Combined laser therapy and endobronchial radiotherapy for unresectable lung carcinoma with bronchial obstruction

American Journal of Surgery
M D AllenJ B Mark


Over a 4 year period, we refined a protocol for treatment of airway obstruction due to recurrent lung carcinoma. Patients undergo bronchoscopy with the Nd:YAG laser available on standby. If bronchial obstruction is found to be due to extrinsic compression, an endobronchial catheter is inserted for iridium 192 brachytherapy, treating a cylindrical volume 7.5 to 15 mm in radius. If an endobronchial lesion is found, the presence of complete versus partial bronchial obstruction determines the course of treatment. Total airway obstruction is treated with the laser until a channel is created and then an endobronchial catheter is placed for adjuvant endobronchial radiotherapy to treat a cylindrical volume 5 mm in radius. Partial airway obstruction is treated with an endobronchial catheter and radiotherapy alone. Segmental obstruction is also treated with a distally placed endobronchial catheter instead of the laser. Using this protocol, we hope to minimize risk to the patient by restricting the use of the laser with its inherent higher potential rate of complications to cases of total obstruction. In addition, we expect to prolong the duration of palliation with endobronchial radiotherapy. The laser is an excellent tool to reopen occl...Continue Reading


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