Direct endobronchial metastases from non-pulmonary primaries are unusual, with a range of presentations. Of non-pulmonary sites of origin, colon, renal and breast are the most frequent. Colon cancer spreads by lymphatic and hematogenous dissemination to regional lymph nodes, liver and lungs. These lesions usually appear remote from the primary occurrence (>5 years). Treatments for endobronchial colon metastases are dependent on the tumors behavior and responsiveness to the palliative measures. Long-term survival with local regional control of the metastases has been reported, although mean survival is short. We describe a case of Gardner’s syndrome with subsequent endobronchial metastases causing respiratory insufficiency.CASE REPORT: A 26-year-old female with Gardner’s syndrome, s/p colectomy with ileocecal anastomosis in 1997 presented in 8/02 with respiratory insufficiency. A CT scan showed collapse of left lung secondary to solitary endobronchial metastases involving the left main stem bronchus. Patient underwent bronchoscopy with balloon dilatation and stent placement at this location. She had a dramatic response to intervention with post-procedure CT scan demonstrating complete expansion of left lung. Rapid tumor in growth through the stent required four weekly sessions of intraluminal high dose brachytherapy (500 cGy) followed by a session of intraluminal photodynamic therapy (PDT). Patient’s functional status improved post consolidation photodynamic therapy, and she has remained disease free at this site 6 months out.DISCUSSION: Direct endobronchial metastasis from extrapulmonary primaries is a rare occurrence. Interventional bronchoscopy with stent placement improved the clinical status of the patient. Restored lumen allowed the patient to undergo brachytherapy and photodynamic therapy. Stent placement with brachytherapy and PDT provided local regional disease control without significant side effects.
Based on our experience with this case: brachytherapy and PDT is safe, and may extend survival with local regional control in this subgroup of patients with endobronchial metastasis.
M.S. Bakshi, None.