Objectives- Despite new therapeutic perspectives, the presence of central airways occlusion (CAO) in patients with locally advanced non-small cell lung cancer (NSCLC) is associated with poor survival. There is no clear evidence on the clinical impact of interventional bronchoscopy as a part of an integrated treatment to cure these patients. Materials and methods- This retrospective cohort study was conducted in two teaching hospitals over a 10 years period (January 2010-January 2020) comparing patients with NSCLC at stage IIIB and CAO at disease onset treated with chemotherapy/radiotherapy (standard therapy-ST) with those receiving interventional bronchoscopy plus ST (integrated treatment-IT). Primary outcome was 1-year survival. The onset of respiratory events, symptoms-free interval, hospitalization, need for palliation, and overall mortality served as secondary outcomes. Results- A total of 100 patients were included, 60 in the IT and 40 in the ST group. Unadjusted Kaplan-Meier estimates showed greater effect of IT compared to ST on 1-year survival (HR=2.1 95%CI[1.1-4.8], p=0.003). IT showed a significantly higher survival gain over ST in those patients showing KRAS mutation (7.6 VS 0.8 months,<0.0001), a lumen occlusion >65% (6.6 VS 2.9 months,<0.001), and lacking the involvement of left bronchus (7 VS 2.3 months,<0.0001). Compared to ST, IT also showed a favorable difference in terms of new hospitalizations (p=0.03), symptom-free interval (p=0.02), and onset of atelectasis (p=0.01). Conclusions- In patients with NSCLC stage IIIB and CAO, additional interventional bronchoscopy might impact on 1-year survival. Genetic and anatomic phenotyping might allow identifying those patients who may gain life expectancy from the endoscopic intervention.

Integrated intErventional bronchoscopy in the treatment of locally adVanced non-small lung cancER with central Malignant airway Obstructions: a multicentric REtrospective study (EVERMORE) / Marchioni, A; Andrisani, D; Tonelli, R; Piro, R; Andreani, A; Cappiello, Gf; Meschiari, E; Dominici, M; Bavieri, M; Barbieri, F; Taddei, S; Casalini, E; Falco, F; Gozzi, F; Bruzzi, G; Fantini, R; Tabbì, L; Castaniere, I; Facciolongo, N; Clini, E.. - In: LUNG CANCER. - ISSN 0169-5002. - 148:(2020), pp. 40-47. [10.1016/j.lungcan.2020.07.032]

Integrated intErventional bronchoscopy in the treatment of locally adVanced non-small lung cancER with central Malignant airway Obstructions: a multicentric REtrospective study (EVERMORE).

Marchioni, A;Andrisani, D;Tonelli, R;Dominici, M;Gozzi, F;Bruzzi, G;Castaniere, I;Clini, E.
2020

Abstract

Objectives- Despite new therapeutic perspectives, the presence of central airways occlusion (CAO) in patients with locally advanced non-small cell lung cancer (NSCLC) is associated with poor survival. There is no clear evidence on the clinical impact of interventional bronchoscopy as a part of an integrated treatment to cure these patients. Materials and methods- This retrospective cohort study was conducted in two teaching hospitals over a 10 years period (January 2010-January 2020) comparing patients with NSCLC at stage IIIB and CAO at disease onset treated with chemotherapy/radiotherapy (standard therapy-ST) with those receiving interventional bronchoscopy plus ST (integrated treatment-IT). Primary outcome was 1-year survival. The onset of respiratory events, symptoms-free interval, hospitalization, need for palliation, and overall mortality served as secondary outcomes. Results- A total of 100 patients were included, 60 in the IT and 40 in the ST group. Unadjusted Kaplan-Meier estimates showed greater effect of IT compared to ST on 1-year survival (HR=2.1 95%CI[1.1-4.8], p=0.003). IT showed a significantly higher survival gain over ST in those patients showing KRAS mutation (7.6 VS 0.8 months,<0.0001), a lumen occlusion >65% (6.6 VS 2.9 months,<0.001), and lacking the involvement of left bronchus (7 VS 2.3 months,<0.0001). Compared to ST, IT also showed a favorable difference in terms of new hospitalizations (p=0.03), symptom-free interval (p=0.02), and onset of atelectasis (p=0.01). Conclusions- In patients with NSCLC stage IIIB and CAO, additional interventional bronchoscopy might impact on 1-year survival. Genetic and anatomic phenotyping might allow identifying those patients who may gain life expectancy from the endoscopic intervention.
3-ago-2020
148
40
47
Integrated intErventional bronchoscopy in the treatment of locally adVanced non-small lung cancER with central Malignant airway Obstructions: a multicentric REtrospective study (EVERMORE) / Marchioni, A; Andrisani, D; Tonelli, R; Piro, R; Andreani, A; Cappiello, Gf; Meschiari, E; Dominici, M; Bavieri, M; Barbieri, F; Taddei, S; Casalini, E; Falco, F; Gozzi, F; Bruzzi, G; Fantini, R; Tabbì, L; Castaniere, I; Facciolongo, N; Clini, E.. - In: LUNG CANCER. - ISSN 0169-5002. - 148:(2020), pp. 40-47. [10.1016/j.lungcan.2020.07.032]
Marchioni, A; Andrisani, D; Tonelli, R; Piro, R; Andreani, A; Cappiello, Gf; Meschiari, E; Dominici, M; Bavieri, M; Barbieri, F; Taddei, S; Casalini, E; Falco, F; Gozzi, F; Bruzzi, G; Fantini, R; Tabbì, L; Castaniere, I; Facciolongo, N; Clini, E.
File in questo prodotto:
File Dimensione Formato  
LUNGCANCER-D-20-00885_R1.pdf

accesso aperto

Tipologia: Post-print dell'autore (bozza post referaggio)
Dimensione 3.83 MB
Formato Adobe PDF
3.83 MB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

Licenza Creative Commons
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1208049
Citazioni
  • ???jsp.display-item.citation.pmc??? 3
  • Scopus 5
  • ???jsp.display-item.citation.isi??? 3
social impact