Outcome of endobronchial electrocautery versus external beam radiotherapy or both together in the palliative management of non-small cell lung cancer

BackgroundApproximately 75% of patients with non-small cell lung cancer (NSCLC) present with locally advanced or metastatic disease which renders them inoperable and virtually incurable. Whene the aim of treatment is palliation, radiotherapy and bronchotherapeutic procedures are often recommended.Aim of the workTo evaluate the outcome of endobronchial electrocautery and or external beam radiotherapy (XRT) in the palliative treatment of patients with inoperable non-small cell lung cancer.Patient and methods40 patients with unresectable stage IIIA and IIIB NSCLC, 33 males and 7 females, their mean age of 60.82 ± 6.23 years were recruited in the study. Eligible patients were randomly classified into 3 groups: Group I: included 11 patients who received combined external irradiation (XRT) with end bronchial electro cautery, Group II: included 11 patients who received end bronchial electrocautery without external irradiation XRT, Group III: including 18 patients who received external palliative irradiation alone. Evaluation of chest symptoms, chest CT, PFTs, ABGs and quality of life outcomes were done before the interventional bronchoscopy and XRT therapies then one week and one month after the end of treatment.ResultsAs regards improvement of endobronchial symptoms; one week after completion of treatment, Group III patients was significantly lesser than Groups I and II and one month after treatment, there was no significant difference between all patient groups except in cough which was in Group III of lesser improvement than Groups I and II. As regards patients who had atelectasis before starting treatment: Group I showed 100% disappearance of atelectasis either complete or partial one month after completion of treatment while Group II showed 77.77% disappearance of atelectasis either complete or partial and finally Group III showed 64.29% disappearance of atelectasis either complete or partial. As regards changes in both FEV1% and FVC%; all patient groups showed significant differences pretreatment and one month after completion of treatment and Group I patients was significantly different than patients of both Groups II & III.ConclusionsThe replacement of external radiation with bronchoscopic therapy may not be a recommended option, but its addition to XRT may be a relatively simple method of augmenting the symptom palliative effect, providing higher response rates for re-expansion of collapsed lung and reducing endobronchial obstruction endoscopically.