title: Interventional bronchoscopy in the treatment of tracheal obstruction secondary to advanced thyroid cancer.
abstract: BACKGROUND
  Surgery is the choice treatment for symptomatic tracheal obstruction due to malignant thyroid disease. Few additional therapeutic alternatives are available: radiotherapy (RT), chemotherapy (CT) or radioiodine therapy (1311). Only few studies on interventional bronchoscopy (IB) as well as alternative or palliative procedures have been reported so far. This study is a retrospective report of results of IB performed in patients with severe tracheal obstruction due to advanced thyroid cancer.
  
  
  METHODS
  Pulmonary and Endocrinology Units of a University Hospital.
  
  
  METHODS
  From January 2, 2000 to March 1, 2004 14 consecutive patients [5 males, mean age: 62.2+/-10.7 (SD) yr] underwent IB due to tracheal obstruction for anaplastic (ATC: 7 patients), differentiated (DTC: 5), medullary (MTC: 1) and non-epithelial malignant (NEMN: 1) thyroid cancer. Eight out of 14 patients had local advanced inoperable disease, 6 had local relapse after surgery, 1311 or RT. Ten out of 14 patients suffered from severe dyspnea. In 4 patients airway patency was maintained by insertion of a stent; in 3 the tracheal lesion was removed by Nd-YAG laser; in 7 both procedures were performed.
  
  
  RESULTS
  All 10 patients with dyspnea showed an improvement in symptoms. Early and late complications were observed in 4 and in 3 patients, respectively. All but 4 DTC patients died 11.9+/-14.2 months after the diagnosis (4.20+/-5.1 after IB). In 4 DTC patients still alive 90.7+/-59.2 since diagnosis and 16.7+/-9.2 months since IB, the airway dilatations allowed further treatments like 131-I and/or RT.
  
  
  CONCLUSIONS
  Interventional bronchoscopy, including Nd-YAG laser and airways stenting are alternatives to surgery in inoperable thyroid-induced tracheal obstruction. Moreover, airway dilatation improves dyspnea and may allow further treatment.
authors.affiliation: Cardio-Thoracic Department, Pulmonary Unit, University Hospital of Pisa, Pisa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ribechini
authors.forename: V
authors.initials: V
authors.lastname: Bottici
authors.forename: A
authors.initials: A
authors.lastname: Chella
authors.forename: R
authors.initials: R
authors.lastname: Elisei
authors.forename: P
authors.initials: P
authors.lastname: Vitti
authors.forename: A
authors.initials: A
authors.lastname: Pinchera
authors.forename: N
authors.initials: N
authors.lastname: Ambrosino
mesh_terms: D000368:Aged; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery*; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods*; D002277:Carcinoma / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013964:Thyroid Neoplasms / Q000150:complications*; D014132:Trachea / Q000601:surgery*