Revisiting bronchoscopic intratumoral chemotherapy in malignant central airway obstruction via EUS-B approach and its review of literature

Abstract

Critical central airway obstruction has always been a dreaded complication to which interventional pulmonologist commonly encounters. There have been various modalities which are used for the management and palliation, which includes mechanical coring, laser, cryoextraction, electrocautery and airway stenting. Rigid bronchoscopy with or without jet ventilation has been corner stone of therapeutics and palliation of central airway obstruction. There are only a few conditions where it is not possible to use rigid bronchoscopy. Here we report a case of metastatic tracheal tumour which presented with critical airway obstruction in a patient who had atlantoaxial instability (AAI) due to rheumatoid arthritis. Here we used endobronchial ultrasound scope (EBUS) via esophageal route, i.e. EUS-B guided approach for sampling of the tracheal tumour, and intratumoral chemotherapy was instilled in multiple sessions, which resulted in shrinking of tumour, thus relieving the critical airway obstruction. This is the first report of using EUS-B approach for intratumoral chemotherapy for tracheal tumors. Bronchoscopic intratumoral chemotherapy therapy (BITC) in tracheal tumors is also one of the options but has not been explored much and there has been a dearth of literature for it.

Left Main Bronchus Obstruction in a Patient with Small-cell Lung Cancer Successfully Treated with Venovenous Extracorporeal Membrane Oxygenation

“…First, endoscopic ultrasound with bronchoscopy-guided fine-needle aspiration (EUS-B-FNA) instead of an EBUS-TBNA may have allowed for a biopsy to be performed without causing airway obstruction. Niwas et al reported a case in which a metastatic tracheal tumor lesion occupying 75% of the main bronchus was biopsied by EUS-B-FNA followed by intratumoral chemotherapy, resulting in tumor shrinkage ( 22 ). However, the safety of this procedure in a case with nearly 100% tracheal stenosis, as in the present case, is unclear.…”

Clinical Applications of Endobronchial Ultrasound (EBUS) Scope: Challenges and Opportunities

“…EUS-B approach for the cisplatin injection in a patient with a critical, nearly complete tracheal occlusion and with atlantoaxial instability that contraindicates rigid bronchoscopy, has also been reported [111].…”