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A Journal on Diseases of the Respiratory System
Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Minerva Pneumologica 2010 March;49(1):25-32
Delayed desobstruction techniques in lung cancer: emphasis on endobronchial brachytherapy
Hennequin C., Tredaniel J.
Cancer, Radiology and Thoracic Oncology Unit Saint-Louis Hospital, Paris, France
Cryotherapy, brachytherapy and photodynamic therapy (PDT) induced a delayed desobstruction and for this reason they are not indicated in case of obstructive tumor with acute dyspnea. However, these techniques have curative and palliative indications and could be performed after external beam irradiation. For early disease with small endobronchial lesions, the rate of complete endoscopic response range from 60% to 100% for all of them. However, larges series with long-term follow-up are lacking. In situ or micro-invasive carcinomas are the best indications for PDT: lesions must be <1 cm without deep infiltration of the bronchial wall. Long-term local control ranged from 50% to 70%. Cryotherapy could also obtain some sustained local control. Endobronchial brachytherapy could treat larger lesions (up to 5 cm) which infiltrate deeper the bronchial wall. In these less favourable cases, long-term results seems comparable to the others techniques. Comparative studies are clearly needed to better define the best modalities for the endoscopic treatment of early lung cancer. In palliative care, after tumor coagulation and debulking of partially obstructive lesions, these techniques could prevent complete obstruction of the central airway. The results of the three techniques are roughly the same, with a symptomatic improvement observed in more than 60% of the patients. Usually, cryotherapy is used in combination with mechanical or laser debulking, and brachytherapy in case of bronchial obstruction without acute dyspnea. Indications of PDT in palliative patients are less frequent, because they must be preserved from sunlight for six weeks.