E-78.New bronchoscopic interventions

s91

E-78. New BronchoscopicInterventions Tom G. Sutedja Dept.

of Pulmonology

Vrije

Vniveristeit

Technical advancementshave provided the bronchoscopist with several therapeutic alternatives for immediate palliation in case of central airway obstruction: stent placement for extraluminal airway compressionand various intraluminal bronchoscopic techniques (IBT) for tumor debulking using Nd-YAG laser, electrocautery and argon plasma coagulation. In non-emergency cases, cryotherapy, brachytherapy and photodynamic therapy (PDT) are alternatives. The low morbidity and efficacy of bronchoscopic techniques have led to its application in treating early stage cancer in individuals consideredto be high-risk surgical candidates.Stage shift, i.e. finding and treating early stage lung cancer at the No stage, may improve the dismal cure rate of lung cancer patients. IBT may be considered as an alternative for surgical resection, provided accurate tumor staging is possible. Early stage cancer with deeper tumor infiltration in the bronchial wall and nodal disease cannot be cured by IBT alone. Accurate staging, using autofluorescencebronchoscopy,endobronchial ultrasound, high-resolution computer tomography and positron emission tomography have been reported and IBT is only appropriate when cancer is found

Medical

Centel;

Amsterdam,

Netherlands

at the carcinoma in situ or microinvasivestage. Long term follow up data showed that an initial IBT approach prior to surgery can be justified in carefully selectedcases.This is important as many individuals at risk also suffer from COPD and cardiovascular diseases due to smoking. So, new bronchoscopic intervention techniques can provide immediate palliation and may be applied for early intervention of cancer located in the central airways. These techniques are obviously less morbid due to its minimal invasivenature and therefore preservequality of life. Key references [l]

Bronchoscopic Treatment of Lung Tumors. Sutedja et al. Lung Cancer 1994;11:1-7 [2] ERS/ATS Statement on Interventional F’ulmonology. European Respiratory Society/American Thoracic Society. Bolliger et al. Eur Resp 3 2002;19:356313 [3] New Techniques

for Early Detection 2003;21:578-665: [4] Treatment of Early Stage Non-small 2002;123:176.%1805

of Lung Cancer. Sutedja G. Eur Resp J Cell Lung Cancer. Mathur

et al. Chest