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(Chest. 1997;111:115-120.)
© 1997 American College of Chest Physicians

Obstructive Atelectasis in Patients With Small Cell Lung Cancer

Incidence and Response to Treatment

Andrew K. Vaaler MD1; Joseph M. Forrester MD1; May Lesar MD2; Margaret Edison RN3; David Venzon PhD4; and Bruce E. Johnson MD3

1 From the Department of Internal Medicine, National Naval Medical Center, Bethesda, Md
2 From the Department of Radiology, National Naval Medical Center, Bethesda, Md
3 From the National Cancer Institute—Navy Medical Oncology Branch, National Cancer Institute, Bethesda, Md.
4 From the Biostatistics and Data Management Section, National Cancer Institute, Bethesda, Md.

Study objectives: Define the incidence of obstructive atelectasis in patients presenting with small cell lung cancer and their response to treatment.

Design: Retrospective review of clinical records and radiographic studies.

Setting: Single federal government institution—the National Cancer Institute—Naval Medical Oncology Branch.

Patients: One hundred seventy-two consecutive patients treated between 1983 and 1993.

Interventions: Patients presenting with obstructive atelectasis were identified. The incidence of dyspnea, cough, and sputum production before starting treatment and 1, 3, and 6 months later was determined. Fiberoptic bronchoscopy and chest radiographs performed before starting treatment were compared with those obtained later in the patients' clinical course.

Measurements and results: Thirty-seven of 172 (22%) patients had obstructive atelectasis. Initial symptoms included cough in 25 (68%), dyspnea in 24 (65%), and productive cough in 10 (27%). The patients' symptoms of cough, dyspnea, and sputum production decreased to one third of the initial prevalence 1 month after the start of treatment. Fiberoptic bronchoscopy and chest radiographs performed 3 months after starting treatment demonstrated bronchial patency in 90%.

Conclusions: Obstructive atelectasis occurs in approximately one fifth of patients presenting with small cell lung cancer. Chemotherapy and chemotherapy plus chest radiotherapy lead to symptomatic, bronchoscopic, and radiographic resolution in similar proportions of patients with obstructive atelectasis.

Key Words: carcinoma • small cell • combination chemotherapy • lung neoplasm • radiation

Submitted on March 5, 1996
Accepted on July 25, 2007




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