Central Airway Recanalisation Using Dual Debulking With Para-Toluenesulfonamide (CLEAR-DUAL-PTS)

Pulmonary adenoid cystic carcinoma (PACC) is a rare salivary gland-type malignancy of the tracheobronchial tree, accounting for 0.04%-0.2% of primary lung cancers. It may cause severe malignant airway obstruction (SMAO), necessitating urgent intervention. Surgical resection remains the primary treatment, but inoperability or patient preference may require alternative strategies. We report a case of a 57-year-old non-smoking female with PACC-SMAO who presented with total left lung collapse due to left main bronchus (LMB) involvement. She declined surgery and underwent bronchoscopic dual debulking combining electrocautery snaring with repeated intratumoural para-toluenesulfonamide (PTS) injections. The intervention safely reduced tumour burden, restored airway patency, and significantly improved clinical and radiological outcomes without adverse events. Our case underscores PTS as a promising adjunct therapy for inoperable PACC-SMAO, warranting further investigation into its long-term efficacy and optimal dosing. This innovative approach may significantly redefine palliative care options.