YAG Laser Photoresection of Lesions Obstructing the Central Airways *

Kvale, Paul A.; Eichenhorn, Michael S.; Radke, Jan R.; Miks, Veronica M.

doi:10.1378/chest.87.3.283

Cited by 122 publications

(42 citation statements)

References 10 publications

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“…Therapeutic bronchoscopy procedures, such as endobronchial laser and insertion of airway stents, are commonly used with a goal to relieve respiratory distress, improve quality of life, and potentially prolong survival. Several studies have demonstrated that in patients with unresectable obstructive lung cancer, a preliminary efficient debulking of the airway by laser photoresection or cryotherapy, before irradiation, lessens morbidity by reducing the number of local complications such as postobstructive infection, respiratory insufficiency, and hemoptysis (11,12,(24)(25)(26)(27). Chhajed and colleagues showed that patients with advanced lung cancer and malignant airway obstruction who underwent interventional bronchoscopy and systemic chemotherapy had survival similar to those without malignant airway obstruction who received systemic treatment (28).…”

Section: Original Researchmentioning

confidence: 99%

Restoration of Patency to Central Airways Occluded by Malignant Endobronchial Tumors Using Intratumoral Injection of Cisplatin

et al. 2015

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Rationale: Malignant airway obstruction is commonly found in patients with lung cancer and is associated with significant morbidity and mortality. Relieving malignant obstruction may improve symptoms, quality of life, and life expectancy.Objectives: The objective of this study was to analyze our experience with bronchoscopic endobronchial intratumoral injection of cisplatin for malignant airway obstruction. Methods:We conducted a retrospective analysis of patients with malignant airway obstruction treated with bronchoscopic intratumoral injection of cisplatin. Patient characteristics, histology, degree of airway obstruction, procedural methods, treatment cycles, performance status, and therapeutic outcomes were evaluated. Tumor response was analyzed based on bronchoscopic measurements performed on completion the of final treatment session. Adverse events and overall survival were abstracted. Measurements and Main Results:Between January 2009 and September 2014, 22 patients (10 men, 12 women; mean age 6 SD, 64.4 6 9.5 yr) were treated with one to four injections of 40 mg of cisplatin mixed in 40 ml of 0.9% NaCl. Treatments were completed 1 week apart. The primary etiologies of airway obstruction included squamous cell carcinoma (n = 11), adenocarcinoma (n = 6), small cell carcinoma (n = 2), large cell undifferentiated carcinoma (n = 1), and metastatic endobronchial cancer (n = 2). Twenty-one of 22 patients were evaluable for response. The majority of patients (15/21, 71.4%) responded to therapy, defined as greater than 50% relative reduction in obstruction from baseline. Treatment response was obtained regardless of tumor histology, concurrent systemic therapy, number of treatment cycles administered, performance status, or use of additional ablative interventions. Responders had significantly improved overall survival as compared with nonresponders, although the difference was small. Severe treatment-related side effects or complications were not observed.Conclusions: Subject to the limitations of a single-center retrospective study and a subjective primary outcome measure, we have demonstrated the feasibility of improving the patency of central airways that are largely or completely occluded by endobronchial malignant tumor using intraluminal injection of cisplatin. Additional longer-term, larger-scale safety and comparative effectiveness studies of this palliative treatment modality are warranted.

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Section: Original Researchmentioning

confidence: 99%

Restoration of Patency to Central Airways Occluded by Malignant Endobronchial Tumors Using Intratumoral Injection of Cisplatin

et al. 2015

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“…Clinical studies have reported constant, immediate and significant improvement in symptoms, quality of life (assessed using the mean±SD Karnofsky index which increased from 77±4 to 91±4 [15]), gas exchange ( partial pressure of oxygen from 59±8 mmHg before intervention; to 78±6 mmHg after), and ventilatory parameters (improvement of 610 mL and 428 mL in forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), respectively) [15][16][17]. In 92% of cases (n=1000), the bronchial diameter is restored, especially in cases of proximal tumours (trachea and main bronchi) [18].…”

Section: Lasermentioning

confidence: 99%

“…Haemorrhages are treated using cold serum, adrenaline or terlipressin local administration, compression with the tube, or short pulses of less than 30 W. Severe haemoptysis only occurs in 1% of cases [10,15,19]. There is a risk of ignition or airway fire, which is usually not serious and can be prevented by maintaining a low inspiratory oxygen fraction (<0.4) [17,19]. Potentially fatal complications include tracheobronchial wall perforations causing vascular fistula (very rare cases of massive haemoptysis at powers of 90 W) [20], gas embolism, and mediastinitis [19].…”

Section: Lasermentioning

confidence: 99%

Integration of interventional bronchoscopy in the management of lung cancer

et al. 2015

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Tracheal or bronchial proximal stenoses occur as complications in 20-30% of lung cancers, resulting in a dramatic alteration in quality of life and poor prognosis. Bronchoscopic management of these obstructions is based on what are known as "thermal" techniques for intraluminal stenosis and/or placement of tracheal or bronchial prostheses for extrinsic compressions, leading to rapid symptom palliation in the vast majority of patients. This invasive treatment should only be used in cases of symptomatic obstructions and in the presence of viable bronchial tree and downstream parenchyma.This review aims to clarify 1) the available methods for assessing the characteristics of stenoses before treatment, 2) the various techniques available including their preferred indications, outcomes and complications, and 3) the integration of interventional bronchoscopy in the multidisciplinary management of proximal bronchial cancers and its synergistic effects with the other specific treatments (surgery, radiotherapy or chemotherapy). @ERSpublications Central airway obstruction is a severe complication of lung cancer that can be managed by interventional bronchoscopy http://ow.ly/OdAhF

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“…Among the traditional ablative techniques, laser was the first technique used by pulmonologists [2][3][4][5][6][7]. Other ablative techniques have since become available to thoracic endoscopists such as thermocoagulation, argon plasma coagulation, cryotherapy, photodynamic therapy, and brachytherapy.…”

Section: Ablative Techniquesmentioning

confidence: 99%

“…However, some European physicians continued to use the rigid system for the treatment of airway diseases, among whom the father of modern therapeutic bronchoscopy, Jean-François Dumon, unanimously regarded as a pioneer in the field of interventional pulmonary medicine. He was one of the first bronchoscopists [2][3][4][5] to use laser therapy in the airway and contributed to standardize its utilization [6,7]. Another of his many contributions was the invention of a dedicated silicone stent for the trachea and bronchi [8].…”

Section: Introductionmentioning

confidence: 99%

Silicone stents, the rigid bronchoscope, and the standard of care in central airway stenosis

Dutau

Maldonado

Laroumagne

et al. 2012

Curr Respir Care Rep

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Central airway stenoses often represent a therapeutic challenge and require a multidisciplinary approach involving interventional pulmonologists and thoracic surgeons. While surgery is often the preferred definitive modality, advances in bronchoscopic techniques have led to substantial improvements in patient symptoms and longterm quality of life using minimally invasive techniques generally safe when performed by experienced proceduralists. Endobronchial laser therapy, cryotherapy, conventional electrocautery, or argon plasma coagulation and photodynamic therapy have been used successfully. A variety of stents, silicone or self-expandable (covered or non-covered metallic stents), have been used though little significant progress has been achieved since the description of the dedicated airway silicone stents first described by JeanFrancois Dumon in the 1980s. Rigid bronchoscopy remains the method of choice for the treatment of both benign and malignant central airway obstruction, but significant technological advances allow for effective treatments using the flexible bronchoscope. Metallic non-covered stents are generally not recommended, except in selected patients with poor short-term prognosis.

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YAG Laser Photoresection of Lesions Obstructing the Central Airways *

Cited by 122 publications

References 10 publications

Restoration of Patency to Central Airways Occluded by Malignant Endobronchial Tumors Using Intratumoral Injection of Cisplatin

Restoration of Patency to Central Airways Occluded by Malignant Endobronchial Tumors Using Intratumoral Injection of Cisplatin

Integration of interventional bronchoscopy in the management of lung cancer

Silicone stents, the rigid bronchoscope, and the standard of care in central airway stenosis

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