Techniques of endoscopic airway tumor treatment

Abstract

Interventional bronchoscopy has a predominant role in the management of both early and advanced-stage airway tumors. Given the very poor prognosis of lung cancer, there is a need for new tools to improve early detection and bronchoscopic treatment of endo-bronchial precancerous lesions. In more advanced stages, interventional bronchoscopy plays an important role, as nearly a third of lung cancers lead to proximal airway obstruction. This will cause great discomfort or even life-threatening symptoms related to local extension, such as dyspnea, post-obstructive pneumonia, and hemoptysis. Surgery for very locally advanced disease is only effective for a limited number of patients and the effects of conventional antitumor therapies, like radiation therapy or chemotherapy, are inconstant and are too delayed in a palliative context. In this review, we aim to provide pulmonologists with an exhaustive technical overview of (I) the bronchoscopic management of benign endobronchial lesions; (II) the bronchoscopic management of malignant tumors, including the curative treatment of localized lesions and palliative management of malignant proximal airway stenosis; and (III) descriptions of the emerging endoscopic techniques used to treat peripheral lung tumors.

Infections causing central airway obstruction: role of bronchoscopy in diagnosis and management

“…Therapeutic bronchoscopy for CAOI is not clearly delineated in the literature, and it is mainly found as scattered case reports and series. The airway management of CAOI is essentially similar to cases of malignant airway obstructions and consist of endobronchial debulking, balloon bronchoplasty, endobronchial laser therapy, argon plasma coagulation, cryotherapy and airway stent placement (151)(152)(153). Both flexible and rigid bronchoscopies can be used to treat CAOI.…”

Photodynamic Therapy for Lung Cancer

“…Tedavi başarısı %80'dir, ancak kanama komplikasyonu vardır (13). İleri (N=636 hasta) ve erken (N=517 hasta) evre akciğer kanserli hastalarda FDT etkinliği, mortalite, morbidite, sağ kalım ve semptomatik etkinlik şeklinde değerlendiril-miştir (15).…”

“…(10,16 Pahalı bir tedavidir ve fatal hemoptizi, pnömotoraks, kardiyak aritmi ve fistül gibi komplikasyonları vardır. Kriyoterapi, özellikle <3 mm derinlikte invazyonu olan ve kıkırdak invazyonu olmayan yüzeyel lezyonlarda başarılı bir tedavi alternatifidir (13). Erken evre akciğer kanserli hastalarda %91 tam yanıt oranı sağlanmıştır (14).…”

Feasibility analysis of flexible bronchoscopy in conjunction with noninvasive ventilation for therapy of hypoxemic patients with Central Airway Obstruction: a retrospective study

“…The syndrome of central airway obstruction(CAO), a common problem in medical and surgical settings (Murgu et al, 2016;Barros Casas et al, 2014), is generally defined as occlusion of >50% of the trachea, mainstem bronchi, bronchus intermedius, or a lobar bronchus. The incidence of this disorder is rising at present, possibly due to (1) the epidemic of lung cancer, which is typically diagnosed at an advanced stage (Guibert et al, 2016) and up to 30% of which causes CAO (Lin & Chung, 2016); (2) the increasing use of artificial airways (Barros Casas et al, 2014); (3) the epidemic of tuberculosis, which is still out of control in parts of the world including Africa and Asia (Dheda et al, 2017). Especially the epidemic of tracheobronchial tuberculosis, which is present in 10%-40% of active pulmonary tuberculosis (Smith, Schillaci & Sarlin, 1987), with involvement of the primary bronchi in 60%-95% of cases (Kashyap, Mohapatra & Saini, 2003).…”

“…Patients with hypoxemic CAO are typically compromised with a life-threatening airway obstruction. In recent decades, interventional bronchoscopy has become an effective treatment for central airway obstruction (Guibert et al, 2016). However, given that a flexible bronchoscop (FB) can occupy 10-15% of the normal tracheal lumen and decrease PaO 2 by 10-20 mmHg (Payne, Goyal & Gupta, 1986), it is not recommended for excessively dyspneic patients without assisted ventilation (Zias et al, 2009).…”