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Jiang M, Xu H, Yu D, Yang L, Wu W, Wang H, Sun H, Zhu J, Zhao W, Fang Q, Yu J, Chen P, Wu S, Zheng Z, Zhang L, Hou L, Zhang H, Gu Y, He Y. Risk-score model to predict prognosis of malignant airway obstruction after interventional bronchoscopy. Transl Lung Cancer Res 2021; 10:3173-3190. [PMID: 34430356 PMCID: PMC8350098 DOI: 10.21037/tlcr-21-301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/18/2021] [Indexed: 12/25/2022]
Abstract
Background Interventional bronchoscopy exhibits substantial effects for patients with malignant airway obstruction (MAO), while little information is available regarding the potential prognostic factors for these patients. Methods Between October 31, 2016, and July 31, 2019, a total of 150 patients undergoing interventional bronchoscopy and histologically-confirmed MAO were collected, in which 112 eligible participants formed the cohort for survival study. External validation cohort from another independent institution comprised 33 MAO patients with therapeutic bronchoscopy. The least absolute shrinkage and selection operator regression (LASSO) was applied to the model development dataset for selecting features correlated with MAO survival for inclusion in the Cox regression from which we elaborated the risk score system. A nomogram algorithm was also utilized. Results In our study, we observed a significant decline of stenosis rate after interventional bronchoscopy from 71.7%±2.1% to 36.6%±2.7% (P<0.001) and interventional bronchoscopy dilated airway effectively. Patients in our study undergoing interventional bronchoscopy had a median survival time of 614.000 days (95% CI: 269.876–958.124). Patients receiving distinct therapeutic methods of interventional bronchoscopy had different prognosis (P=0.022), and patients receiving treatment of electrocoagulation in combination with stenting and electrosurgical snare had worse survival than those receiving other options. Multivariate Cox analysis revealed that nonsmoking status, adenoid cystic carcinoma, and low preoperative stenosis length, as independent predictive factors for better overall survival (OS) of MAO patients. Then, the nomogram based on Cox regression and risk score system based on results from LASSO regression were elaborated respectively. Importantly, this risk score system was proved to have better performance than the nomogram and other single biomarkers such as traditional staging system (area under the curve 0.855 vs. 0.392–0.739). Survival curves showed that patients with the higher risk-score had poorer prognosis than those with lower risk-score (third quantile of OS: 126.000 days, 95% CI: 73.588–178.412 vs. 532.000 days, 95% CI: 0.000–1,110.372; P<0.001). Conclusions Nonsmoking status, adenoid cystic carcinoma, and low preoperative stenosis length, were independent predictive factors for better OS of MAO patients. We proposed a nomogram and risk score system for survival prediction of MAO patients undergoing interventional bronchoscopy with good performance.
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Affiliation(s)
- Minlin Jiang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China.,Tongji University, Shanghai, China
| | - Hao Xu
- Department of Respiratory, the Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Dongmei Yu
- Department of Endoscopy Center, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Li Yang
- Department of Endoscopy Center, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Wenhui Wu
- Pulmonary Hypertension Research Group, Quebec Heart and Lung Institute Research Centre (IUCPQ), Québec City, QC, Canada
| | - Hao Wang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China.,Tongji University, Shanghai, China
| | - Hui Sun
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Jun Zhu
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Wencheng Zhao
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Qiyu Fang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Jia Yu
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Peixin Chen
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China.,Tongji University, Shanghai, China
| | - Shengyu Wu
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China.,Tongji University, Shanghai, China
| | - Zixuan Zheng
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China.,Tongji University, Shanghai, China
| | - Liping Zhang
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Likun Hou
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Huixian Zhang
- Department of Medical Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ye Gu
- Department of Endoscopy Center, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Yayi He
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
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Iyoda A, Azuma Y, Sakai T, Koezuka S, Otsuka H, Tochigi N, Isobe K, Sano A. Intraoperative argon-plasma coagulation treatment for patients with malignant pleural mesothelioma. Mol Clin Oncol 2021; 15:188. [PMID: 34349988 PMCID: PMC8327076 DOI: 10.3892/mco.2021.2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/01/2021] [Indexed: 12/02/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is often associated with asbestos exposure and carries an extremely poor prognosis. The present study assessed the effectiveness of argon plasma coagulation (APC) treatment in patients with MPM who underwent radical pleural decortication (PD). The clinical data from 11 patients who underwent radical PD treated with APC at Toho University Omori Medical Center from July 2015 to March 2020 were retrospectively analyzed. Clinical features, local recurrence, and clinical prognoses were evaluated. The median overall survival was 18.5 months, and the 1- and 2-year overall survival rates were 71.6 and 43.0%, respectively. One patient survived 5 years but had recurrent tumors. The median disease-free survival was 11.1 months. The 1- and 2-year disease-free survival rates were 49.9 and 12.5%, respectively. Three patients had no recurrences, two of whom were followed continuously (39.6 and 10.2 months). The present study revealed that APC treatment for MPM might be associated with good survival and prognosis. APC as an additional intraoperative treatment for patients with MPM may be further investigated with larger multi-center clinical trials to support its efficacy.
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Affiliation(s)
- Akira Iyoda
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Yoko Azuma
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Takashi Sakai
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Satoshi Koezuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Hajime Otsuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Naobumi Tochigi
- Department of Surgical Pathology, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Kazutoshi Isobe
- Division of Respiratory Medicine, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Atsushi Sano
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
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Bawaadam H, Ivanick N, AlShelli I, Krishna G. Endobronchial Leiomyoma: A case report with cryoprobe extraction and review of literature. Respir Med Case Rep 2021; 33:101467. [PMID: 34401303 PMCID: PMC8349092 DOI: 10.1016/j.rmcr.2021.101467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/26/2021] [Accepted: 07/04/2021] [Indexed: 11/29/2022] Open
Abstract
Large airway tumors are uncommon, accounting for about 0.6% of all pulmonary tumors [[1], [2], [3]]. The majority of these tumors (80–90%) are malignant, represented primarily by squamous cell carcinoma and adenoid cystic carcinoma [2,4]. Benign central airway tumors are less common and are generally comprised of hamartomas and papillomas. Tracheobronchial leiomyomas are exceedingly rare, representing only about 0.6% of all benign lung neoplasms [3]. We report here on a case of primary endobronchial leiomyoma without uterine involvement treated successfully with cryoresection with excellent outcome.
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Affiliation(s)
- Hasnain Bawaadam
- Department of Medicine, Division of Pulmonary and Critical Care, University of California San Francisco, San Francisco, CA, USA
| | - Nathaniel Ivanick
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ihab AlShelli
- Department of Pulmonary Medicine, Cleveland Clinic, Weston, FL, USA
| | - Ganesh Krishna
- Department of Medicine, Division of Pulmonary and Critical Care, University of California San Francisco, San Francisco, CA, USA.,Department of Medicine, Division of Pulmonary and Critical Care, Palo Alto Medical Foundation, Palo Alto, CA, USA
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4
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Gao HX, Li Q, Chang WL, Zhang YL, Wang XZ, Zou XX. Carcinoma ex pleomorphic adenoma of the trachea: A case report. World J Clin Cases 2019; 7:2623-2629. [PMID: 31559302 PMCID: PMC6745320 DOI: 10.12998/wjcc.v7.i17.2623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/06/2019] [Accepted: 08/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Carcinoma ex pleomorphic adenoma (CXPA) is defined as a malignant salivary gland tumor arising from a primary or recurrent pleomorphic adenoma. Only three cases of CXPA of the trachea have been reported in the literature.
CASE SUMMARY We report a case of tracheal CXPA in a 55-year-old woman, who presented with a more than 3-mo history of progressive dyspnea. Computed tomography of the neck and thorax revealed an inhomogeneous, broad-based lesion arising from the tracheal wall on the right side. Endoscopy revealed a subglottic neoplasm causing up to 90% luminal stenosis. The tumor was resected using a high-frequency electrosurgical snare combined with argon plasma coagulation. Histopathology and immunohistochemistry revealed that the tumor was a CXPA of the trachea.
CONCLUSION We report the fourth case of tracheal CXPA, and present the first instance of resection of CXPA using high-frequency electrosurgical snare and laser ablation. We also discuss the pathogenesis, diagnosis, histopathology, and systemic therapy of this rare disease.
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Affiliation(s)
- Heng-Xing Gao
- Respiratory Department, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Quan Li
- Department of Radiology, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Wen-Li Chang
- Department of Pathology, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Ya-Long Zhang
- Department of Pathology, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Xiao-Zhi Wang
- Respiratory Department, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Xue-Xue Zou
- Department of Radiology, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
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Yarmus L, Mallow C, Akulian J, Lin CT, Ettinger D, Hales R, Voong KR, Lee H, Feller-Kopman D, Semaan R, Seward K, Wahidi MM. Prospective Multicentered Safety and Feasibility Pilot for Endobronchial Intratumoral Chemotherapy. Chest 2019; 156:562-570. [PMID: 30776363 PMCID: PMC6717117 DOI: 10.1016/j.chest.2019.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/19/2018] [Accepted: 02/01/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Malignant airway obstruction (MAO) occurs in 30% of patients with advanced-stage lung cancer, leading to debilitating dyspnea, cough, and hemoptysis. Other than recanalization of the airways, these patients lack long-lasting palliative therapy. The goal of this study was to determine the safety and feasibility of local injection of paclitaxel into the airway wall with a novel microinjection catheter. METHODS In this multicentered prospective trial, 23 patients with non-small cell lung cancer and MAO were enrolled from July 2014 through June 2016 to undergo rigid bronchoscopy with recanalization, followed by injection of 1.5 mg of paclitaxel with a novel injection catheter. Primary end points consisted of safety (adverse events, severe adverse events, and unanticipated adverse device effects) as well as feasibility (number of injections, injection success). Secondary end points consisted of airway patency improvement, quality of life metrics, and need for further interventions and/or stenting. RESULTS Nineteen patients underwent rigid bronchoscopy with successful recanalization and paclitaxel injection. There were no adverse events, severe adverse events, or unanticipated adverse device effects. There was an average of 3.4 injections given for a total dose of 1.5 mg of paclitaxel in all patients. There was significantly less stenosis postprocedure vs preprocedure (25%-50% vs 75%-90%; P < .001), which was unchanged at 6 weeks (25%-50%). None of the participants required further interventions or airway stenting. CONCLUSIONS The injection of paclitaxel after recanalization of MAO in patients with non-small cell lung cancer is safe and feasible, using a novel airway injection device. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT02066103; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Lonny Yarmus
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Christopher Mallow
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jason Akulian
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Cheng Ting Lin
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Ettinger
- Division of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Russell Hales
- Division of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kinh Ranh Voong
- Division of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hans Lee
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Feller-Kopman
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roy Semaan
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Momen M Wahidi
- Section of Interventional Pulmonology, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University, Durham, NC
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6
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Abstract
A 65-year-old man presented with obstructive pneumonia due to squamous cell carcinoma of the lung, which invaded the right main bronchus. Argon plasma coagulation was performed, which reduced his symptoms. Right pneumonectomy was performed after preoperative chemotherapy; the pathological diagnosis was T3N1M0 Stage IIIA. Fifteen months after surgery, he presented with bloody sputum. Bronchoscopy showed multiple endotracheal tumors, and a pathological examination revealed squamous cell carcinoma; the same histology as the primary lung cancer. We hypothesized that direct implantation during bronchoscopic therapy or hematogenous or lymphatic spread might have led to metastasis. A careful follow-up is required after bronchoscopic therapy.
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Affiliation(s)
- Kazuki Hayasaka
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Japan
| | - Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Japan
| | - Naoki Yanagawa
- Department of Pathology, Yamagata Prefectural Central Hospital, Japan
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7
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Successful Treatment of Carcinomatous Central Airway Obstruction with Bronchoscopic Electrocautery Using Hot Biopsy Forceps during Mechanical Ventilation. Case Rep Oncol Med 2017; 2017:5378583. [PMID: 28373918 PMCID: PMC5360962 DOI: 10.1155/2017/5378583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 03/02/2017] [Indexed: 12/02/2022] Open
Abstract
We report the case of a 72-year-old man with occlusion of the left main bronchus due to squamous cell carcinoma of the lung. He required tracheal intubation and mechanical ventilation because of the aggravation of atelectasis and obstructive pneumonia. Electrocautery using hot biopsy forceps was performed during mechanical ventilation with a 40% fraction of inspired oxygen. He was extubated following improvement in the atelectasis and obstructive pneumonia and discharged with shrinkage of the tumor after chemotherapy. We describe a safe electrocautery procedure using hot biopsy forceps during mechanical ventilation with reference to previous reports.
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8
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Vergnenègre C, Hureaux J, Morvant B, Urban T, Jeanfaivre T. Un adénome des glandes muqueuses bronchiques réséqué par voie endoscopique. Rev Mal Respir 2017; 34:253-256. [DOI: 10.1016/j.rmr.2016.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/01/2016] [Indexed: 10/19/2022]
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Guibert N, Mhanna L, Droneau S, Plat G, Didier A, Mazieres J, Hermant C. Techniques of endoscopic airway tumor treatment. J Thorac Dis 2016; 8:3343-3360. [PMID: 28066616 DOI: 10.21037/jtd.2016.11.49] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Interventional bronchoscopy has a predominant role in the management of both early and advanced-stage airway tumors. Given the very poor prognosis of lung cancer, there is a need for new tools to improve early detection and bronchoscopic treatment of endo-bronchial precancerous lesions. In more advanced stages, interventional bronchoscopy plays an important role, as nearly a third of lung cancers lead to proximal airway obstruction. This will cause great discomfort or even life-threatening symptoms related to local extension, such as dyspnea, post-obstructive pneumonia, and hemoptysis. Surgery for very locally advanced disease is only effective for a limited number of patients and the effects of conventional antitumor therapies, like radiation therapy or chemotherapy, are inconstant and are too delayed in a palliative context. In this review, we aim to provide pulmonologists with an exhaustive technical overview of (I) the bronchoscopic management of benign endobronchial lesions; (II) the bronchoscopic management of malignant tumors, including the curative treatment of localized lesions and palliative management of malignant proximal airway stenosis; and (III) descriptions of the emerging endoscopic techniques used to treat peripheral lung tumors.
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Affiliation(s)
- Nicolas Guibert
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Laurent Mhanna
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Sylvain Droneau
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Gavin Plat
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Alain Didier
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Julien Mazieres
- Pulmonology Department, Larrey University Hospital, Toulouse, France
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10
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Shu L, Hu Y, Wei R. Argon Plasma Coagulation Combined with a Flexible Electronic Bronchoscope for Treating Foreign Body Granulation Tissues in Children's Deep Bronchi: Nine Case Reports. J Laparoendosc Adv Surg Tech A 2016; 26:1039-1040. [PMID: 27788023 DOI: 10.1089/lap.2016.0388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Deep bronchial obstruction in children caused by foreign bodies is a medical emergency frequently accompanied by the formation of granulation tissue in the airway mucosa, which is resected during removal of the foreign body. Argon plasma coagulation (APC), initially developed to achieve hemostasis in gastrointestinal bleeding during endoscopic procedures, is also used for interventional bronchoscopic therapies of malignant airway tumors. In this pilot study, we describe successful alternative resections of granulation tissues during foreign body removal by flexible bronchoscopy through concomitant APC applications in 9 children aged from 16 months to 4 years old.
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Affiliation(s)
- Linhua Shu
- 1 Department of Respiration, Shanghai Children's Hospital, Shanghai Jiao Tong University , Shanghai, China
| | - Yijing Hu
- 1 Department of Respiration, Shanghai Children's Hospital, Shanghai Jiao Tong University , Shanghai, China
| | - Rong Wei
- 2 Department of Anesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University , Shanghai, China
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11
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Guibert N, Mazieres J, Marquette CH, Rouviere D, Didier A, Hermant C. Integration of interventional bronchoscopy in the management of lung cancer. Eur Respir Rev 2016; 24:378-91. [PMID: 26324799 DOI: 10.1183/16000617.00010014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Tracheal or bronchial proximal stenoses occur as complications in 20-30% of lung cancers, resulting in a dramatic alteration in quality of life and poor prognosis. Bronchoscopic management of these obstructions is based on what are known as "thermal" techniques for intraluminal stenosis and/or placement of tracheal or bronchial prostheses for extrinsic compressions, leading to rapid symptom palliation in the vast majority of patients. This invasive treatment should only be used in cases of symptomatic obstructions and in the presence of viable bronchial tree and downstream parenchyma. This review aims to clarify 1) the available methods for assessing the characteristics of stenoses before treatment, 2) the various techniques available including their preferred indications, outcomes and complications, and 3) the integration of interventional bronchoscopy in the multidisciplinary management of proximal bronchial cancers and its synergistic effects with the other specific treatments (surgery, radiotherapy or chemotherapy).
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Affiliation(s)
- Nicolas Guibert
- Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France
| | - Julien Mazieres
- Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France
| | - Charles-Hugo Marquette
- Hospital Pasteur and Institute for Research on Cancer and Ageing (IRCAN) (Inserm U10181/UMR CNRS 7284) University Nice Sophia Antipolis, Nice, France
| | - Damien Rouviere
- Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France
| | - Alain Didier
- Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France
| | - Christophe Hermant
- Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France
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12
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Usefulness of Rigid Bronchoscopic Intervention Using Argon Plasma Coagulation for Central Airway Tumors. Clin Exp Otorhinolaryngol 2015; 8:396-401. [PMID: 26622961 PMCID: PMC4661258 DOI: 10.3342/ceo.2015.8.4.396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/17/2014] [Accepted: 08/08/2014] [Indexed: 12/05/2022] Open
Abstract
Objectives Argon plasma coagulation (APC) is a noncontact form of electrocautery that utilizes ionized argon as the electrical current. A rigid bronchoscopic use of APC for the management of central airway obstruction could be safe and rapidly effective. This study evaluated the usefulness of rigid bronchoscopy with APC for the management of central airway obstructions due to benign or malignant tumors. Methods Twenty patients with obstructing central airway tumors were retrospectively reviewed from February 2008 to February 2013 at Chonnam National University Hospital. All patients received rigid bronchoscopic tumor removal under general anesthesia. APC was applied before and after tumor removal. Results The median age of patients was 59 years (interquartile range [IQR], 51 to 67 years) and 70% were female. The causes of airway obstruction included malignancy (n=8) and benign tumor (n=12). Airway tumors comprised intraluminal lesions (n=11, 55%) and mixed intraluminal/extraluminal lesions (n=9, 45%). The median tumor size was 15 mm (IQR, 10 to 18 mm). The median degree of airway obstruction was significantly reduced after intervention (90% [IQR, 88% to 96%] vs. 10% [IQR, 0% to 20%], P<0.001). The median American Thoracic Society dyspnea grade (3 [IQR, 1 to 4] vs. 1 [IQR, 0 to 1], P<0.001) and forced expiratory volume in one second (1.03 L [IQR, 0.52 to 1.36 L] vs. 1.98 L [IQR, 1.57 to 2.64 L], P=0.004) were significantly improved after intervention. There were no procedure-related acute complications and deaths. Conclusion Rigid bronchoscopy with APC is an effective and safe procedure to alleviate central airway obstruction caused by tumors.
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13
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Gupta P, Aggarwal R, Rijal P, Chugh K. Endobronchial leiomyoma in an immunocompetent four-year-old female child. Asian Cardiovasc Thorac Ann 2014; 22:356-8. [PMID: 24585919 DOI: 10.1177/0218492313478628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pulmonary leiomyoma are uncommonly encountered benign mesenchymal neoplasms in children, usually found in immunosuppressed individuals in association with human immunodeficiency virus or Ebstein-Barr virus infection. We describe an interesting case of a 4-year-old immunocompetent girl who presented with pleural effusion and lung collapse secondary to endobronchial leiomyoma. She underwent a left thoracotomy and a left pneumonectomy for excision of the bronchial mass.
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Affiliation(s)
- Pallav Gupta
- Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
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14
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Sato K, Takeyama Y, Kato T, Hashimoto H, Fukui Y, Gonda H, Suzuki R. Tracheal Adenoid Cystic Carcinoma Treated by Repeated Bronchoscopic Argon Plasma Coagulation as a Palliative Therapy. Ann Thorac Cardiovasc Surg 2014; 20 Suppl:602-5. [DOI: 10.5761/atcs.cr.12.02156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Bartosik W, Crowther S, Narski M, Fabre A. Video-assisted lobectomy for endobronchial leiomyoma. Interact Cardiovasc Thorac Surg 2010; 12:313-5. [PMID: 21123193 DOI: 10.1510/icvts.2010.255851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Endobronchial leiomyomas are rare tumours arising from the smooth muscle on the bronchial tree. We describe a patient with a six-month history of chest infections, who was treated surgically with a video-assisted thoracic surgery (VATS) lobectomy. The pathology revealed an endobronchial leiomyoma that coexisted with postobstructive pulmonary non-necrotising granulomas.
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Affiliation(s)
- Waldemar Bartosik
- Department of Thoracic Surgery, Saint Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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Caso clínico 2. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010. [DOI: 10.1016/s0873-2159(15)31258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kwon MH, Kang MI, Jeong JH, Won HK, Park HW, Park JH, Kim ST, Kwon SJ, Choi E, Na MJ, Cho HM, Kim YJ, Kim YM, Cho YJ, Son JW. Synchronous Roentgenographically Occult Lung Carcinoma Treated with Argon Plasma Coagulation in a Patient with Resectable Primary Lung Cancer. Tuberc Respir Dis (Seoul) 2008. [DOI: 10.4046/trd.2008.65.2.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mi-Hye Kwon
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Mi-Il Kang
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Ji-Hyun Jeong
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Hee-Kwan Won
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Hyun-Woong Park
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Jung-Ho Park
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Sung-Tae Kim
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Sun-Jung Kwon
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Eugene Choi
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Moon-Jun Na
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Hyun-Min Cho
- Department of Chest Surgery, Konyang University College of Medicine, Daejon, Korea
| | - Young-Jin Kim
- Department of Chest Surgery, Konyang University College of Medicine, Daejon, Korea
| | - Yoon-Mee Kim
- Department of Pathology, Konyang University College of Medicine, Daejon, Korea
| | - Young-Jun Cho
- Department of Diagnostic Radiology, Konyang University College of Medicine, Daejon, Korea
| | - Ji-Woong Son
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
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Abstract
BACKGROUND Tracheal tumors are uncommon, making up only 0.2% of all respiratory malignancies in the United States. One consequence of this low incidence is that few centers accumulate meaningful experience. Another is the lack of awareness of effective therapy. Bronchial gland tumors demonstrate oncologic diversity and include benign, low-grade, and high-grade malignant tumors. METHODS We reviewed the present knowledge of bronchial gland tumors of the trachea, carina, and bronchi, including the epidemiology, presentation, evaluation, tumor types, and treatment options. RESULTS The malignant bronchial gland tumors, adenoid cystic carcinoma and mucoepidermoid carcinoma, are far more common than benign mucinous cystadenoma or pleomorphic adenoma. Complete resection of localized tumors has excellent long-term results in symptomatic benign tumors. The disease-free survival after resection of malignant tumors is limited by distant metastasis and regional disease, while local recurrence is uncommon. Postoperative mediastinal radiation is now accepted adjuvant therapy. Experience at our institute demonstrates a significant survival advantage for patients with complete resection compared to unresectable patients. CONCLUSIONS Expanding knowledge of diagnostic evaluation and surgical therapy can improve the long-term survival of patients with tracheobronchial gland tumors.
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Colt HG, Crawford SW. In vitro study of the safety limits of bronchoscopic argon plasma coagulation in the presence of airway stents. Respirology 2007; 11:643-7. [PMID: 16916340 DOI: 10.1111/j.1440-1843.2006.00890.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE AND BACKGROUND The purpose of this study was to identify the safety limits of bronchoscopic argon plasma coagulation (APC) around indwelling airway stents. METHODOLOGY This is an experimental in vitro study simulating a patient-care environment. Uncovered and covered Nitinol (Ultraflex), uncovered and covered Wallstent and studded silicone stents were deployed in the tracheobronchial tree of a ventilated and oxygenated heart-lung block from an expired pig. APC was performed at power settings of 40 and 80 W using F(I)O(2) of 0.21, 0.40 and 1.00 and an argon gas-flow rate of 0.8 L/min through a flexible fiberoptic bronchoscope. The primary outcome was the time taken for the APC to cause stent damage. Stent damage was defined as discoloration, ignition or rupture. RESULTS Airway fires involving all five stents consistently occurred in the presence of 100% oxygen at powers of 40 W and 80 W. At lower F(I)O(2) (0.21 and 0.40) silicone stents were not damaged at 40 W and 80 W. Uncovered Ultraflex stents were undamaged using 40 W at either F(I)O(2) (0.21 and 0.40), but could be damaged using both F(I)O(2) levels when the power was increased to 80 W. Covered Ultraflex and both uncovered and covered Wallstents were damaged at both power settings (40 W and 80 W) and F(I)O(2) (0.21 and 0.40) levels, with a trend towards earlier damage using higher F(I)O(2) and power. CONCLUSION Working within the parameters identified in this study (power 40 W, F(I)O(2) 0.21, APC flow-rate 0.8 L/min), APC is a safe method for tissue devitalization and destruction and avoids the risk of airway stent ignition, especially if short bursts of APC are employed. The safety limits identified using an F(i)O(2) of 0.4, however, are also important because some patients undergoing resection may require oxygen therapy.
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Affiliation(s)
- Henri G Colt
- Pulmonary and Critical Care Medicine Division, University of California-Irvine Medical Center, 101 The City Drive South, Orange, CA 92868-3298, USA.
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Choi JC, Yu CM, Ryu YJ, Jeon K, Choi KA, Kwon OJ, Kim H. The role of endoscopic surgery for completely obstructive endobronchial benign tumor. Korean J Intern Med 2006; 21:15-9. [PMID: 16646559 PMCID: PMC3891058 DOI: 10.3904/kjim.2006.21.1.15] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The improving techniques of therapeutic bronchoscopy have been replacing conventional surgery for resecting endobronchial benign tumor. However, there could be some limitation for performing bronchoscopic intervention for the patients with complete bronchial obstruction. To evaluate the role of endoscopic surgery for completely obstructive endobronchial benign tumor, we retrospectively reviewed the medical records of 7 patients who underwent bronchoscopic resection due to completely obstructive benign tumor. METHODS Rigid bronchoscopy was performed under general anesthesia. After the stalk of tumor was identified with using a 1 mm biopsy forceps as a probe, a Nd-YAG laser was used to coagulate the stalk of tumor. The tumor was then removed. RESULTS Bronchoscopic resection was successful in 6 out of 7 patients. The histological diagnoses were 3 leiomyomas, 3 harmatomas and 1 lipoma. There was no mortality in our study. Pneumomediastinum developed in 1 patient, and this patient was treated with 3 days of oxygen therapy. In 5 out of the 6 successful patients, there was no recurrence for a median of 35 months. In 1 patient, leiomyoma recurred after 17 months, and this was treated by pneumonectomy. CONCLUSIONS Endoscopic surgery could be applied to the patients with completely obstructive endobronchial benign tumor.
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Affiliation(s)
- Jae-Chol Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang Min Yu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung A Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
Primary tumours of the trachea can be benign or malignant and account for fewer than 0.1% of tumours. However, they are a diagnostic and therapeutic challenge. Benign tumours are usually misdiagnosed as asthma or chronic lung disease, and can delay diagnosis for months or years. Because of their rapid growth and onset of haemoptysis, malignant tumours are often diagnosed earlier than benign tumours and patients thus often present with locally advanced disease. Inappropriate treatment is an equally frustrating issue. Modern techniques for tracheal surgery-laryngotracheal, tracheal, or carinal resection-combined with radiotherapy, can be offered curatively with low perioperative risks. Nevertheless, the low numbers of patients undergoing resection and the associated poor survival in epidemiological studies over the past two decades have shown that surgery is rarely considered outside referral centres, with radiotherapy or another form of local treatment (eg, endotracheal stents, debridement, brachytherapy) generally preferred. The liberal use of these other techniques should be avoided because surgery has the potential to cure all patients with benign and low-grade tumours and most patients with malignant primary tracheal tumours, and other techniques are usually palliative at best.
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Affiliation(s)
- Paolo Macchiarini
- Department of General Thoracic Surgery, Hospital Clinic of Barcelona, University of Barcelona, 170 Villaroel, E-30889 Barcelona.
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Abstract
Primary tracheal tumors often present with locally advanced tumors. A majority of patients can safely undergo tracheal, laryngotracheal, or carinal resection with low perioperative risk. Airway interventions at the time of diagnosis should be selected carefully to avoid a compromise of curative treatment. Precise judgment is required to determine resectability. The proximity of intrathoracic organs creates anatomical limits to en bloc resection and necessitates adjuvant radiotherapy in malignant tumors. Early referral for consideration of surgical resection might offer the best opportunity for improving the overall prognosis of tracheal tumors.
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Affiliation(s)
- Henning A Gaissert
- Division of Thoracic Surgery, Massachusetts General Hospital, Blake 1570, 55 Fruit Street, Boston, MA 02114, USA.
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Okada S, Ishimori S, Yamagata S, Satoh S, Yaegashi S, Tanaba Y. Placement of self-expandable metallic stents with a laryngeal mask and a fiberoptic flexible bronchoscope for obstructive tracheobronchial lesions. J Thorac Cardiovasc Surg 2002; 124:1032-4. [PMID: 12407393 DOI: 10.1067/mtc.2002.127005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Shinichiro Okada
- Department of Thoracic Surgery and Medicine, Kamaishi Municipal Hospital, Iwate, Japan.
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