Background: Intubated patients due to tracheal stenosis by the tumor rarely received radiotherapy because most of radiation oncologists think radiotherapy for these patients very risky. Therefore, the effect of radiotherapy for these patients is poorly identified. The objective of this study is to investigate the effective of radiotherapy for intubated patients due to tracheal stenosis by the tumor.
Methods: A total of 3 patients with tracheal intubation due to tracheal stenosis by squamous cell carcinoma of the lung undergoing radiotherapy in 2016 were identified.
Results: Three patients were admitted to the hospital because of tracheal stenosis due to locally advanced squamous cell carcinoma of the lung. Patient age was 67, 75, and 84 years old, respectively. Just a month before admission, their Eastern Cooperative Oncology Group Performance Status was 0. After admission, bronchoscopy with transbronchial biopsy was taken and they got intubated on the mechanical ventilator. The prescribed dose was 28 Gy at 7 Gy per fraction, 20 Gy at 4 Gy per fraction, and 25 Gy at 5 Gy per fraction. Two patients were extubated on Day 14 of admission. They were also able to return to their social activities one month after admission. They were given re-irradiation 4 months after completion of radiotherapy because of the loco-regional recurrence. One survived for 21 months without any treatment after re-irradiation. The other was alive 7 months after admission, but the follow-up was interrupted after that. Unfortunately, one patient was discontinued radiotherapy at 16 Gy because of her bad general medical condition. She died due to acute respiratory distress syndrome on day 22. No one was given chemotherapy. Acute toxicity related to radiotherapy was not experienced. Malfunction of the ventilator was concerned, but no ventilator broke down during radiotherapy.
Conclusion: Palliative radiotherapy enabled two of three patients to relief symptoms and return to their social activities. Our experiences suggest that intubated patients due to tracheal stenosis by squamous cell carcinoma of the lung can receive radiotherapy safely and can be rehabilitated well.