[Palliative measures in tumor-induced obstruction of the airways]

Abstract

Local stenoses of the central airways in malignant inoperable disease are sometimes present at the time of diagnosis or develop over time after the completion of systemic palliative treatment. These stenoses should be relieved by local means in order to prevent the development of atelectasis and poststenotic pneumonia. Otherwise, patients will develop progressive dyspnea, and their general condition will decline rapidly. Various methods aimed at the relief of local obstructions exist and are often used in combination. Most procedures are performed under general anaesthesia using the rigid bronchoscope. Intraluminal obstructions can be relieved by laser-, cryo- and brachytherapy (endobronchial radiation). Extrinsic stenoses caused by airway compression from outside or by thickening of the airway wall through submucosal tumor growth must be dilated. At the end of these procedures, the insertion of silicone stents is ideally suited to maintain airway patency in dilated extrinsic stenoses and to prevent recurrent intraluminal tumor growth after laser therapy. The various methods aimed at the relief of malignant local airway obstructions are discussed, with emphasis on the recently developed silicone stents.