Malignant Airway Obstruction and the Use of Nd:YAG Laser: A Systematic Review on Its Efficacy and Safety

Abstract

Endobronchial malignancies with significant airway obstruction can lead to multiple complications including pneumonia, and atelectasis over a period of time. Various intraluminal treatments have proven their value in palliative treatment for advanced malignancies. Nd:YAG (neodymium-doped yttrium aluminum garnet; Nd:Y3Al5O12) laser has established its role as a major palliative intervention due to its minimal side effects and improvement in quality of life by relieving local symptoms.The systematic review was conducted with the goal of elucidating the patient characteristics, pre-treatment parameters, clinical outcomes, and possible complications resulting from the use of the Nd:YAG laser. A thorough literature search for relevant studies was conducted on PubMed, Embase, and Cochrane Library from the inception of the idea to November 24, 2022. Our study included all original studies including retrospective studies and prospective trials, but excluded case reports, case series with less than 10 patients, and studies with incomplete or irrelevant data. A total of 11 studies were included in the analysis. The primary outcomes focused on the evaluation of pulmonary functional tests, postprocedural stenosis, blood gas parameters after the procedure, and survival outcomes. Improvement in clinical status, improvement in objective scale for dyspnea, and complications were the secondary outcomes.Our study shows that Nd:YAG laser treatment is an effective form of palliative treatment to provide subjective and objective improvement in patients with advanced and inoperable endobronchial malignancies. Due to the heterogeneous study populations in the studies reviewed and the presence of many limitations, more studies are still warranted to reach a definitive conclusion.

Bilateral Endobronchial Prostatic Metastases: A Rare Clinical Entity with Diagnostic and Therapeutic Challenges: A Case Report and Literature Review

“…Our literature review reveals that hormonal therapy remains the mainstay of treatment in a majority of the cases of prostatic carcinoma with EBM except for three cases where debulking therapy has been employed; cryotherapy in one case [9], and argon plasma coagulation in two cases including ours [10] [see Table 1]. In clinical decision-making, the choice of endobronchial tumor ablation with laser therapy is supported by a growing body of evidence demonstrating its e cacy and safety in similar cases [11]. By leveraging the bene ts of targeted local therapy, this approach optimizes outcomes and symptom control.…”

“…Likewise, endobronchial tumor debulking therapy emerges as a viable option for managing endobronchial metastasis, particularly when chemotherapy proves ineffective [9][10][11]. This minimally invasive technique offers precise tumor targeting, symptom relief, and reduced complications [9][10][11].…”

“…This minimally invasive technique offers precise tumor targeting, symptom relief, and reduced complications [9][10][11]. For patients with contraindications or limited response to chemotherapy like our patient, debulking therapies like argon plasma coagulation, Nd:YAG laser ablation and cryotherapy provides an effective alternative, improving quality of life by alleviating symptoms such as dyspnea, cough, and hemoptysis [9][10][11].…”

“…By leveraging the bene ts of targeted local therapy, this approach optimizes outcomes and symptom control. It offers a valuable therapeutic option for patients with endobronchial metastases where chemotherapy is not feasible or is ineffective [11]. Hence, individualized treatment modalities are adopted for EBM secondary to adenocarcinoma of the prostate.…”

Advancements in airway stents: a comprehensive update

“…In this analysis, stenting results in improvement in dyspnea, facilitates addition therapy (e.g.. Radiation), improved pulmonary function and performance scores with low complication rates and high technical success rates [12 ▪▪ ].…”