[Combination endobronchial and conventional therapy possibilities in inoperable central lung tumors]

Up to 85% of patients with bronchogenic carcinoma are inoperable at the time of diagnosis and treatment remains largely palliative. Prognosis depends on the clinical tumor stage. In non-small cell carcinoma the clinical stages (I-IV) are defined according to the TNM classification, whereas in small cell carcinoma limited disease is distinguished from extensive disease. Neither classification accurately takes endobronchial tumor spread into account. At the time of diagnosis up to 30% of all lung cancer patients present with central airway obstruction and clinical signs of dyspnea, atelectasis and pneumonia. Most patients with central airway stenosis have inoperable tumors (stage IIIb and IV) and have until recently undergone conventional treatment consisting exclusively of chemo- and radiotherapy. Currently the best results are obtained with combined chemoradiotherapy. The rapid developments in the area of endobronchial treatment modalities enable us to relieve bronchial obstructions fast and safely. This achieves immediate symptomatic relief which in many cases is a precondition for starting chemo- or radiotherapy. Successful reopening of a major airway helps to prolong local tumor control and thus survival. Patients with inoperable lung cancer and obstruction of central airways should undergo initial endobronchial therapy followed by conventional chemo-radiotherapy.