External Beam Radiotherapy for Malignant Central Airway Obstruction in a Remote Rural Patient: A Case Study.

Abstract

Introduction: Malignant central airway obstruction (MCAO) is a challenging therapeutic scenario, caused by tumour burden which limits airflow within the large airways. Squamous cell carcinoma (SCC) of the lung accounts for 50% of MCAO seen in the setting of non-small cell lung cancer. Here, we present the challenging case of a 63-year-old Indigenous Australian Female rom a remote rural community with background history of metastatic SCC of presumed pulmonary origin, who presented with a 1-week history of dyspnoea, stridor, and hoarse voice.

Case presentation: A CT chest and neck demonstrated a superior mediastinal mass compressing the trachea to a narrowest diameter of 3 mm. The patient was stabilised in her local health centre, then transferred to our tertiary care facility for further evaluation and management. This stenotic lesion was not amenable to bronchoscopic or surgical intervention but was instead treated successfully with a short course of external beam radiotherapy, to total dose of 25Gy delivered over 10 fractions. The patient had almost complete resolution of respiratory symptoms with no significant radiotherapy related toxicity.

Conclusion: Here, we discuss a challenging case of MCAO in a remote rural Australian patient and demonstrate the utility of external beam radiotherapy in this setting. We also discuss aspects of cancer related healthcare disparities which exist for Indigenous Australians. In doing so, we wish to highlight the need for improved cancer healthcare for such communities.