Figures
- FIGURE 1
a and b) Computed tomography images of polypoid metastasis in the trachea of a patient with severe dyspnoea and haemoptysis. c) Tumour was removed by coring with rigid bronchoscope. d) Basis of the tumour was treated by argon plasma coagulation to stop bleeding and prevent recurrence.
- FIGURE 2
a) Atelectasis of the left lung as a consequence of combined (endobronchial/extramural compression) malignant stenosis of the left main bronchus. b) Atelectasis was resolved after stent placement and the patient improved enough to receive further multimodal treatment.
- FIGURE 3
Patient with severe central airway stenosis due to extramural tumour compression. a) Computed tomography image in which stenosis of trachea and right main bronchus is evident. b) Flow–volume loop before stent placement. c) Flow–volume loop after stent placement. d) Stent in the trachea several months later after successful chemoradiotherapy with almost complete remission. e) Removed stent. f) Trachea after stent removal is fully patent.
- FIGURE 4
Cryotherapy is effective for additional treatment of the basis of removed polypoid tumours or minor lesions in the central airways. Its effect extends deeply, with a low risk of perforation.
- FIGURE 5
Early squamous cell carcinoma in the central airways (arrows), discovered accidentally.
Tables
- TABLE 1
Comparison of treatment modalities regarding tumour location and time of therapy effect
Immediate effect Delayed effect Endoluminal tumour Laser
Electrocautery/APC
Cryoextraction
Mechanical debulkingCryotherapy
Photodynamic therapy
Brachytherapy
External irradiationExtraluminal compression Dilatation and stent placement External irradiation APC: argon plasma coagulation.
- TABLE 2
Summary of different treatment modalities, their specific roles and their aims of treatment
Treatment modality Indications/specific role Aim of treatment Indication for life-threatening situations Laser Debulking in endobronchial tumours Debulking and relief of airway obstruction with immediate effect Yes Electrocautery Debulking in endobronchial tumours Debulking and relief of airway obstruction with immediate effect Yes APC Debulking in endobronchial tumours Debulking and relief of airway obstruction with immediate effect Yes Cryoextraction/cryotherapy Debulking in endobronchial tumours Debulking and relief airway obstruction with immediate effect Yes Mechanical debulking Debulking in endobronchial tumours Debulking and relief of airway obstruction with immediate effect Yes Balloon dilatation Extraluminal compression Relief of airway obstruction with immediate effect Yes Stent Extraluminal compression Relief of airway obstruction with immediate effect Yes Photodynamic therapy Endobronchial treatment in inoperable lung cancer Local disease control No Brachytherapy Treatment in early invasive mucosal or submucosal NSCLC in nonsurgical candidates
Locally advanced centrally located lung cancer
Endobronchial boost to full-course external beam radiation therapy with incomplete response/recurrenceLocal disease control No MWA Preparation for the debulking of endobronchial tumours Relief of airway obstruction with immediate effect in combination with mechanical debulking Yes Intratumoural therapy Administration of cytotoxic agents within the tumours with EBUS Local disease control No APC: argon plasma coagulation; MWA: microwave ablation; NSCLC: nonsmall cell lung cancer; EBUS: endobronchial ultrasound.
