Safety, feasibility, and usefulness of bronchoscopic thermal ablation techniques in the management of endobronchial neoplasms

Abstract

Background
A common sign of lung cancer is central involvement of the airway. Bronchoscopic electrocautery, laser, argon plasma coagulation (APC), cryotherapy, photodynamic therapy, brachytherapy, intra-tumoral chemotherapy, mechanical debridement, and rotational micro-debrider are common treatments for patients with endobronchial neoplasms with the goals of debulking and palliation.


Aim
To evaluate the safety, feasibility, and usefulness of Bronchoscopic thermal ablation techniques in the management of endobronchial neoplasms.


Methods
This prospective, interventional, comparative cohort study was conducted in The Chest Department at Kasr Al Ainy Hospital, Cairo University. The study enrolled Forty-Nine patients who were diagnosed with Endobronchial neoplasms. All patients were subjected to a medical history and clinical examination, blood tests (CBC, KFT, LFT, coagulation profile and ABG), and Radiological imaging (Chest x-ray and CT chest). Patients were categorized into three groups according to the bronchoscopic thermal ablation techniques used: group 1(Cryotherapy), group 2 (electrocautery) and group 3(Argon plasma coagulation).


Results
Males represented 67.35%, and Smokers represented 85.71% of the included patients. Respectively, all three techniques showed significant improvement in the degree of obstruction and relief of clinical symptoms (cough, dyspnea, and hemoptysis) post procedure. The of the procedure duration was the shortest in electrocautery compared to other procedures. Bleeding was the most frequently reported with cryotherapy, while bronchial perforation, pneumothorax and pneumomediastinum were more common in the electrocautery and APC groups.


Conclusion
Bronchoscopic cryotherapy, electrocautery and Argon plasma coagulation are effective ablation techniques for treating endobronchial lesions. They play an important role in the palliative care of malignant central airway lesions.