Alleviation of malignant dysphagia in inoperable lung cancer

Abstract

BACKGROUND: Due to the close anatomical relationship between the esophagus and the bronchial tree, lung cancer can cause malignant dysphagia. Patients with this complication may require palliation through esophageal and/or bronchial tree restoration. METHODS: Between the years 2008 and 2018, malignant dysphagia was diagnosed in 84 lung cancer patients. Their response to esophageal and/or bronchial tree stenting was studied retrospectively. Patients were stratified into three groups: esophageal compression without obstruction of the bronchi (Group I, n=64), esophageal compression and bronchial obstruction without fistulas (Group II, n=12), and dysphagia and esophagotracheal fistula (Group III, n=8). Group I had one stent implanted, whilst in Groups II and III, two stents were introduced. Both self-expanding stents and silicone Y stents were utilized. Prior to intervention and during the follow-up period, patients were assessed for degree of dysphagia and dyspnea, quality of life, and survival. RESULTS: Following endoprosthetic restoration, dysphagia score improved in all patient groups with reductions in Group I (2.68 vs. 1.2, P=0.0001), in Group II (2.76 vs. 1.3, P=0.0001), and in Group III (2.74 vs. 1.3, P=0.0001). There was no dyspnea recorded in Group I before an intervention, however it was present and reduced in Group II (2.86 vs. 0.4, P=0.001) and Group III (2.89 vs. 0.5, P=0.0001) following intervention. Quality of life was improved for all patient groups, with an increase in Karnofsky performance scale in Group I (56 vs. 72, P=0.0001), Group II (56 vs. 70, P=0.0001) and Group III (53 vs. 67, P=0.0001). Three patients (3.6%) developed respiratory failure and 1 patient (0.8%) died. Two patients (2.4%), following esophageal stenting, required bronchial tree stenting. Dysphagia occurred in 5 patients (6.0%) due to granuloma formation. In these cases, the stents were removed and re-stenting was carried out. In 3 of the patients (3.6%) the stents were removed due to migration and re-stenting was performed. CONCLUSIONS: Patients with malignant dysphagia due to lung cancer may require esophageal stenting as well as bronchial tree stenting. This treatment offers improvements in dysphagia and dyspnea scores, as well as in quality of life, and allows for the implementation of oncological treatments.