Flexible Bronchoscopic Stenting Followed by Radiation in Malignant Obstruction of Central Airways

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Abstract
The aim of this study was to test the efficiency of short-term balloon-expandable metallic stent application (Strecker device) in tumorous stenoses with subsequent irradiation and to develop a method for implanting these metallic stents using a flexible bronchoscope. Eight patients suffering from bronchial carcinoma with severe stenosis of the central airways (carina region, main stem bronchus) and dyspnea were examined. Strecker stents were applied by flexible bronchoscopy using intubation and fluoroscopic guidance. General anesthesia and muscle relaxation were used during dilatation of the stenosis and stent application. In four cases, the application of two stents was indicated (length of stenosis. >35 mm); in the other four cases, one stent was sufficient. Stent implantation was followed by immediate postoperative percutaneous irradiation in four cases and/or by afterloading in five cases. Radiotherapy has been efficient in each case and led to dilatation of the stenosis after an average irradiation dosage of 23 Gy and an average time of 39 days; thus most of the stents could be easily removed by forceps using flexible bronchoscopy. The results suggest that the implantation of metallic Strecker stents by flexible bronchoscopy is an efficient short-term therapy in patients suffering from bronchial carcinoma with severe dyspnea, if irradiation follows.

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