The technique of endoscopic airway tumor treatment (original) (raw)
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2018
One of the major role of EBBT is palliation of symptoms caused by endobronchial cancer ingrowth. Boost EBBT to endobronchial gross tumors combined with external beam radiotherapy (EBRT) provides not only palliative but curative possibilities2. In small endobronchial tumors EBBT is used as definitive curative treatment3.EBBT is also used for non-oncologic pathologies4,5. The majority of non-small cell lung cancer (NSCLC)found at loco-regionally advanced stage and frequently associated with bronchial obstruction Various endoscopic techniques available today are including cryotherapy, stent, laser, photodynamic, and EBBT6,7. Among these EBBT in the only one that provides biologically tumoricidal effect keeping the normal tissue structure as is.
Endobronchial Chemotherapy in Malignant Airway Lesions of the Lung
Journal of Bronchology, 2007
Bronchoscopic palliative treatment is a modality that could reduce the symptoms in patients with inoperable lung cancer. Our interest is to study the palliative effect of intrabronchial chemotherapy using cisplatin, in patients with inoperable lung cancers. Between the years of 2003 and 2006, patients with unresectable lung cancer and endobronchial lesion were selected for tumor debulking via intrabronchial injection of cisplatin. After flexible bronchoscopy, maximum 20mL cisplatin with the concentration of 50 mg/100mL was injected into the bulk of the tumor through the special needle. The procedure was performed weekly for 4 sessions. After the end of fourth session, this procedure was done monthly. Patients were followed according to the symptoms, size of the involved lumen, and changes in the shape and size of intrabronchial lesion after local chemotherapy. A hundred patients were studied (72 men, 28 women). All of them diagnosed with inoperable lung cancer. According to the histology, they were categorized as adenocarcinoma (n=48), squamous cell carcinoma (n=32), and nonsmall cell lung cancer, unspecified (n=20). At the end of the forth session of local chemotherapy, the involved lumen was considerably opened (more than 25%) in 80 patients. We suggest that endobronchial chemotherapy with cisplatin could be used for debulking of the tumor in the caseswith inoperable lung cancer.
Endobronchial irradiation for malignant airway obstruction
International Journal of Radiation Oncology*Biology*Physics, 1989
An afterloading endobronchial irradiation (EBRT) technique using Iridium-192 (Ir-192), was piloted for malignant airway obstruction. Under bronchoscopic guidance, a catheter is threaded distal to the lesion. Orthogonal radiographs and computerized tomographic (CT) scans are obtained for dosimetry. Forty implants in 38 patients have been performed. Thirty-two patients had lung cancer; 23 had received prior irradiation and eight had prior chemotherapy. Eight patients underwent pre-endobronchial irradiation laser excision. Median implant duration was 50.5 hr; median dose at 1 and 2 cm from source center was 50 and 20 Gy, respectively. The procedure was well tolerated with four long-term complications (10.5%). Twelve of 38 patients are currently alive with a median survival of 5+ months and a range of 1 to 21+ months. Changes in performance status (PS), symptom resolution, radiographic demonstration of re-aeration of atelectatic lung, changes in pulmonary function (PFT), and post-endobronchial irradiation bronchoscopy were used to assess response. Seventy percent of the patients' remaining life was rendered symptom-free or improved. A 70% radiographic response was noted. Fourteen patients underwent post-endobronchial irradiation bronchoscopy with 12 complete responses. Endobronchial irradiation, therefore, appears to be a safe, effective technique to palliate malignant airway obstruction.
Endobronchial Brachytherapy for Lung Cancer
Japanese Journal of Lung Cancer, 2006
High-dose rate endobronchial brachytherapy for endobronchial carcinomas became prevalent with the increasing use of afterloading brachytherapy machines: a tiny Iridium-192 seed is driven within the prepositioned catheter by remote afterloading. We performed the procedure more safely with an applicator which provides a space between the source and the bronchial wall than with only an intraluminal catheter. In patients presenting with superficial endobronchial tumors)often found by a regular health checkup with sputum cytology* , this treatment technique is more often used with curative intent than palliation. In order to reduce late complications, combining with external beam radiotherapy, using an applicator with two wings acting as spacers, evaluating point modifications depending on the airway diameter are performed. Combined treatment with endobronchial brachytherapy and external beam radiotherapy is effective)comparable to the treatment results of operating procedures*for endobronchial lesions with acceptable complications. In this paper, we described our techniques, results, and the indications for high-dose rate endobronchial brachytherapy, along with a review of literature.
European Journal of Cardio-thoracic Surgery, 2001
Objective: Many patients with advanced lung cancer invading the airway require only palliation; however, induction chemotherapy and surgery may sometimes be considered. Preliminary endoscopic palliation may improve quality of life and functional status, allows better evaluation of tumor extension and contributes to prevent infectious complications. We reviewed our experience with preliminary laser treatment, induction chemotherapy and surgical resection in patients with lung cancer invading the airway. Methods: Twenty-one patients with stage IIIA and IIIB lung cancer presenting with an 80% unilateral airway obstruction were treated with laser resection, induction chemotherapy and surgery. Spirometry, arterial blood gasanalysis, quality of life (QLQ±C30 score) and performance status were recorded before and after laser treatment and after chemotherapy. Complications during chemotherapy, surgical morbidity and mortality, and survival were also recorded. Results: No complications were observed after endoscopic treatment. FEV 1 signi®cantly improved from 1.4^0.4 l/s to 2.2^0.7 l/s, as well as FVC (from 2^0.5 to 3.1^0.8 l), and remained stable after chemotherapy. The QLQ±C30 score signi®cantly improved after laser treatment (from 45^4.8 to 31^2.5) as well as the Karnofsky status (from 76^5 to 90). One patient developed pneumonia during induction chemotherapy. Three patients were not operated on. We performed ®ve pneumonectomies (one right tracheal sleeve pneumonectomy) and 13 lobectomies (®ve associated to a bronchial sleeve resection). One patient (5.5%) died after the operation. Four patients experienced minor postoperative complications. Three-year survival after the operation was 52%. Conclusions: Preliminary endoscopic palliation of lung cancer invading the airway is feasible, improves evaluation and staging, helps to reduce the incidence of complications during induction chemotherapy without increasing surgical morbidity and mortality. q
Bronchoscopic Treatment of Benign Endoluminal Lung Tumors
Canadian Respiratory Journal
Background and Aim. Endobronchial benign tumors are a rarely seen clinical entity but may cause significant symptoms. Endobronchial treatment has the potential for relieving symptoms while saving the patient from invasive surgical procedures. No trials have been published that present and compare the various endobronchial treatment modalities for endobronchial benign tumors. The aim of the present study is to define safety and efficacy of endobronchial treatment in patients with benign endobronchial tumors from the point of complications and success rate. Methods. This study is a retrospective cohort study from a review of medical charts. Eligibility criteria included diagnosis of a benign endobronchial tumor. Our institution’s bronchoscopy and pathology database was searched for specific benign tumors, and the results were further detailed based on the endobronchial location. Results. Forty-four patients with pathologically confirmed benign endobronchial tumors were included. Tumor...
Cancer Biotherapy & Radiopharmaceuticals, 2010
The efficacy of high dose-rate endobronchial radiotherapy (HDERT) against proximal airway obstruction that results from lung cancer has not been thoroughly evaluated. This study retrospectively reviewed tumor= obstruction characteristics prior to therapy, interventions applied, symptoms before and after intervention, complications, and survival of all patients with proximal airway obstruction resulting from lung cancer who received HDERT between 1995 and 2003 in a tertiary teaching center. Thirty-four (34) patients received HDERT, while 28 had additional treatment (external radiotheraphy ¼ 23, neodymium yttrium aluminum garnet laser ablation ¼ 9, stenting ¼ 7, electrosurgery ¼ 5, cryosurgery ¼ 3, and photodynamic therapy ¼ 1). Sixteen (16) patients developed complications, the most frequent being respiratory failure and bronchial-wall necrosis, while 19 experienced symptomatic relief. The median (95% confidence interval) survival of these 34 patients was 7.8 (5.9-9.8) months, significantly longer (p ¼ 0.004) than a historic control of 3.9 (3.7-7.1) months from the Cleveland Clinic Foundation, in Cleveland, OH, and comparable to other previous reports. No single factor predicted complications or symptomatic relief. However, female gender, presence of only one symptom, absence of fatigue=weight loss, >1 HDERT sessions, and postprocedure symptom relief were associated with improved survival. Contemporary HDERT with or without additional treatment modalities is effective against central airway compromise resulting from lung cancer.