Thermal Ablation and Intralesional Cisplatin Injection as Adjunct to Systemic Chemotherapy in Managing Malignant Central Airway Obstruction: A Case Report
DOI:
https://doi.org/10.70172/pjcd.v22i2.10329Keywords:
malignant airway obstruction, intralesional chemotherapy, cisplatin, cryotherapy, non-small cell lung cancerAbstract
Endobronchialultrasound (EBUS)-guidedintralesional chemotherapy and thermal ablation using cryotherapy and electrocautery can be used for the management of malignant central airway obstruction (CAO). This is a case of a 62-year-old male presenting with cough, hoarseness, and shortness of breath. He was diagnosed with squamous cell carcinoma stage IVA (T4N2M1a), causing malignant CAO that progressed to impending respiratory failure (ECOG PS 4). Chest CT scan findings included a left main bronchus mass measuring 3.7 x 5.8 x 5.9 cm causing complete atelectasis, a right pleural-based mass, and osteolytic destruction of the 3rd lateral ribs. Bronchoscopy showed a fungating, friable mass in the carina extending to the orifice of the right and left mainstem bronchus with 70% and 100% occlusion, respectively. A multimodality treatment approach was taken with tumor debulking by thermal ablation with cryotherapy and electrocautery, EBUS-guided intralesional cisplatin, and systemic chemotherapy. Subsequently, there was an interval decrease in the size of the tumor in multiple areas, with left lung re-expansion. The clinical symptoms of the patient significantly improved and ECOG status increased to 1. No adverse effects were noted post procedure. Intralesional cisplatin can be an effective and safe adjunct treatment in malignant CAO, alongside thermal ablation and systemic chemotherapy.
References
Hohenforst-Schmidt W, Zarogoulidis P, Darwiche K, et al. Intratumoral chemotherapy for lung cancer: re-challenge current targeted therapies. Drug Des Devel Ther. 2013;7:571-83. https://doi.org/10.2147/DDDT.S46393
Mehta, HJ, Begnaud A, Penley AM, et al. Restoration of patency to central airways occluded by malignant endobronchial tumors using intratumoral injection of cisplatin. Annals of the American Thoracic Society. 2015;12(9), 1345–1350. https://doi.org/10.1513/AnnalsATS.201503-131OC
Celikoglu SI, Karayel T, Demirci S, Celikoglu F, Cagatay T. Direct injection of anti-cancer drugs into endobronchial tumours for palliation of major airway obstruction. Postgrad Med J. 1997;73(857):159–162. https://doi.org/10.1136/pgmj.73.857.129
Rozman A, Grabczak EM, George V, et al. Interventional bronchoscopy in lung cancer treatment. Breathe (Sheff). 2024;20(2):230201. https://doi.org/10.1183/20734735.0201-2023
Khan F, Anker CJ, Garrison, G, Kinsey CM. Endobronchial ultrasound–guided transbronchial needle injection for local control of recurrent non–small cell lung cancer. Annals of the American Thoracic Society. 2015;12, 101–104. https://doi.org/10.1513/AnnalsATS.201408-358BC
DeMaio A, Sterman D. Bronchoscopic intratumoural therapies for non-small cell lung cancer. Eur Respir Rev. 2020;29(156):200028. https://doi.org/10.1183/16000617.0028-2020
Olaussen KA, Dunant A, Fouret P, et al. DNA repair by ERCC1 in non–small-cell lung cancer and cisplatin-based adjuvant chemotherapy. New England Journal of Medicine. 2006;355, 983–991. https://doi.org/10.1056/NEJMoa060570
Mehta HJ, Jantz MA. Endobronchial ultrasound-guided intratumoral injection of cisplatin for the treatment of isolated mediastinal recurrence of lung cancer. J Vis Exp. 2017;(120):54855. https://doi.org/10.3791/54855
Mori V, Roy GS, Bates JHT, Kinsey CM. Cisplatin Pharmacodynamics following endobronchial ultrasound-guided transbronchial needle injection into lung tumors. Sci Rep. 2019;9(1):6819. https://doi.org/10.1038/s41598-019-43270-y
Celikoglu F, Celikoglu SI, York AM, Goldberg EP. Intratumoral administration of cisplatin through a bronchoscope followed by irradiation for treatment of inoperable non-small cell obstructive lung cancer. Lung Cancer. 2006;51(2):225–236. https://doi.org/10.1016/j.lungcan.2005.10.012
Celikoglu F, Celikoglu SI, Goldberg EP. Bronchoscopic intratumoral chemotherapy of lung cancer. Lung Cancer. 2008;61(1):1–12. https://doi.org/10.1016/j.lungcan.2008.03.009
Crona DJ, Faso A, Nishijima TF, McGraw KA, Galsky MD, Milowsky MI. A systematic review of strategies to prevent cisplatin-induced nephrotoxicity. Oncologist. 2017;22(5):609-619. https://doi.org/10.1634/theoncologist.2016-0319
Astolfi L, Ghiselli S, Guaran V, et al. Correlation of adverse effects of cisplatin administration in patients affected by solid tumours: a retrospective evaluation. Oncol Rep. 2013;29(4):1285-92. https://doi.org/10.3892/or.2013.2279
Zheng X, Zhu Y, Zhao Y, Feng S, Zheng C. Taxanes in combination with platinum derivatives for the treatment of ovarian cancer during pregnancy: A literature review. Int J Clin Pharmacol Ther. 2017;55(9):753-760. https://doi.org/10.5414/CP202995
Jang JG, Ahn JH, Lee SS. Delayed onset of mediastinitis with tracheomediastinal fistula following endobronchial ultrasound-guided transbronchial needle aspiration: A case report. Thorac Cancer. 2021;12(7):1134-1136. https://doi.org/10.1111/1759-7714.13888
Baust JG, Gage AA, Bjerklund Johansen TE, Baust JM. Mechanisms of cryoablation: clinical consequences on malignant tumors. Cryobiology. 2014;68(1):1-11. https://doi.org/10.1016/j.cryobiol.2013.11.001
Nelson BE, Adashek JJ, Lin SH, Subbiah V. The abscopal effect in patients with cancer receiving immunotherapy. Med. 2023 Apr 14;4(4):233-244. https://doi.org/10.1016/j.medj.2023.02.003
Detterbeck FC. The eighth edition TNM stage classification for lung cancer: What does it mean on main street? J Thorac Cardiovasc Surg. 2018 Jan;155(1):356-359. https://doi.org/10.1016/j.jtcvs.2017.08.138
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Copyright (c) 2024 Mariane Ann A. Gabaon, MD, Marc Anthony G. Donguines, MD, Rogelio N. Velasco, Jr., MD, Joven Roque V. Gonong, MD
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