The treatment of malignant endobronchial obstruction with laser ablation.
BACKGROUND
We compared a new endoscopic treatment for malignant endobronchial obstruction known as photodynamic therapy (PDT) with the more established 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 obstruction by thermal laser vaporization (Nd:YAG) or by PDT using the tunable dye laser in combination with a light-sensitive dye (PDT). The Nd:YAG procedure vaporized the obstructing neoplasm, whereas the PDT procedure photoablated the 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 treatment with the Nd:YAG laser and 19 patients received treatment with PDT. Morbidity rates were comparable in both groups (22% for Nd:YAG vs 31% for PDT; P > .05). Equally common complications in both groups were respiratory failure and hypoxemia. Five Nd:YAG patients (6%) died within 30 days after treatment (3 of respiratory failure, 2 of massive hemoptysis), whereas 2 patients (10%) in the PDT group (1 of massive hemoptysis, 1 of acute myocardial 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 treatment of malignant bronchial obstruction because it is technically easier, potentially safer, and does not require general anesthesia.
Taber
S W
SW
Department of Surgery, University of Louisville School of Medicine, KY 40292, USA.
Buschemeyer
W C
WC
Fingar
V H
VH
Wieman
T J
TJ
D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology; D018287:Carcinoma, Large Cell / Q000150:complications / Q000601:surgery; D018288:Carcinoma, Small Cell / Q000150:complications / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000601:surgery*; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000473:pathology; D006258:Head and Neck Neoplasms / Q000473:pathology; D006801:Humans; D053685:Laser Therapy; D008175:Lung Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery*; D008223:Lymphoma; D009382:Neoplasms, Unknown Primary / Q000473:pathology; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies