OBSTRUCTIVE ATELECTASIS IN PATIENTS WITH SMALL-CELL LUNG-CANCER - INCIDENCE AND RESPONSE TO TREATMENT

Study objectives: Define the incidence of obstructive atelectasis in p atients presenting with small cell lung cancer and their response to t reatment, Design: Retrospective review of clinical records and radiogr aphic studies. Setting: Single federal government institution-the Nati onal Cancer Institute-Naval Medical Oncology Branch. Patients: One hun dred seventy-two consecutive patients treated between 1983 and 1993. I nterventions: Patients presenting with obstructive atelectasis were id entified, The incidence of dyspnea, cough, and sputum production befor e starting treatment and 1, 3, and 6 months later was determined. Fibe roptic bronchoscopy and chest radiographs performed before starting tr eatment were compared with those obtained later in the patients' clini cal course. Measurements ana results: Thirty-seven of 172 (22%) patien ts had obstructive atelectasis, Initial symptoms included cough in 25 (68%), dyspnea in 24 (65%), and productive cough in 10 (27%), The pati ents' symptoms of cough, dyspnea, and sputum production decreased to o ne third of the initial prevalence 1 month after the start of treatmen t. Fiberoptic bronchoscopy and chest radiographs performed 3 months af ter starting treatment demonstrated bronchial patency in 90%. Conclusi ons. Obstructive atelectasis occurs in approximately one fifth of pati ents presenting with small cell lung cancer. Chemotherapy and chemothe rapy plus chest radiotherapy lead to symptomatic, bronchoscopic, and r adiographic resolution in similar proportions of patients with obstruc tive atelectasis.