Laser therapy in 100 tracheobronchial tumours.

Abstract

One hundred patients with tracheobronchial tumours were treated with the neodymium YAG (yttrium-aluminium-garnet) or If clearance of the airways was considered inadequate at the first attempt, we were prepared to give up to three sessions of laser treatment during the initial admission to hospital, after which no further treatment was attempted if the patient did not improve. Follow up treatments were given at one to three month intervals, depending on the speed with which symptoms recurred, for as long as further response was seen and breathlessness or haemoptysis remained predominant symptoms.Response to treatment was assessed by the patients' account of their symptoms and by the results of pulmonary function tests, which included peak expiratory flow rate, spirometric values, and a flow-volume loop. Exercise tolerance was measured by the six minute walking test.5 Full pulmonary function testing was not completed in a few of our early patients and could not be performed in some patients because of extreme breathlessness, but peak flow rate was always attempted on the ward with a Wright peak flow meter. These tests were performed before and after treatment and repeated at outpatient sessions and before subsequent treatments. A symptomatic improvement was recorded if the patient said that he or she felt better and if there was an improvement in the six minute walk. Objective improvement was recorded if there was a grea-341 Hetzel, Nixon, Edmondstone, Mitchell, Millard, Nanson, Woodcock, Bridges, Humberstone ter than 25% rise in peak flow rate, since this information was consistently available. Such cases usually showed improvement in spirometric indices and flow-volume loops as well. In patients with an unrecordable peak flow 601 min-' was taken as the starting point for this calculation.In patients treated for haemoptysis diary charts were recorded from the time of admission for assessment for laser treatment. After discharge home records were continued by the patient, who was asked to record each day whether blood had been coughed up and if so how much. An objective response was defined as complete cessation of haemoptysis for at least one month. A symptomatic response was defined as a significant reduction in frequency and quantity of haemoptysis. It was considered unjustifiable to delay treatment for more than a few days to monitor haemoptyses before the first treatment. In patients who were subsequently treated again (for recurrence of haemoptyses after initial good control) it was, however, possible to compare pre-treatment and post-treatment records covering several weeks. Diary charts were also used to help in deciding when further treatment was indicated.The first 14 patients were treated with the argon laser (Spectra Physics), wavelength 488 and 514 nm, output 12 w. All other patients were treated with the neodymium YAG laser (Barr and Stroud or Medilas), wavelength 1060 nm, maximum output 100 w. The laser beam was transmitted through a 200 um quartz (argon) or 600 micron glass (Nd YAG) opti...

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