Integration of interventional bronchoscopy in the management of lung cancer.
Tracheal or bronchial proximal stenoses occur as complications in 20-30% of lung cancers, resulting in a dramatic alteration in quality of life and poor prognosis. Bronchoscopic management of these obstructions is based on what are known as "thermal" techniques for intraluminal stenosis and/or placement of tracheal or bronchial prostheses for extrinsic compressions, leading to rapid symptom palliation in the vast majority of patients. This invasive treatment should only be used in cases of symptomatic obstructions and in the presence of viable bronchial tree and downstream parenchyma. This review aims to clarify 1) the available methods for assessing the characteristics of stenoses before treatment, 2) the various techniques available including their preferred indications, outcomes and complications, and 3) the integration of interventional bronchoscopy in the multidisciplinary management of proximal bronchial cancers and its synergistic effects with the other specific treatments (surgery, radiotherapy or chemotherapy).
Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France guibert.n@chu-toulouse.fr.
Nicolas
N
Guibert
Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France.
Julien
J
Mazieres
Hospital Pasteur and Institute for Research on Cancer and Ageing (IRCAN) (Inserm U10181/UMR CNRS 7284) University Nice Sophia Antipolis, Nice, France.
Charles-Hugo
CH
Marquette
Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France.
Damien
D
Rouviere
Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France.
Alain
A
Didier
Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France.
Christophe
C
Hermant
D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001982:Bronchial Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D020680:Bronchoscopes; D001999:Bronchoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D003131:Combined Modality Therapy; D019091:Critical Pathways; D003452:Cryosurgery / Q000009:adverse effects / Q000295:instrumentation; D004564:Electrocoagulation / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation; D007834:Lasers; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D010166:Palliative Care; D018579:Patient Selection; D010778:Photochemotherapy / Q000009:adverse effects / Q000295:instrumentation; D012307:Risk Factors; D015607:Stents; D014135:Tracheal Stenosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome