Obstructive atelectasis in patients with small cell lung cancer. Incidence and response to treatment.

STUDY OBJECTIVES

Define the incidence of obstructive atelectasis in patients presenting with small cell lung cancer and their response to treatment.

DESIGN

Retrospective review of clinical records and radiographic studies.

SETTING

Single federal government institution-the National Cancer Institute-Naval Medical Oncology Branch.

PATIENTS

One hundred seventy-two consecutive patients treated between 1983 and 1993.

INTERVENTIONS

Patients presenting with obstructive atelectasis were identified. The incidence of dyspnea, cough, and sputum production before starting treatment and 1, 3, and 6 months later was determined. Fiberoptic bronchoscopy and chest radiographs performed before starting treatment were compared with those obtained later in the patients' clinical course.

MEASUREMENTS AND RESULTS

Thirty-seven of 172 (22%) patients had obstructive atelectasis. Initial symptoms included cough in 25 (68%), dyspnea in 24 (65%), and productive cough in 10 (27%). The patients' symptoms of cough, dyspnea, and sputum production decreased to one third of the initial prevalence 1 month after the start of treatment. Fiberoptic bronchoscopy and chest radiographs performed 3 months after starting treatment demonstrated bronchial patency in 90%.

CONCLUSIONS

Obstructive atelectasis occurs in approximately one fifth of patients presenting with small cell lung cancer. Chemotherapy and chemotherapy plus chest radiotherapy lead to symptomatic, bronchoscopic, and radiographic resolution in similar proportions of patients with obstructive atelectasis.