Real-world faceoff: EBRT vs interventions for malignant central airway obstruction

Area of Science:

• Thoracic Oncology
• Pulmonary Medicine
• Radiation Oncology

Background:

• Malignant central airway obstruction (MCAO) is a critical complication in thoracic oncology.
• Limited real-world comparative survival data exists for MCAO treatments like external beam radiation therapy (EBRT), stenting, and debulking.

Purpose of the Study:

• To compare the real-world survival outcomes of different treatments for MCAO.
• To evaluate the effectiveness of EBRT versus stenting, debulking, and combination therapy.

Main Methods:

• A retrospective analysis of adult MCAO patients from the TriNetX US Collaborative Network (2008-2023).
• Propensity-score matching was used to compare cohorts undergoing EBRT, stenting, debulking, or stent + EBRT.
• Kaplan-Meier and Cox proportional hazards models analyzed survival data.

Main Results:

• EBRT demonstrated longer median survival compared to stenting and debulking.
• EBRT showed superior survival and lower mortality compared to stent + EBRT.
• Combination therapy offered no survival advantage over stenting alone and was associated with higher mortality.
• EBRT provided the greatest survival benefit early after treatment, with significant reductions in 7- and 30-day mortality.

Conclusions:

• External beam radiation therapy (EBRT) provides significant early survival benefits for MCAO patients.
• EBRT should be considered a first-line treatment for MCAO.
• Procedural interventions like stenting and debulking are best reserved for patients with acute or complex airway compromise.