The treatment of malignant endobronchial obstruction with laser ablation

Background. We compared a new endoscopic treatment for malignant endobronch ial obstruction known as photodynamic therapy (PDT) with the more establish ed therapy of neodymium: yttrium-aluminum garnet laser (Nd:YAG) therapy. Methods. A retrospective review was conducted of the medical records at our institution from 1988 to 1999 of patients treated for bronchial obstructio n by thermal laser vaporization (Nd:YAG) or by PDT using the tunable dye la ser in combination with a light-sensitive dye (PDT). The Nd:YAG procedure v aporized the obstructing neoplasm, whereas the PDT procedure photoablated t he obstruction. Thirty-day mortality and morbidity rates were analyzed for both treatment groups using chi-square analysis. Results. Of the 102 patients who were suitable for review, 83 received trea tment with the Nd:YAG laser and 19 patients received treatment with PDT. Mo rbidity rates were comparable in both groups (22 % for Nd:YAG vs 31 % for P DT; P >.05). Equally common complications in both groups were respiratory f ailure and hypoxemia. Five Nd:YAG patients (6 %) died within 30 days after treatment (3 of respiratory failure, 2 of massive hemoptysis), whereas 2 pa tients (10 %) in the PDT group (1 of massive hemoptysis, 1 of acute myocard ial infarction) died (P >.05). Conclusions, PDT and Nd:YAG have similar mortality and morbidity rates. In our experience, PDT is a better choice for the tr treatment of malignant br onchial obstruction because it is technically easier potentially safer, and does not require general anesthesia.