treatment option?. Indian J Cancer 2015;52:368-9

How to cite this URL:
Naronha V, Pinninti R, Joshi A, Prabhash K. Chemotherapy for obstructive atelectasis in nonsmall cell lung cancer: Is this a treatment option?. Indian J Cancer [serial online] 2015 [cited 2019 Sep 18];52:368-9. Available from: http://www.indianjcancer.com/text.asp?2015/52/3/368/176756


Sir,

The utility of chemotherapy is well established in management of oncologic emergencies related to hemato-lymphoid and chemo-sensitive solid organ malignancies (germ cell tumors; small cell carcinoma lung);[1] However, invasive interventions with technical expertise are required for the treatment of structural oncologic emergencies related to other solid organ malignancies (nonsmall cell carcinoma lung [NSCLC]; colon).[2],[3] The need for rapid tumor responses makes chemotherapy less attractive. We report here a clinical instance in which chemotherapy played a major role in the management of obstructive atelectasis (OA) with respiratory failure in a patient with advanced NSCLC.

We report a 29-year-old lady; never smoker; no co-morbidities; presented with cough of 2 months duration.

Chest radiograph revealed right lung lower lobe mass [Figure 1]a; computed tomography thorax revealed right lung mass; also noted was an intra-luminal growth causing partial luminal obstruction in right principal bronchus just below the level of carina [Figure 1]b; additionally noted were left supraclavicular, ipsilateral prevascular and sub-carinal lymphadenopathy and mild pericardial effusion. Left supraclavicular lymph node biopsy revealed metastatic nonsmall cell carcinoma favor adenocarcinoma. On Immunohistochemistry, the tumor cells show diffuse and strong positivity for thyroid transcription factor 1 and are focally positive for p40.
Figure 1: (a) Chest radiograph showing right lung lower lobe mass. (b) Computed tomography thorax revealed right lung mass; also noted was an intra-uminal growth causing partial luminal obstruction (black arrow) in right principal bronchus just below the level of carina

Click here to view


She later presented in an emergency room with complaints of dyspnea of New York heart association class IV severity; right sided chest pain and increasing severity of the cough of 8 h duration. Clinical examination revealed tachypnea (28 cycles/min); tachycardia (110 beats/min); oxygen O2 saturation of 90% on room air. Repeat chest radiograph revealed white out of the right hemi-thorax with tracheal and mediastinal shift to right [Figure 2]a.
Figure 2: Chest radiographs (a) at presentation (b) on day 4 of chemotherapy (c) postintra-.bronchial laser de-.bulking

Click here to view


Ultrasonogram thorax revealed minimal pericardial effusion with collapse of the entire right lung. Fiber optic bronchoscopy revealed the large polypoidal growth completely occluding the right main bronchus 1 cm from the carina; surgical debulking was not attempted considering the risk of intra-bronchial bleeding and the intraluminal radiotherapy was possible technically. Patient developed hoarseness of voice and aspiration while swallowing liquids; nasogastric tube insertion done to prevent aspiration.

Patient was considered for the intra-bronchial laser de-bulking of the tumor to relieve the OA, however the definitive procedure was delayed in view of logistics by a period of 5 days patient's performance status had significantly deteriorated and was dependent on inhalational O2 to maintain saturation.

Bronchoscopic endobronchial intra tumoral chemotherapy (EITC) is a new intervention to treat tumor related airway obstruction; where in the use of direct intra-tumoral injection with chemotherapy for tumor regression to open the airway has been safely attempted.[4] However, the effects of EITC on later bronchoscopic laser intervention are not clear.

After a detailed discussion with the patient regarding the possible risks, patient was initiated on chemotherapy with pemeterexed and cisplatin. She tolerated the chemotherapy well and had subjective relief of symptoms post day 2 of chemotherapy, repeat chest radiograph on day 4 of chemotherapy revealed improved lung expansion in the right upper zone and persisting homogenous opacity in the lower zone [Figure 2]b. Patient's general condition too improved significantly; she was not tachypneic and was able to maintain oxygen saturation on room air.

Patient underwent intra-bronchial laser debulking on day 7 of chemotherapy. Peri-operative period was uneventful. There was an immediate improvement in air entry in the right infra-scapular and infra-axillary region; repeat chest radiograph revealed good lung expansion with evidence of the mass lesion in the right middle zone [Figure 2]c.

There are virtually no reports available to guide the utility of chemotherapy in the acute management of OA with respiratory failure in NSCLC. This case report highlights the safety and utility of chemotherapy in this situation.

 
  References Top

1.
Vaaler AK, Forrester JM, Lesar M, Edison M, Venzon D, Johnson BE. Obstructive atelectasis in patients with small cell lung cancer. Incidence and response to treatment. Chest 1997;111:115-20.  Back to cited text no. 1
    
2.
Urruticoechea A, Mesía R, Domínguez J, Falo C, Escalante E, Montes A, et al. Treatment of malignant superior vena cava syndrome by endovascular stent insertion. Experience on 52 patients with lung cancer. Lung Cancer 2004;43:209-14.  Back to cited text no. 2
    
3.
Azar T, Berger DL. Adult intussusception. Ann Surg 1997;226:134-8.  Back to cited text no. 3
    
4.
Celikoglu F, Celikoglu SI. Intratumoural chemotherapy with 5-fluorouracil for palliation of bronchial cancer in patients with severe airway obstruction. J Pharm Pharmacol 2003;55:1441-8.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

Top
Print this article  Email this article
 

    

  Site Map | What's new | Copyright and Disclaimer
  Online since 1st April '07
  2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow