Repetitive endoscopic laser treatments for palliation of lung malignancies
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Endobronchial laser therapy is generally safe and well tolerated. Because the laser is a form of nonionizing radiation, therapy can be repeated as often as needed. Two male patients, 50 and 55 years old, were referred to our clinic because of severe dyspnea and massive hemoptysis, the first 3 years ago and the second 1.5 years ago. In his medical history, the former patient had a thoracotomy for thymoma resection 5 years ago. Rigid bronchoscopy was performed under general anesthesia, Nd:YAP (neodymium-yttrium, aluminum, pevroskite) laser resection and silicon stent insertion were carried out for an endobronchial mass that was almost completely obliterating the left main bronchus. During the next 2 years, the same procedure was repeated 6 times to prevent distal tracheal obliteration. The left lung has now been totally collapsed for 2 years and the patient is still alive and healthy. The latter was a patient with a centrally located nonsmall cell lung cancer invading the middle and lower trachea, right main and upper lobe bronchi causing near-total obstruction. Rigid bronchoscopy was performed under general anesthesia. Nd:YAP laser coagulation and mechanical resection were carried out and a Dumon "Y" stent was inserted. In 1.5 years, therapeutic bronchoscopy was repeated 6 times. The patient is alive without dyspnea or respiratory insufficiency, although with brain metastases. Endoscopic laser resection of lung malignancies is rapid, effective, repeatable, and complementary to other treatments; although it should be considered only palliative, it could be curative in benign lesions and early cancers.