Application of paclitaxel as adjuvant treatment for benign cicatricial airway stenosis

Abstract

Benign cicatricial airway stenosis (BCAS) is a potentially life-threatening disease. Recurrence occurs frequently after endoscopic treatment. Paclitaxel is known to prevent restenosis, but its clinical efficacy and safety is undetermined. Therefore, in this study, we investigated the efficacy and associated complications of paclitaxel as adjuvant treatment for BCAS of different etiologies. The study cohort included 28 patients with BCAS resulting from tuberculosis, intubation, tracheotomy, and other etiologies. All patients were treated at the Department of Respiratory Diseases, Beijing Tian Tan Hospital, Capital Medical University, China, between January 2010 and August 2014. After primary treatment by balloon dilation, cryotherapy, and/or high-frequency needle-knife treatment, paclitaxel was applied to the airway mucosa at the site of stenosis using a newly developed local instillation catheter. The primary outcome measures were the therapeutic efficacy of paclitaxel as adjuvant treatment, and the incidence of complications was observed as well. According to our criteria for evaluating the clinical effects on BCAS, 24 of the 28 cases achieved durable remission, three cases had remission, and one case showed no remission. Thus, the durable remission rate was 85.7%, and the combined effective rate was 96.4%. No differences in outcomes were observed among the different BCAS etiologies (P=0.144), and few complications were observed. Our results indicated that paclitaxel as an adjuvant treatment has greater efficacy than previously reported BCAS treatment methods.

Keywords

paclitaxel / bronchoscopy / benign cicatricial airway stenosis / efficacy / complications

References

[1] LorenzRR. Adult laryngotracheal stenosis: etiology and surgical management. Curr Opin Otolaryngol Head Neck Surg, 2003, 11(6): 467-472 PMID: 14631181

[2] LiYQ, LiQ, BaiC, et al. . Causes of benign central airway stenoses and the efficacy of interventional treatments through flexible bronchoscopy. Zhonghua Jie He He Hu Xi Za Zhi (Chinese), 2008, 31(5): 364-368

[3] TsakiridisK, DarwicheK, VisouliAN, et al. . Management of complex benign post-tracheostomy tracheal stenosis with bronchoscopic insertion of silicon tracheal stents, in patients with failed or contraindicated surgical reconstruction of trachea. J Thorac Dis, 2012, 4: 32-40 PMID: 23304439 PMCID: 3537388

[4] AgarwalR, KhanA, AggarwalAN, et al. . Initial experience of endobronchial silicon stents from a tertiary care centre in North India. Indian J Chest Dis Allied Sci, 2011, 53(2): 93-98 PMID: 21545070

[5] TerraRM, BibasBJ, MinamotoH, et al. . Decannulation in tracheal stenosis deemed inoperable is possible after long-term airway stenting. Ann Thorac Surg, 2013, 95(2): 440-444 PMID: 23201102

[6] HirshorenN, EliasharR. Wound-healing modulation in upper airway stenosis—Myths and facts. Head Neck, 2009, 31(1): 111-126 PMID: 18767172

[7] BegeN, SteinmullerSO, KalinowskiM, et al. . Drug eluting stents based on Poly(ethylene carbonate): optimization of the stent coating process. Eur J Pharm Biopharm, 2012, 80(3): 562-570 PMID: 22209978

[8] RanadeSV, MillerKM, RichardRE, et al. . Physical characterization of controlled release of paclitaxel from the TAXUS Express2 drug-eluting stent. J Biomed Mater Res A, 2004, 71(4): 625-634 PMID: 15514926

[9] CuiJ, ZhangJ, WangJ, et al. . Effect of topical application with mitomycin C in the management of benign cicatricial airway stenosis. Zhonghua Jie He He Hu Xi Za Zhi (Chinese), 2012, 35(12): 901-906

[10] GreerM, FuehnerT, WarneckeG, et al. . Paclitaxel-coated balloons in refractory nonanastomostic airway stenosis following lung transplantation. Am J Transplant, 2014, 14(10): 2400-2405 PMID: 25055720

[11] WangLH, ZhangJ, ChenN, et al. . The pilot study of the effect of paclitaxel by local application on scar formation after airway injury in rabbits. Zhonghua Jie He He Hu Xi Za Zhi (Chinese), 2013, 36(3): 202-206

[12] IwamotoY, MiyazawaT, KurimotoN, et al. . Interventional bronchoscopy in the management of airway stenosis due to tracheobronchial tuberculosis. Chest, 2004, 126(4): 1344-1352 PMID: 15486402

[13] ShitritD, ValdsislavP, GrubsteinA, et al. . Accuracy of virtual bronchoscopy for grading tracheobronchial stenosis: correlation with pulmonary function test and fiberoptic bronchoscopy. Chest, 2005, 128(5): 3545-3550 PMID: 16304311

[14] ChenN, ZhangJ, XuM, et al. . The influence of mitomycin C and paclitaxel on the proliferation and apoptosis of human pulmonary fibroblast. Zhonghua Jie He He Hu Xi Za Zhi (Chinese), 2013, 36(9): 655-660

[15] WangT, ZhangJ, WangJ, et al. . The inhibition effect of paclitaxel on the proliferation of human pulmonary fibroblasts. Zhonghua Jie He He Hu Xi Za Zhi (Chinese), 2010, 33(1): 17-20

[16] ChoongCK, PhanL, MassettiP, et al. . Prolongation of patency of airway bypass stents with use of drug-eluting stents. J Thorac Cardiovasc Surg, 2006, 131(1): 60-64 PMID: 16399295

[17] GeorgeM, LangF, PascheP, et al. . Surgical management of laryngotracheal stenosis in adults. Eur Arch Otorhinolaryngol, 2005, 262(8): 609-615 PMID: 15668812

[18] LimSY, KimH, JeonK, et al. . Prognostic factors for endotracheal silicone stenting in the management of inoperable post-intubation tracheal stenosis. Yonsei Med J, 2012, 53(3): 565-570 PMID: 22477001 PMCID: 3343434

[19] OhSK, ParkKN, LeeSW. Long-term results of endoscopic dilatation for tracheal and subglottic stenosis. Clin Exp Otorhinolaryngol, 2014, 7(4): 324-328 PMID: 25436054 PMCID: 4240492

[20] ZhangJ, WangJ, WangT, et al. . A pilot study on interventional bronchoscopy in the management of airway stenosis with benign hyperplasia. Zhonghua Jie He He Hu Xi Za Zhi (Chinese), 2011, 34(5): 334-338