[Special endobronchial palliative measures]

Inoperable pulmonary malignancies can present with local stenoses of the central airways either at the time of diagnosis or later on. Depending on their localization, these obstructions cause progressive dyspnea, postobstructive atelectasis and/or pneumonia. The patient's general condition will deteriorate, and at the tracheal level life-threatening dyspnea can develop. If central airways stenosis is suspected, fiberbronchoscopy is mandatory to decide whether local endobronchial palliation is a feasible treatment modality. Usually, local palliation is combined with chemo-and/or radiotherapy. Laser resection using the Nd-YAG laser is performed for obstructions caused by endoluminal tumour growth and leads to an immediate effect after a single session. Brachytherapy means local, endobronchial irradiation with a short depth of penetration. The active probe is placed with the aid of the fiberbronchoscope. Brachytherapy can be used alone, but is often combined with an initial laser resection for the consolidation of the treatment effect. The principal of photodynamic therapy consists of photosensitization of tumour cells followed by local laser light application which leads to cell death. In selected cases this treatment can be curative. Extrinsic stenoses which are caused by external compression of the airways or by thickening of the airway walls through submucosal tumour spread must be treated by dilatation and insertion of stents (endoprostheses) to maintain airway patency. These stents--mostly self-expanding silicone or metal devices--are usually inserted with the rigid bronchoscope. Again, endobronchial and/or percutaneous radiotherapy is added to obtain longer local tumour control.