title: Endobronchial palliation using Nd:YAG laser is associated with improved survival when combined with multimodal adjuvant treatments.
abstract: BACKGROUND
  Endobronchial neodymium:yttrium aluminum garnet (Nd:YAG) laser therapy has been shown to be safe and effective in palliating large airway malignancies. The role of multimodal therapy with stenting, brachytherapy, chemotherapy, and radiotherapy together with Nd:YAG laser therapy is unclear.
  
  
  OBJECTIVE
  This study aims to confirm the safety and effectiveness of Nd:YAG laser therapy in the contemporary setting and to investigate the effectiveness of multimodal therapy compared with laser alone.
  
  
  METHODS
  One hundred fifty-three Nd:YAG laser treatments on 110 patients between 1999 and 2004 were reviewed retrospectively. Symptom scores for dyspnoea, hemoptysis, and cough before and after the procedure were compared. Survival and time to reintervention were analyzed using the Kaplan-Meier method. Multimodality treatment was compared with Nd:YAG laser therapy alone to determine differences in survival and time to reintervention. p values less than 0.05 were considered significant.
  
  
  RESULTS
  There were no operative mortalities directly caused by laser intervention, although 30-day mortality was 6.5%. Deaths were attributable to progression of advanced neoplastic processes rather than laser intervention, and 6.5% of patients had some postoperative morbidity. After Nd:YAG laser intervention, 76% of patients reported improvement to dyspnoea, 94% for hemoptysis, and 75% for cough. Median survival after Nd:YAG laser treatment was 6.64 months; 21% of patients required repeated laser treatment. Compared with Nd:YAG laser treatment alone, multimodality treatments significantly prolonged median time to reintervention by 1.7 months (p = 0.002) and prolonged median survival by 4.9 months (p < 0.001) in patients with NSCLC.
  
  
  CONCLUSIONS
  Nd:YAG laser intervention is safe and effective for palliation of endobronchial malignancies. In most cases, it only needs to be performed once. Compared with Nd:YAG laser therapy alone, multimodal treatment prolonged survival.
authors.affiliation: Department of Surgical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Australia. charles.han@svhm.org.au
authors.forename: Charles C
authors.initials: CC
authors.lastname: Han
authors.forename: Davin
authors.initials: D
authors.lastname: Prasetyo
authors.forename: Gavin M
authors.initials: GM
authors.lastname: Wright
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001984:Bronchial Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D001999:Bronchoscopy; D003131:Combined Modality Therapy; D003371:Cough / Q000175:diagnosis; D004417:Dyspnea / Q000175:diagnosis; D005260:Female; D006469:Hemoptysis / Q000175:diagnosis; D006801:Humans; D053685:Laser Therapy; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D015996:Survival Rate