Endobronchial Management of Advanced Lung Cancer
Endobronchial Management of Advanced Lung Cancer
Patients with lung cancer often have bulky endobronchial disease, endobronchial extension, or airway compression. Many endobronchial treatment modalities are available to supplement traditional therapies for advanced lung cancer.
The author reviews the use of several endobronchial treatment modalities that can augment standard antitumor therapies for advanced lung cancer, including rigid and flexible bronchoscopy, laser therapy, endobronchial prosthesis, and photodynamic therapy.
Since the early 1980s, technical advances in interventional techniques have enhanced symptom-free survival and quality of life for patients with lung cancer. Although interventional procedures are not definitive therapies, they often relieve the strangling sensation produced by airway occlusion.
Endobronchial interventions are important adjuncts in the multimodality management of lung cancer and should become standard considerations in the management of patients with advanced lung cancer. For patients with respiratory symptoms associated with their disease, these interventions provide symptom palliation and improved quality of life.
Most of the estimated 169,500 new cases of lung cancer diagnosed in the United States in the year 2001 will be in an advanced stage. More than 50% of these patients will have involvement of the central airways. This can be in the form of bulky endobronchial disease,endobronchial extension, or extrinsic compression of the airways by the tumor or by lymph adenopathy. Many of these patients have respiratory symptoms due to their disease. Shortness of breath, hemoptysis, and cough are often the complaints that bring patients to a physician and to the complex treatment programs currently used for the management of lung cancer. Some of these patients may benefit from endobronchial intervention as part of the management of their disease.
Standard management techniques of lung cancer -- surgery, radiation therapy, and chemotherapy -- measure treatment response, 5-year survival, and recurrence rates. When treating endobronchial disease,the concepts of symptom-free survival, dyspnea indices, and quality-of-life scores also need to be evaluated.Some patients become incapacitated by their symptoms of dyspnea. Many studies not only demonstrate improvement in clinical symptoms and quality of life, but also suggest increased overall survival with the use of endobronchial management techniques.
Not all endobronchial disease causes complete obstruction of the airways. Sometimes patients have partial obstruction, which often has a less severe symptom complex. As these patients enter treatment programs,the endobronchial component of their disease,in response to these treatments, can lead to more complicated concerns. External-beam radiotherapy can induce endobronchial inflammation and swelling, further compromising the airways. Radiation or chemotherapy can lead to necrosis of the endobronchial component of the cancer. The inflammation and necrotic tissue can cause further airway compromise by inducing airway obstruction, lung collapse, and possible postobstructive pneumonia. Therefore, endobronchial techniques should be considered throughout the management of lung cancer patients.
Lastly, when all management options have been used, end-stage patients will often develop compromise of their airways as the cancer continues to progress.Endobronchial management options may help to relieve some of their symptoms, allowing them freedom from shortness of breath as they go home in conjunction with hospice or other palliative therapies.
Most endobronchial techniques are performed on an outpatient basis. Unless a patient presents with respiratory failure,many of the procedures performed provide immediate relief of symptoms. This rapid symptomatic improvement allows patients to return home with an improved quality of life or better prepares them to continue treatment at their local programs.Although interventional procedures are not definitive therapies,they often provide partial to total relief of the strangling sensation produced by complete airway occlusion.
Interventional pulmonary programs that include endobronchial procedures need an armamentarium of therapeutic modalities rather than a single invasive approach to manage patients with complicated lung cancer. As each patient's anatomy differs,the manner in which the patient's cancer leads to symptoms varies.Several procedures used in conjunction (eg, laser and stenting) may be necessary to provide the most efficacious management of the disease. Offering a multitude of modalities allows the best selection of approaches for the patient.
The following sections discuss a variety of techniques and tools available to the interventionalist. In many cases, no one technique is better than the others,and some combination of these techniques often offers the greatest benefit to the patient.
Patients with lung cancer often have bulky endobronchial disease, endobronchial extension, or airway compression. Many endobronchial treatment modalities are available to supplement traditional therapies for advanced lung cancer.
The author reviews the use of several endobronchial treatment modalities that can augment standard antitumor therapies for advanced lung cancer, including rigid and flexible bronchoscopy, laser therapy, endobronchial prosthesis, and photodynamic therapy.
Since the early 1980s, technical advances in interventional techniques have enhanced symptom-free survival and quality of life for patients with lung cancer. Although interventional procedures are not definitive therapies, they often relieve the strangling sensation produced by airway occlusion.
Endobronchial interventions are important adjuncts in the multimodality management of lung cancer and should become standard considerations in the management of patients with advanced lung cancer. For patients with respiratory symptoms associated with their disease, these interventions provide symptom palliation and improved quality of life.
Most of the estimated 169,500 new cases of lung cancer diagnosed in the United States in the year 2001 will be in an advanced stage. More than 50% of these patients will have involvement of the central airways. This can be in the form of bulky endobronchial disease,endobronchial extension, or extrinsic compression of the airways by the tumor or by lymph adenopathy. Many of these patients have respiratory symptoms due to their disease. Shortness of breath, hemoptysis, and cough are often the complaints that bring patients to a physician and to the complex treatment programs currently used for the management of lung cancer. Some of these patients may benefit from endobronchial intervention as part of the management of their disease.
Standard management techniques of lung cancer -- surgery, radiation therapy, and chemotherapy -- measure treatment response, 5-year survival, and recurrence rates. When treating endobronchial disease,the concepts of symptom-free survival, dyspnea indices, and quality-of-life scores also need to be evaluated.Some patients become incapacitated by their symptoms of dyspnea. Many studies not only demonstrate improvement in clinical symptoms and quality of life, but also suggest increased overall survival with the use of endobronchial management techniques.
Not all endobronchial disease causes complete obstruction of the airways. Sometimes patients have partial obstruction, which often has a less severe symptom complex. As these patients enter treatment programs,the endobronchial component of their disease,in response to these treatments, can lead to more complicated concerns. External-beam radiotherapy can induce endobronchial inflammation and swelling, further compromising the airways. Radiation or chemotherapy can lead to necrosis of the endobronchial component of the cancer. The inflammation and necrotic tissue can cause further airway compromise by inducing airway obstruction, lung collapse, and possible postobstructive pneumonia. Therefore, endobronchial techniques should be considered throughout the management of lung cancer patients.
Lastly, when all management options have been used, end-stage patients will often develop compromise of their airways as the cancer continues to progress.Endobronchial management options may help to relieve some of their symptoms, allowing them freedom from shortness of breath as they go home in conjunction with hospice or other palliative therapies.
Most endobronchial techniques are performed on an outpatient basis. Unless a patient presents with respiratory failure,many of the procedures performed provide immediate relief of symptoms. This rapid symptomatic improvement allows patients to return home with an improved quality of life or better prepares them to continue treatment at their local programs.Although interventional procedures are not definitive therapies,they often provide partial to total relief of the strangling sensation produced by complete airway occlusion.
Interventional pulmonary programs that include endobronchial procedures need an armamentarium of therapeutic modalities rather than a single invasive approach to manage patients with complicated lung cancer. As each patient's anatomy differs,the manner in which the patient's cancer leads to symptoms varies.Several procedures used in conjunction (eg, laser and stenting) may be necessary to provide the most efficacious management of the disease. Offering a multitude of modalities allows the best selection of approaches for the patient.
The following sections discuss a variety of techniques and tools available to the interventionalist. In many cases, no one technique is better than the others,and some combination of these techniques often offers the greatest benefit to the patient.
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