• Title/Summary/Keyword: Malignant Airway Obstruction

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Cryosurgery for Malignant Endobronchial Tumor (악성 기관-기관지 종양에 대한 냉동 수술법)

  • Cho, Jong Ho;Kim, Kwang Taik;Lee, Sung Ho
    • Korean Journal of Bronchoesophagology
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    • v.18 no.1
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    • pp.5-8
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    • 2012
  • Cryosurgery is a safe method for palliation of endobronchial malignancies causing airway obstruction. Due to its simplicity and effectiveness for controlling bleeding, endobronchial cryosurgery is considered to be a good method that is clinically applicable to a malignant endobronchial tumor. In cases with stenosis caused by an endoluminal tumor, cryo-recanalization with a cryoprobe was immediately effective in most of the patients. A novel technique described by Hetzel in 2004 to achieve rapid recanalization of central airway obstruction with endobronchial cryoprobe. Cryorecanalization technique is feasible and offers many advantages in the interventional therapy of malignant intraluminal tumors of the respiratory tract.

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Bronchoscopic Cryotherapy in Patients with Central Airway Obstruction (기관지 내시경적 냉동치료를 통한 중심성 기도폐쇄의 치료)

  • Lyu, Ji-Won;Song, Jin-Woo;Hong, Sang-Bum;Oh, Yeon-Mok;Shim, Tae-Sun;Lim, Chae-Man;Lee, Sang-Do;Koh, Youn-Suck;Kim, Woo-Sung;Kim, Dong-Soon;Choi, Chang-Min
    • Tuberculosis and Respiratory Diseases
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    • v.68 no.1
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    • pp.6-9
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    • 2010
  • Background: The efficacious use of interventional bronchoscope for patients with central airway obstruction due to malignant or benign lesions has been proven. Among many therapeutic bronchoscopic procedures, endobronchial cryotherapy is an established recanalization method for the obstruction of the respiratory tract. Recently, the use of this procedure has been increasing in Korea. However, limited data are available in the literature regarding its efficacy in Korea. Methods: Thirty patients, who had been treated with a flexible cryoprobe for cryotherapy were enrolled; clinical characteristics and treatment outcomes were analyzed. The patients had been treated with the technique using nitrous oxide as a cryogen under local anesthesia. Objective outcomes were 3 different degrees of therapeutic success by use of follow-up bronchoscopic findings as follows: successful, partially successful, and unsuccessful response. Subjective outcomes were evaluated as an improvement in symptoms. Results: The mean age of enrolled patients was $59{\pm}11$ years and there was a male (22/30) dominance. Twenty-three patients had malignant tumor and 7 patients had benign lesions with central airway obstruction. Successful recanalization was achieved in 11 (37%) patients, and partially successful response was achieved in 15 (50%) patients. Dyspnea was improved in 84.2% (16/19) of patients. At least one respiratory symptom was resolved in 91.3% (21/23) patients. Seven patients (23.3%) needed additional bronchoscopic electrocautery because of the bleeding as a complication of cryotherapy. Conclusion: Endobronchial cryotherapy is an effective and less expensive procedure for the management of central airway obstruction. However, the procedure should be performed under the preparing for an emergency situation, such as massive bleeding.

Endobronchial Brachytherapy for Malignant Airway Obstruction: Low Dose Rate Versus High Dose Rate (악성 종양에 의한 기도폐쇄시 내기관지 근접치료 : 저선량 치료 대 고선량 치료의 비교)

  • Cho, Young-Kap
    • Radiation Oncology Journal
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    • v.14 no.2
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    • pp.123-128
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    • 1996
  • Purpose : This is a retrospective study to compare the Palliation rates, survival rates and complications of low dose rate and high dose rate endobronchial brachytherapy in the management of malignant airway obstruction. Materials and methods : Forty three consecutive patients with malignant airway compromise from primary or metastatic lung tumors were treated with low dose rate(LDR) endobronchial Iridium-192 insertion(21 patients) between October 1988 and June 1992, and high dose rate(HDR) endobronchial brachytherapy(22 patients) between August 1992 and April 1994 with palliative aim Flexible fiberoptic bronchoscopy under fluoroscopic control was utilized in all 91 procedures. Twenty seven LDR Procedures delivered a dose of 5-7.5 Gy to a 1.0 cm radius respectively. Results : Subjective and objective responses to treatments were evaluated on follow-up examinations by clinical examination, chest x-rays and CT scan of the chest on some patients. Fifteen of 21 LDR patients and 19 of 22 HDR Patients showed subjective improvement in terms of better breathing and less Productive cough as well as complete disappearance of hemoptysis. Objective improvement on chest x-rays and CT scan of the chest had been demonstrated on 8 LDR Patients and 10 HDR patients. Conclusion : The technique of LDR and HDR endobronchial brachytherapy is simple and well tolerated procedure with minimal morbidity It Provides excellent palliation by keeping airway Patent in these short life-spanned patients.

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Airway Stenting in Tracheobronchial Diseases : Silastic stenting (기도질환에서 실리콘 기도스텐트 치료)

  • Kim, Ho-Joong
    • Korean Journal of Bronchoesophagology
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    • v.10 no.2
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    • pp.5-8
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    • 2004
  • Stenosing airway disease is classified as intraluminal obstruction, extrinsic compression, and malacia by the anatomical site of the lesion. Stenting therapy is indicated for symptomatic relief of life-threatening dyspnea caused by the last two types. Airway stents are made with metal mesh and/or silicone rubber, and currently more than 20 kinds of stent are available. Among many kinds of silicone stent, the Dumon stent is mostly widely used for benign and malignant airway stenoses, but general anesthesia and rigid bronchoscopy are needed for insertion. It can be removed when the stenosing airway disease subsides completely. In many clinical studies, most patients $(85-90\%)$ improved immediately after stenting, and procedure-related mortality was low $(<3\%)$ in experienced centers. Stent displacement, mucus impaction, and granulation tissue formation are potential complications. Stenting is one of many effective therapeutic modalities for stenosing central airway disease. Careful patient selection, experiences, and continuous development of new technology will bring better results.

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Two cases of femorofemoral cardiopulmonary bypass prior to induction of anaesthesia in the management of tracheal obstruction by thyroid cancer (기도 폐쇄로 인한 삽관불능이 갑상선 암환자엣 심장폐우회 마취에 의한 치험 2예)

  • 왕수건;김기태;이병주;권재영;김영대;이강대
    • Korean Journal of Bronchoesophagology
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    • v.9 no.1
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    • pp.101-104
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    • 2003
  • One of major problem in endotracheal intubation for general anesthesia is intrathoracic tracheal obstruction induced by tumor such as, intrathoracic goiter and malignant lymphoma etc. Small amount of secretion or hemorrhage and mild tracheal edema may cause aggravation of tracheal obstruction during endotracheal intubation. Also, it is too difficult to perform the emergency tracheostomy in middle tracheal obstruction. We tried to perform femorofemoral cardiopulmonary bypass without endotracheal intubation for induction of general anesthesia in case of middle tracheal obstruction and We reported with review of literature.

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Clinical Experience of Rigid Bronchoscopy in Single Center

  • Kim, Hyun-Jin;Kim, Sei-Won;Lee, Hye-Yeon;Kang, Hyeon-Hui;Kang, Ji-Young;Kim, Ju-Sang;Kim, Myung-Sook;Kim, Seung-Soo;Kim, Jin-Woo;Yun, Hyeong-Gyu;Kim, Chi-Hong;Kim, Kwan-Hyoung;Moon, Hwa-Sik;Cho, Kwang-Jae;Moon, Seok-Hwan;Lee, Sang-Haak
    • Tuberculosis and Respiratory Diseases
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    • v.72 no.6
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    • pp.486-492
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    • 2012
  • Background: The aim of this study was to analyze clinical situations requiring rigid bronchoscopy and evaluate usefulness of rigid bronchoscopic intervention in benign or malignant airway disorders. Methods: We retrospectively reviewed 29 patients who underwent rigid bronchoscopy from November 2007 to February 2011 at St. Paul's Hospital, The Catholic University of Korea School of Medicine. Results: Of the 29 patients, the most frequent underlying etiology was benign stenosis of trachea (n=20). Of those 20 patients, 16 had post-intubation tracheal stenosis (PITS), 2 had tracheal stenosis due to inhalation burn (IBTS) and other 2 had obstructive fibrinous tracheal pseudomembrane (OFTP). Other etiologies were airway malignancy (n=6), endobronchial stenosis due to tuberculosis (n=2), and foreign body (n=1). For treatment, silicone stent insertion was done in 16 cases of PITS and IBTS and mechanical removal was performed in 2 cases of OFTP. In 6 cases of malignant airway obstruction mechanical debulking was performed and silicone stents were inserted additionally in 2 cases. Balloon dilatation and electrocautery were used in 2 cases of endobronchial stenosis due to tuberculosis. In all cases of stent, airway obstructive symptom improved immediately. Granulation tissue formation was the most common complication. Conclusion: Tracheal stenosis was most common indication and silicone stenting was most common procedure of rigid bronchoscopy in our center. Rigid bronchoscopic procedures, at least tracheal silicone stenting, should be included in pulmonary medicine fellowship programs because it is a very effective and indispensable method to relieve critical airway obstruction which needs training to learn.

Serious Complications after Self-expandable Metallic Stent Insertion in a Patient with Malignant Lymphoma

  • Cho, Sung Bae;Cha, Seon Ah;Choi, Joon Young;Lee, Jong Min;Kang, Hyeon Hui;Moon, Hwa Sik;Kim, Sei Won;Yeo, Chang Dong;Lee, Sang Haak
    • Tuberculosis and Respiratory Diseases
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    • v.78 no.1
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    • pp.31-35
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    • 2015
  • An 18-year-old woman was evaluated for a chronic productive cough and dyspnea. She was subsequently diagnosed with mediastinal non-Hodgkin lymphoma (NHL). A covered self-expandable metallic stent (SEMS) was implanted to relieve narrowing in for both main bronchi. The NHL went into complete remission after six chemotherapy cycles, but atelectasis developed in the left lower lobe 18 months after SEMS insertion. The left main bronchus was completely occluded by granulation tissue. However, the right main bronchus and intermedius bronchus were patent. Granulation tissue was observed adjacent to the SEMS. The granulation tissue and the SEMS were excised, and a silicone stent was successfully implanted using a rigid bronchoscope. SEMS is advantageous owing to its easy implantation, but there are considerable potential complications such as severe reactive granulation, stent rupture, and ventilation failure in serious cases. Therefore, SEMS should be avoided whenever possible in patients with benign airway disease. This case highlights that SEMS implantation should be avoided even in malignant airway obstruction cases if the underlying malignancy is curable.

A Case of Liposarcoma of Hypopharynx (하인두에 발생한 지방육종 1예)

  • Kim, Yong-Hyun;Nam, Sang-Won;Min, Soo-Kee;Park, Bum-Jung
    • Korean Journal of Head & Neck Oncology
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    • v.27 no.2
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    • pp.237-239
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    • 2011
  • Liposarcoma is the second most common sarcoma of the adult life, next to malignant fibrous histiocytoma. Liposarcoma in larynx and hypopharynx is extremely rare. The symptoms are variable, but it has a clinical importance because they can cause unpredictable airway obstruction, particularly during the induction of general anesthesia. A 79-year-old male patient was referred to our department for mild airway obstruction and throat discomfort. Neck CT scan showed a mass within both postcricoid area and pyriform sinus. The mass was removed via laryngeal microsurgery. In this article, we report a case of liposarcoma of the posterior wall of hypopharynx with a review of the related literature.

Short-term Results of Endobronchial Brachytherapy for Malignant Airway Obstructions (악성 기도 폐쇄에 대한 기관내 근접 조사 방사선치료의 단기 임상 경험)

  • Ahn Yong Chan;Lim Do Hoon;Choi Dong Rak;Kim Moon Kyung;Kim Dae Yong;Huh Seung Jae;Kim Ho Joong;Chung Man Pyo;Kwon O Jung;Rhee Chong Heon
    • Radiation Oncology Journal
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    • v.14 no.4
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    • pp.299-306
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    • 1996
  • Purpose : Respiratory symptoms related with malignant airway disease have been the main causes of lowered qualify of life and also sometimes may be life-threatening if not properly managed. The authors report the short-term experiences of endobronchial brachytherapy for symptomatic malignant airway obstruction using high dose rate after-loading brachytherapy unit. Materials and Methdos : Twenty-five Patients with symptomatic malignant airway obstruction were treated with endobronchial brachytherapy between the period of December 1994 and March 1996 at Department of Radiation Oncology of Samsung Medical Center Twenty-one ($84\%$) were patients with non-small cell lung cancer, three with tracheal malignancies, and one with recurrence of esophageal cancer. Twenty Patients were given elective external beam radiation therapy, while six were given endobronchial laser evaporation therapy on emergency bases in addition to endobronchial brachytherapy. Three procedures for each patient were planned and total of 70 procedures were completed. Results : Improvement rates of major respiratory symptoms after endobronchial brachytherapy procedures were $88\%$(22/25). $96\%$(22/23), $100\%$ (15/15), and $100\%$(9/9) for cough, dyspnea, hemoptysis and obstructive pneumonia, respectively. ECOG performance scores were improved in $56\%$ of total patients group, while there was no case with worsened ECOG score. Fifteen patients died and the median interval from the start of treatment to death was 4 months (range: $1\~17$ months), while that of ten survivors was 9 months (range $5\~19$ months). There were five patients with controlled intrathoracic disease, who have survived over one rear. All deaths were associated with uncontrolled local and/or distant disease. Four Patients died of massive fatal hemoptysis, three of who received emergency endobronchial laser evaporation therapy before the start of endobronchial brachytherapy. Conclusion : Endobronchial brachytherapy has been confirmed as an excellent palliative treatment modality improving respiratory symptoms as well as patients' general performance status. Based on the current observations, use of endobronchial brachytherapy in curative setting as a boost technique may be warranted.

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A Case of Primary Malignant Lymphoma of Trachea (기관에서 발현된 악성 림프종 1례)

  • Kim, Hyung-Woo;Sun, Hui-Kyoung;Jin, Seong-Lim;Kim, Joon-Hee;Yum, Ho-Kee;Kim, Re-Hwe
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.5
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    • pp.1067-1072
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    • 1998
  • Primary malignant tumor of trachea is rare and often extensive at presentation, and frequently causes life-threatening airway obstruction. Primary extranodal lymphomas comprise about 10% of all malignant lymphomas. However, the primary malignant lymphoma of trachea is extremely rare. We presented here a case of 62-year-old male, was diagnosed as a primary extranodal lymphoma arising in the trachea with review of literature.

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