Expandable Metallic Stent for Endobronchial Metastasis from Colorectal Cancer: Reports of 2 Cases.

In recent years, there have been many reports about the efficacy of stenting for central bronchial stenosis. When central bronchial stenosis is due to metastasis of a malignant tumor to the trachea and/or bronchi (endobronchial metastasis: EM), it is classified as "narrow EM" and "broad EM." [1] We managed two patients in whom bilateral stent placement was required for narrow and broad EM arising from colorectal cancer. Case 1: In September 2011, a 66-year-old man underwent low anterior resection for advanced colorectal cancer associated with unresectable liver metastasis. The liver metastasis became resectable after chemotherapy, with two resection procedures and radiofrequency ablation (RFA) being performed. Thereafter, lung metastasis occurred and a tumor in the left lung was resected. In May 2015, he developed respiratory distress. CT identified multiple lesions protruding into the lumen of the trachea and the left and right main bronchi. There was no evidence of mediastinal relapse or local relapse at the resection margin, and tumors were only detected in the tracheobronchial walls. Accordingly, narrow EM was diagnosed. An expandable metallic stent (EMS) was placed on the right side where stenosis was more severe, and radiation therapy was conducted for the non-stented tumors. The patient died 8 months later. Case 2: A 69-year-old woman had undergone laparoscopic right hemicolectomy and adjuvant chemotherapy for Stage lllb cancer of the ascending colon. Due to subsequent elevation of tumor markers, PET-CT was conducted and abnormal uptake was seen in the apex of the right lung and right upper abdomen. Both lesions were resected, and omental and lung metastases were diagnosed. She received treatment with UFT / calcium folinate, but relapse occurred at the resection margin in the right lung. At 7 years and 5 months after initial surgery, she complained of respiratory distress at an outpatient visit. CT demonstrated displacement of the trachea and right main bronchus due to enlargement of upper mediastinal lymph nodes. There was also severe stenosis of the right main bronchus due to tumor infiltration. Because there was both infiltration from local recurrence after resection and upper mediastinal lymph node enlargement, broad EM was diagnosed. An EMS was placed at the site of severe stenosis in the right main bronchus. Similar to Case 1, radiation therapy was also conducted, but respiratory distress occurred after 3 months due to tumor re-growth at the stent margin. Accordingly, stent-in-stent placement was performed and her respiratory symptoms improved. However, superior vena cava syndrome occurred 1 month later and the patient died. We consider that placing an EMS is effective in patients with tracheal stenosis due to EM that is judged to be an oncological emergency.

Endobronchial therapy of neoplasms.

The techniques and modalities provided by interventional pulmonology play a major role in the management of patients with symptomatic airways obstruction. The majority of these obstructions are part of pulmonary involvement by primary lung neoplasms or metastatic lesions from other organs. Benign lesions, although capable of producing similar symptoms, are more rare. Performance of successful interventional pulmonology is dependent on the skill and dexterity of the operator paired with a highly trained and dedicated ancillary team of nurses, anesthetists, and respiratory therapists. Successful endobronchial management of airway obstruction not only provides significant improvement in patients' quality of life, it also adds to their survival time. Both results fulfill the stated goals of appropriate and desired palliative therapy. Interventional pulmonology also contributes to research of the process of lung carcinogenesis and the introduction of targeted therapy for early minimally invasive cancer and the potential chemotherapy of premalignant lesions.

Photodynamic therapy enhanced by hyperbaric oxygen in acute endoluminal palliation of malignant bronchial stenosis (clinical pilot study in 40 patients).

OBJECTIVES: Photodynamic tumor therapy (PDT) is based upon a photochemical reaction that is limited by the availability of molecular oxygen in the target tissue. The use of hyperbaric oxygenation (HBO) increases the amount of oxygen available for the process may thereby enhance the efficacy of PDT. We proved in a prospective, non-randomized clinical pilot study the acute effects on malignant bronchial stenosis and the technical feasibility of combined PDT/HBO. METHODS: Forty patients (29 males, 11 females, mean age: 64.3 years; range 39-82 years) with inoperable, advanced malignant bronchial tumor stenosis were studied prospectively. Photosensitization was carried out using a hematoporphyrin-derivative 2 mg/kg bw 48 h prior to PDT. The light dose was calculated as 300 J/cm fiber tip. The assessment of outcome 1 and 4 weeks after PDT/HBO was done by endoscopy, chest X-ray, spirometry, laboratory parameters, subjective report of dyspnea and Karnofsky performance status. RESULTS: At 1 and 4 weeks after the treatment the patients felt a significant improvement of dyspnea and hemoptysis alongside with an objective subsiding of poststenotic pneumonia, though spirometric parameters revealed no significant difference. A significant reduction of tumor stenosis (P<0.05) and an improvement of the Karnofsky performance status (P<0.05) were documented 1 and 4 weeks after PDT/HBO. No therapy related complications were observed. CONCLUSION: Although the small number of patients does not allow to draw definitive conclusions, the results suggest that combined PDT/HBO represents a new, safe and technically feasible approach. It enables efficient and rapid reduction of the endoluminal tumor load and helps conditioning the patient for further treatment procedures.

[The role of Nd-YAG in the management of tracheobronchial stenosis]. / Neodymium-YAG laser szerepe a tracheobronchialis szükületek kezelésében.

122 patients with the main airway stenosis were treated with Nd-YAG laser phototherapy. The endobronchial laser treatment was performed either with flexible bronchoscope (64%), or with rigid instrument (36%). This method can result a final recovery of the patients with benign tumors, or inflammatory processes, at the patients with malignant tumors can be achieved an effective palliation. Taking account the generally accepted indications and contraindications of the endobronchial laser phototherapy the number of the complications can be reduced.

Laser therapy in 100 tracheobronchial tumours.

One hundred patients with tracheobronchial tumours were treated with the neodymium YAG (yttrium-aluminium-garnet) or argon laser for symptoms of airways obstruction caused by tumour (59 cases), complete collapse of a lung (17 cases), or recurrent haemoptysis (24 cases). Seventy four of them had relapsed or failed to respond to radiotherapy or chemotherapy and all were inoperable. Objective improvement in results of lung function tests or haemoptysis diary charts was seen in 37 patients with airways obstruction (63%), five (29%) with collapsed lung, and 14 (58%) with haemoptysis. Overall, 68 patients had symptomatic benefit and there was objective improvement in 56. Two deaths occurred in 288 treatment sessions both occurring as a result of asphyxia from minor haemorrhage in patients with advanced cylindromas and critical narrowing of the trachea or single remaining bronchus. In suitable patients with intraluminal tumour laser phototherapy is a valuable addition to conventional treatment.

[Spontaneous pneumothorax treated with continuous suction drainage (author's transl)]. / Ergebnisse der Behandlung des Spontanpneumothorax mit der Dauersaugdrainage

In a 5-year period 90 patients were treated. In case of a total collapse of the lung we made use of continuous aspiration. 2/3 of all patients with spontaneous pneumothorax recovered. Only in 5 cases a surgical intervention became necessary.

Cephazolin in severe purulent exacerbations of chronic bronchitis. Preliminary study.

Cephazolin has certain advantages over other systemic cephalosporins. It was given in a dose of 2-3 g daily for 7 days in 40 patients with severe purulent exacerbations of chronic bronchitis, 11 with purulent bronchiectasis and 24 with secondarily infected bronchial carcinoma. Most had failed to respond to high doses of other antibiotics. Results were very good and toxicity minimal.

[Coincidence of two carcinomata with excessive high level of serumestrogen (author's transl)]. / Koinzidenz zweier Karzinome mit ungewöhnlich hohem Serumöstrogenspiegel

A case of an unusual combination of a metastasing bronchus cancer, a non-metastasing cancer of prostata and an excessive high level of serum-estrogen is described. This casuistic gives rise to some more general discussion of the pathogenesis and differential diagnosis of paraneoplastic endocrinopathies.

PIP: Breast cancer was discovered in a 78-year-old man, which came from a metastasizing bronchus cancer. Investigation showed a level of serum estrogen 20 times higher than normal. This was probably due to a nonmetastasizing prostate cancer, spironalactone therapy for heart trouble, paraneoplactic endocrinopathy, and the Pierre-Marie-Bamberger syndrome.

[Paraneoplastic hypercalcemia in primary bronchial cancer]. / L'Hypercalcémie paranéoplasique du cancer bronchique primitif

Paraneoplastic hypercalcemia is frequently observed in squamous cell carcinoma of the bronchus. Clinically, apart from the general symptoms which are always very marked, neurological signs are the most common. This hypercalcemia, accompanied by hypophosphatemia, is of sudden onset and immediately very high. Metabolic alkalosis, with hypokalemia and hypochloremia, differentiates it from true hyperparathyroidism. Symptomatic treatment is only transiently effective. However, the obvious effect of mitramycin may be useful before surgical operation, which alone produces a lasting normalisation of serum calcium. Inappropriate secretion of a parathormone substance by the tumour may be demonstrated by radio-immunoassay, and this explains a large number of cases of hypercalcemia but this does not exclude other possible factors in the etiology. Finally, hypercalcemia originally attributed to bony lysis, may be explained in some cases by a paraneoplastic process.