|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 3 | Page : 368-369
Chemotherapy for obstructive atelectasis in nonsmall cell lung cancer: Is this a treatment option?
V Naronha, R Pinninti, A Joshi, K Prabhash
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
|Date of Web Publication||18-Feb-2016|
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|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 Jun 26];52:368-9. Available from: http://www.indianjcancer.com/text.asp?2015/52/3/368/176756
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); 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)., 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|
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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|
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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. 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.
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[Figure 1], [Figure 2]