Management of endobronchial tumors

Owing to the high morbidity and mortality rates related to airways obstruction, an effective management of endobronchial tumors is essential to improve survival and symptoms in these patients. As interventional pulmonology plays a major role in this context, the purpose of the present review is to focus on current evidence and indications of therapeutic bronchoscopy, in particular of ablative techniques.

Several ablative techniques are currently available and include 'immediate' or 'delayed' procedures according to the expected time to restore airways patency. In case of critical lesions, it is mandatory to promptly restore ventilation through the immediate techniques, whereas the delayed approaches, with a prolonged effect, should be reserved for a nonemergency setting, according to clinical and prognostic factors. Recent data confirmed that almost every technique, in experienced hands, when the specific indications are met, is highly effective in restoring airways patency, with a valuable risk-benefits profile.

Owing to the complex heterogeneity of different clinical settings, management of endobronchial tumors requires a multimodal approach to assess the best strategy. Despite the lack of high-quality prospective studies comparing the individual techniques or strategy, it is undisputed that therapeutic bronchoscopy should not be considered as a last resort, but rather as a key step of such multimodal management.