*Schulich School of Medicine and Dentistry, Western University, London, Ontario; †Department of Radiation Oncology, London Regional Cancer Program, London, Ontario; and ‡Department of Epidemiology and Biostatistics, Western University, London, Ontario.
J Thorac Oncol. 2013 Nov;8(11):1365-70. doi: 10.1097/JTO.0b013e3182a47501.
The optimal approach to patients with malignant airway obstruction who require intubation and mechanical ventilation but are ineligible for bronchoscopic interventions is uncertain. Radiotherapy (RT) may be delivered but requires substantial resources in this patient population. In the absence of evidence, it is unknown whether RT facilitates extubation or delays an appropriate transition to end-of-life care.
We performed a 10-year retrospective review of intensive care unit (ICU) patients treated with RT while on mechanical ventilation for malignant airway obstruction. Primary study endpoints were overall survival (OS) and extubation success (ES), defined as 48 hours or more without reintubation or death. Secondary endpoints included rates of discharge from the ICU and to home. Logistic regression and Cox regression analyses were performed to identify factors associated with OS and ES.
Twenty-six patients were eligible for analysis. Seven patients (27%) were extubated; extubations occurred between days 4 and 22 after RT initiation. All patients were discharged from the ICU and most (n = 6) were also discharged home. An association between higher radiation doses and ES was observed (odds ratio per 5 Gy increase: 0.63; p = 0.080). Median OS was only 0.36 months (range, 0-113 months), and 6-month OS was 11%. On Cox regression analysis, increased radiation dose was predictive of improved OS (hazard ratio per 5 Gy increase: 0.74; p = 0.016).
A significant minority of patients receiving RT were successfully extubated. Higher radiation doses were predictive of improved OS and showed a trend for increased ES. Survival beyond 6 months was uncommon, however, the majority of patients with ES were able to be discharged home.
对于需要插管和机械通气但不符合支气管镜介入治疗条件的恶性气道阻塞患者，最佳治疗方法尚不确定。可以进行放射治疗（RT），但在这类患者人群中需要大量资源。在缺乏证据的情况下，尚不清楚 RT 是否有助于拔管或延迟适当过渡到临终关怀。
我们对在因恶性气道阻塞接受机械通气的同时接受 RT 治疗的重症监护病房（ICU）患者进行了为期 10 年的回顾性研究。主要研究终点是总生存率（OS）和拔管成功率（ES），定义为 48 小时或更长时间没有再插管或死亡。次要终点包括从 ICU 出院和回家的比例。进行逻辑回归和 Cox 回归分析，以确定与 OS 和 ES 相关的因素。
共有 26 名患者符合分析条件。7 名患者（27%）成功拔管；拔管发生在 RT 开始后第 4 天至第 22 天之间。所有患者均从 ICU 出院，其中大多数（n=6）也出院回家。观察到较高的放射剂量与 ES 之间存在关联（每增加 5Gy 的比值比：0.63；p=0.080）。中位 OS 仅为 0.36 个月（范围为 0-113 个月），6 个月 OS 为 11%。Cox 回归分析显示，增加放射剂量可预测 OS 改善（每增加 5Gy 的风险比：0.74；p=0.016）。
接受 RT 的患者中，有相当一部分患者成功拔管。较高的放射剂量与 OS 改善相关，并显示出 ES 增加的趋势。然而，超过 6 个月的生存并不常见，但是具有 ES 的大多数患者能够出院回家。
