COMBINED ENDOBRONCHIAL AND CONVENTIONAL T HERAPY OF INOPERABLE CENTRAL LUNG-CANCER

Up to 85% of patients with bronchogenic carcinoma are inoperable at th e time of diagnosis and treatment remains largely palliative. Prognosi s depends on the clinical tumor stage. In non-small cell carcinoma the clinical stages (I-IV) are defined according to the TNM classificatio n, whereas in small cell carcinoma limited disease is distinguished fr om extensive disease. Neither classification accurately takes endobron chial tumor spread into account. At the time of diagnosis up to 30% of all lung cancer patients present with central airway obstruction and clinical signs of dyspnea, atelectasis and pneumonia. Most patients wi th central airway stenosis have inoperable tumors (stage IIIb and IV) and have until recently undergone conventional treatment consisting ex clusively of chemo- and radiotherapy. Currently the best results are o btained with combined chemoradiotherapy. The rapid developments in the area of endobronchial treatment modalities enable us to relieve bronc hial obstructions fast and safely. This achieves immediate symptomatic relief which in many cases is a precondition for starting chemo- or r adiotherapy. Successful reopening of a major airway helps to prolong l ocal tumor control and thus survival. Patients with inoperable lung ca ncer and obstruction of central airways should undergo initial endobro nchial therapy followed by conventional chemo-radiotherapy.