Initial Combination Therapy with YAG Laser Photoresection and Irradiation for Inoperable Non-Small Cell Carcinoma of the Lung

Eichenhom, Michael S.; Kvale, Paul A.; Miks, Veronica M.; Seydel, H. Gunter; Horowitz, B.; Radke, Jan R.

doi:10.1378/chest.89.6.782

Cited by 53 publications

(18 citation statements)

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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%

“…Effective recanalization of obstructed airways reduces postobstructive infections, respiratory insufficiencies, and duration of hospitalization, while improving quality of life (10)(11)(12). Local therapies also enhance the effect of subsequent systemic chemotherapy and/or external radiotherapy and have a favorable effect on survival outcomes (8).…”

mentioning

confidence: 99%

“…Local therapies also enhance the effect of subsequent systemic chemotherapy and/or external radiotherapy and have a favorable effect on survival outcomes (8). In contrast, failure to treat malignant airway obstruction, even if followed by radiotherapy, has been associated in several series with a poor prognosis (11,12).…”

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confidence: 99%

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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%

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confidence: 99%

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

et al. 2015

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“…Life expectancy of patients presenting with symptomatic obstruction successfully treated is equal to that of asymptomatic patients for equivalent stage of the disease [41]. Usually, benefits noted after successful bronchoscopic treatment of obstruction last for 2-3 months [36]. Benefit duration after stent placement is generally reported to be around 4 months [42].…”

Section: Malignant Extrinsic Compression and Endoluminal Intrinsic Lesionsmentioning

confidence: 99%

“…Extrinsic compression without intraluminal disease is readily treated with dilatation followed by stenting. Mixed (intrinsic and extrinsic) obstruction treatment is usually multimodality with debulking and stent insertion (FIGURE 7).An efficient endoscopic treatment allows for oncologic treatments to be done in better conditions with reduced complications and improve subjective respiratory symptoms, lung function [35], performans status, survival [36][37][38][39] and quality of life [40]. Life expectancy of patients presenting with symptomatic obstruction successfully treated is equal to that of asymptomatic patients for equivalent stage of the disease [41].…”

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confidence: 99%

The use of self-expandable metallic stents in the airways in the adult population

Dutau¹,

Musani

Plojoux³

et al. 2014

Expert Review of Respiratory Medicine

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The airway stents restore patency in the face of luminal compromise from intrinsic and/or extrinsic pathologies. Luminal compromise beyond 50% often leads to debilitating symptoms such as dyspnea. Silicone stents remain the most commonly placed stents worldwide and have been the "gold standard" for the treatment of benign and malignant airway stenoses over the past 20 years. Nevertheless, silicone stents are not the ideal stents in all situations. Metallic stents can serve better in some selected conditions. Unlike silicone stents, there are large and increasing varieties of metallic stents available on the market. The lack of prospective or comparative studies between various types of metallic stents makes the choice difficult and expert-opinion based. International guidelines are sorely lacking in this area.KEYWORDS: airway stenting . benign airway stenosis . bronchoscopy . central airway obstruction . self-expandable metallic stentDumon was the first physician to place a dedicated and specially designed airway stent in 1987 in Marseille. This dedicated stent consisted of a silicone tube with small studs on the external surface to reduce migration [1]. Consequently, several companies started to develop other airway stents with silicone and metal. In the last 20 years, numerous reports have been published about the use of selfexpanding and balloon expandable metal stents for the treatment of tracheobronchial malignant and benign stenoses, tracheobronchomalacia (TBM), fistulas and dehiscences [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16].Self-expandable stents are made of a shapememory alloy, generally nitinol (nickel-titanium). When the stent is released, it expands spontaneously to reach its original shape and diameter. On the other hand, balloon expandable metallic stents (the first generation of airway metallic stents) were made of metal (steel) meshes that did not possess a memory shape. A balloon was then necessary to deploy them. Most of these stents had originally been developed for use in the vascular system but were found to be adequate for placement in the central airways after only minor modifications, if any at all. The latest developments include stents made of shape memory alloys and composite stents made from metals and polymers [17][18][19]. But, so far, the Dumon stent (Tracheobronxane Ò , Novatech, La Ciotat, France) remains the most commonly placed stent worldwide. Dumon stents have been the 'gold standard' for the treatment of benign and malignant airway stenoses over the past 20 years [20,21], with two specific designs: straight and Y-shaped (for disease involving the carina) [22]. By the way, it is interesting to notice that, in the Thoracic Endoscopy Unit of Marseille, where the Dumon stent was conceptualized and used, the percentage of silicone stent placement has dropped from 100% in 2000 to 65% in 2013. The remaining 35% of the stents used are now fully covered, selfexpandable, metallic stents (SEMS). This goes to prove that the Dumon stents are not the ideal stents in all situa...

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Fire and Ice: Laser Bronchoscopy, Electrocautery and Cryotherapy

Jantz¹,

Silvestri²

2006

Thoracic Endoscopy: Advances in Interventional Pulmonology

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Initial Combination Therapy with YAG Laser Photoresection and Irradiation for Inoperable Non-Small Cell Carcinoma of the Lung

Cited by 53 publications

References 9 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

The use of self-expandable metallic stents in the airways in the adult population

Fire and Ice: Laser Bronchoscopy, Electrocautery and Cryotherapy

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