Long-term survival after endobronchial fire during treatment of severe malignant airway obstruction with the Nd:YAG laser.

We present a case of Nd:YAG laser treatment of nearly total airway obstruction by malignant tumor in which an endobronchial fire occurred. The patient survived without complications of the fire and was followed-up until death over 22 months after the fire. The events leading to the fire are presented and recommendations provided to prevent similar occurrences.

Iodine 125 seed implants for prostatic carcinoma. Five- and ten-year follow-up.

Between 1975 and 1985 132 patients underwent bilateral pelvic lymphadenectomy and insertion of Iodine 125 seeds for biopsy-proved localized carcinoma of the prostate. Surgical stages were A2 9 percent, B 64 percent, C 9 percent, and D1 18 percent. Operative mortality was zero. Short and long-term complications were less than 33 percent. Ten-year survival rates of evaluable patients for surgical Stages A2, B1, B2, and C1 were 75 percent, 70 percent, 48 percent, and 44 percent, respectively. For these patients, ten-year disease-free rates for Stages A2, B1, B2, and C1 were 67 percent, 36 percent, 60 percent, and 25 percent, respectively. Interstitial radiotherapy may play a role in the treatment of nonsurgical candidates with low volume and well- to moderately-differentiated adenocarcinoma of the prostate.

Endoscopic laser therapy for respiratory distress due to obstructive airway tumors.

Neodymium-YAG laser therapy for unresectable malignant airway obstructions has a promising future. Nine patients with moderate to severe respiratory distress all experienced rapid relief of dyspnea and substantial improvement in pulmonary function within hours to days after treatment with laser phototherapy. The quality of life and survival was improved in otherwise hopeless cases. A nonfatal case of pneumothorax was the only major complication.

Postradiation biopsy and histological effects in early-stage prostatic cancer treated with 125iodine implants.

One hundred twenty patients with adenocarcinoma of the prostate were treated with 125I irradiation to the prostate and pelvic lymphadenectomy. Clinical stages were A-2 (13 pts), B-1 (34 pts), B-2 (49 pts), and C-1 (24 pts). The tumors were well differentiated in 44%, moderately differentiated in 39% and poorly differentiated in 17%. Nineteen of 22 patients with positive lymph nodes had either moderately or poorly differentiated tumors. A total radiation dosage between 15,000 and 24,000 rads per year were given to all patients. Seventy-six patients had been rebiopsied at 1 year, and 26 were positive for malignancy (34%). Thirty-eight patients had rebiopsy at 2 years, and 16 were positive (42%). Forty-four percent of the postradiation biopsies were of a different histologic grade from the primary lesion. Radiation injury was identified in 95% of the posttreatment biopsies and were moderate or severe in 71%. One hundred one patients are living from 1 to 9 years. Eight patients have died of metastatic carcinoma, and 11 have died of cardiovascular problems.

A study of factors contributing to the development of osteoradionecrosis of the jaws.

The histories of 14 patients in whom osteoradionecrosis developed were compared with those of 28 patients who had similar tumors and/or treatment and were not afflicted with osteoradionecrosis. 1. Fourteen of 15 episodes of bone complications occurred in the mandible, and 70% occurred within 1 year after the completion of radiation therapy. 2. A high dose of radiation, with conventional fractionation, did not specifically predispose patients to osteoradionecrosis. Fifty percent of the ORN patients actually received a total dose of 6000 rad or less. Combined radiation therapy and surgery did not seem to significantly increase the risk inasmuch as both groups of patients had similar combinations. In two of four patients who received methotrexate, however, osteoradionecrosis developed during the time of administration. 3. One of the most prevalent negative factors associated with the ORN patients was the continued heavy use of alcohol and tobacco by 86% of them. These strong tissue irritants could have significantly contributed to the breakdown of mucosa and exposure of bone. Alcohol and tobacco could also have potentiated the combined effects of the other negative factors, such as contributing to poor oral hygiene. 4. The ORN patients had poorer oral hygiene than the control group. Seventy-five percent of the patients with teeth who had osteoradionecrosis continued to have poor oral hygiene. In contrast, none of the control patients had poor oral hygiene. 5. A combination of factors relating to stage of tumor and treatment was found in the ORN patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Nd:YAG laser followed by radiation for treatment of malignant airway lesions.

Patients with malignant obstructive airway lesions often present with total or segmental atelectasis of lung. In spite of prompt initiation of palliative external radiation alone, some patients were unable to complete the planned course of radiation therapy. Since May 1983, 17 patients with malignant obstructive endobronchial lesions have been treated by endoscopic Nd:YAG laser vaporization of the tumor. One to seven days later, fractionated external radiation therapy was initiated. Endoscopic use of the laser was repeated as needed during the course of treatment. Fifteen out of 17 patients successfully completed the planned course of therapy. The improved performance status was sustained in 13 of 15 patients for 2-13 months. A control group was selected from among patients with similarly located lesions who underwent external radiation treatment only prior to the availability of the Nd:YAG laser therapy. One patient developed radiation pneumonitis six weeks after completion of a second course of external radiation, another patient developed bronchopleural fistula after laser treatment which healed following closed chest tube drainage. The others had longer palliation of symptoms and improved quality of life. The results indicate that relief of airway obstruction by use of the Nd:YAG laser improved the patients' ability to tolerate subsequent external radiation treatment.