INTERVENTIONAL BRONCHOLOGY IN PALLIATION OF CENTRAL BRONCHIAL-CARCINOMA

Despite all efforts the 5-year survival rate of bronchial carcinomas r emains below 10%. Palliation for improvement of life quality is a dail y challenge in a chest hospital. Besides radiation and chemotherapy., interventional bronchological measures gain importance as palliative m easures. Forceps removal and endoscopical kryosurgery of tumor tissue have been replaced by ND-YAG lasertherapy. While thermal laser ablatio n is restricted to intraluminal tumors, brachytherapy (afterloading) i s able to destroy tumor cells in and around the bronchial wall. Photod ynamic therapy (PDT) with hematoporphyrins and dye-lasers is indicated for early cancer and flat and spreading tumors. Whether PDT is superi or to thermal laser treatment of exophytic neoplasms remains to be ans wered. From its theoretical concept this is the most promising form of therapy because complete tumor eradication might be possible. Extrabr onchial compression of the airways by tumor or lymph nodes can be prev ented by stent implantation. Advantages and disadvantages of a variety of silicone and expandable stents are discussed. Based on our experie nce with 2000 palliative treatments, we present a flow chart with our decision structure and the techniques with examples.