Monday, June 12, 2006

Stenting and lung cancer

Just curious what you all think of the role of stenting in advanced lung cancer. This obviously would not effect such hard endpoins as survival, but it seems to alleviate dyspnea and might mpact on quality of life. Unfortunately I do not think there is much data out there to support this, but this does not necessarily mean that these endpoints are not impacted. Until there is data, what are you all doing with advanced lung ca with regards to interventional bronchoscopy?

6 comments - CLICK HERE to read & add your own!:

Baleeiro said...

I have looked that up before as well. There is actually good data on improved performance status and quality of life. For nice pictures and good physiologic data check out Miyazawa et al. AJRCCM 2004; 169. pp. 1096-1102.

Jennings said...

You are right there does seem to be a bit of data out there supporting the notion that qual of life is improved with stenting. Sometimes it's hard to escape the bias that if it wasn't done at our place of training (U of M) it must not have a role. Obviously this is not true. But it is somewhat suprising that interventional bronch is not done there....

Baleeiro said...

I agree. We also use APC (argon plasma photocoagulation) here with very good palliative success.

Arenberg said...

If you left your training at U of M with the impression that stentinng had no role in management of malignant airway obstruction, it is not from anything I ever said on the topic. the problem is that the indications are for rarely seen conditions, patients in good performance statu (i.e. with decent underlying functional status), and clinically significant endobronchial disease with physiologic compromise, AND who have already received the maximal amout of external beam radiotherapy (as defined by the radiation oncologist). In such patients, there are many options, only one of which is deploying a stent. Other options, all of which are equally efficacous and each of which has its own set of plusses & minuses include; brachytherapy (which we do at U of M), rigid bronch with laser, or cautery (which we do at U of M). Our sureons occasionally deply stents in the airways, but usually use one of the other approaches described here.

No need to take a dig at your former institution just because we don't have an active interventional bronchoscopist on staff. The metropolitan area probably has enough business to sustain one such program, and thhe one at HFHS under Simoff is just fine for that. I have sennt him patients when I thought it appropriate.

Jennings said...

No dig meant. The original intent of the post was to look into the discrepancy between 2 institutions' use of stenting because I want to know what role stents play in lung cancer palliation. I hope I am allowed to say (without interpretation that statemtn is a "dig" that I find it suprising that a major center doesn't do stenting. My initial impression was that *because* of this, perhaps the role of stenting is not particularly strong. We seem to do a *lot* of stenting here for nonoperable lung cancer which is in stark contrast to UM. The conclusion from that is either a) we do too many here and there's no data to support it or b)there is a definiate role and thus it would be suprising that UM doesn't do it (since there is a lot of inoperable lung Ca there as well.
I hope I am can be suprised by that without giving off the impression that I am criticizing (because I wasn't).

Arenberg said...

Jeff, I should have used one of those wink icon thingies to convey that I was giving you s***. My take on the discrepancy is that the interventional program at HFHS results (rightfully) in more stents and similar procedures being done there, like a referral bias might do for any disease. I would suspect the truth lies somewhere between the two extremes of HFHS doing too many, and UM lacking the experise to do it. We certainly lack the experience, and therefore the expertise to routinely do stents here, and HFHS may employ stenting more frequently because of the convenience and the speed with which you can palliate using that approach.

My point was that there are many palliative options for malignant ( and benign) airway obstruction, and eac center probably has their own bias on which they use. I don't think a one-size-fits-all is right for anything, and that's why I occasionally refer patients to HFHS for stenting.