Chest
Volume 110, Issue 6, December 1996, Pages 1536-1542
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Clinical Investigations: Ron/Hoscopy
Endoscopic Treatment of Malignant Airway Obstructions in 2,008 Patients

https://doi.org/10.1378/chest.110.6.1536Get rights and content

We report our 13-year experience with endoscopic treatment of malignant obstructions of the airway by Nd:YAG laser, stents, and intraluminal brachytherapy in 2,008 patients. We performed 2,610 laser resections in 1,838 patients, 66 high dose rate brachytherapies, and we placed 393 tracheobronchial silicone stents in 306 patients. We used the rigid bronchoscope in 96% of the laser procedures and in all cases requiring stent placement; general anesthesia was given to 90% of these patients. Endobronchial radiotherapy was performed under local anesthesia. In 93% of patients undergoing laser resection, we obtained an immediate patency of the airway with consequent improvement of quality of life. The median time between the first and second laser treatment was 102 days, being longer in the case of stent placement (when required) or in association with brachytherapy. Even if endoscopic treatment should be considered only for palliation, laser vaporization could be curative in case of in situ carcinoma. Since 1983, we have treated 23 such lesions in 17 patients and up to now, none has recurred. Finally, endoscopic resection may allow a better assessment of the true extent of the tumor, shifting to surgery patients originally considered to have inoperable disease or allowing lung-sparing operations (21 and 18 patients of our series, respectively). The total mortality rate was 0.4% (12 patients over 2,798 treatments; 2,710 Nd:YAG laser+151 stents without laser+37 brachytherapies without laser) in the first week after the procedures, and was mainly related to cardiovascular problems and respiratory failure. In conclusion, endoscopic resection of lung malignancies is rapid, effective, repeatable, and complementary to other treatments; although it should be considered only palliative, laser resection could be curative in patients with in situ carcinomas and early cancers. Laser, stents, and endoluminal brachytherapy should be available in all centers with major experience; a well-trained team is mandatory to plan the most appropriate treatment and manage any possible complication.

Section snippets

Materials and Methods

From April 1982 to December 1994, 2,008 patients with obstructions of the airway due to malignant tumors were treated endoscopically by the first author only (1,838 patients underwent laser resection of which 173 were followed by stent placement and 29 by endoluminal brachytherapy, 133 were stented without any other treatment, and 37 received brachytherapy alone), for a total of 2,798 procedures. At the beginning of our experience, only patients already treated by the oncologist with poor

Results

From April 1982 to December 1994, we performed 4,381 Nd:YAG laser endoscopic resections and 3,133 (in 2,190 patients) were for lung tumors; 2,610 treatments were performed in 1,838 patients with lung cancer

Immediate results were assessed according to the classification criteria proposed by Unger27 and Dumon et al:28 good results were obtained in 93% of patients with bronchogenic carcinoma (Table 6). Poor results were related to the presence of extrinsic compression or to extensive infiltrations

Discussion

Endoscopic resection of tracheobronchial malignancies is mainly devoted to reduce respiratory distress by giving a patent airway to the patient and improve his or her quality of life. Although palliation could be achieved also by mechanical debridement, cryotherapy and photodynamic therapy,33, 34, 35, 36, 37, 38, 39 Nd:YAG laser allows quick and better results in terms of immediate and medium-term palliation. In fact, before laser became available at our institution, we performed 33 mechanical

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