Survival characteristics after neodymium: YAG laser photoresection in advanced stage lung cancer

In order to assess the long-term clinical benefits of palliative Nd:YAG laser photoresection, we studied 69 patients with obstructing exophytic tracheobronchial lesions treated with this modality between Oct 25, 1984 and May 8, 1989. In 55 patients, there was greater than 75 percent restoration of the luminal caliber ("successful"), and this group was compared to 14 patients in whom the lumen was not restored ("unsuccessful"). Stratifying for squamous cell carcinoma (squamous) alone vs other lung histologic cell types (non-squamous) demonstrated a significant survival benefit for "successful" squamous vs "unsuccessful" squamous and for "successful" squamous vs "successful" nonsquamous (p less than 0.05). The prolongation in survival was unrelated to patients' age, baseline Karnofsky performance indices, technical aspects of photoresection, and other modes of therapy (ie, radiation or chemotherapy or both). Although only six of 24 of the "successfully" photoresected patients with squamous cell carcinoma survived for one year, only one patient with inoperable mucoepidermoid carcinoma in the nonsquamous group survived beyond ten months. Karnofsky indices improved in both "successful" (p less than 0.001) and "unsuccessful" (p less than 0.05) photoresection groups. Improvement in the latter group may be attributed to either a salutary effect of the bronchoscopic procedure or variability in patients' level of functioning. We conclude that a subset of patients with advanced stages of squamous cell carcinoma and airway obstruction due to exophytic tumor may derive substantial benefit in both functional status and survival after Nd:YAG laser photoresection. In addition, unsuccessful restoration of the airway is a grave prognostic sign leading to limited survival.