Endobronchial Electrocautery is an Excellent Alternative for Nd

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Abstract
The Nd:YAG laser is the most popular instrument to treat patients with intraluminal tumor in the major airways. It is usually performed under general anesthesia. Fiberoptic bronchoscopic electrocautery (FBE) under local anesthesia was shown to be effective in providing rapid palliation. We have studied prospectively the effectiveness of FBE for clearing intraluminal tumor. Patients with visible intraluminal tumor in the large airways were treated with FBE. ND:YAG laser equipment was kept ready for use during FBE sessions. A treatment session was terminated when significant tumor clearance had been achieved, or in cases with extraluminal tumor compression. Fifty-six patients, median age 64 years (range 20–90), were treated, and 82 FBE sessions were completed. Thirty-seven patients (66%) had intraluminal non-small-cell cancer, ten had typical carcinoid and the rest had miscellaneous tumors. Significant tumor clearance was documented in 39 patients (70%). The remaining patients proved to have extraluminal tumor. Ten sessions (12%) were completed under general anesthesia, in nine cases for the treatment of carcinoid. No conversion to Nd:YAG laser treatment was necessary, but additional Nd:YAG treatment was given to obtain more in-depth necrosis in one patient. A switch to rigid bronchoscopy was necessary to control bleeding in one patient. In this phase II prospective study, FBE achieved sufficient clearance of intraluminal tumor in the majority of patients who were considered to be Nd:YAG laser candidates. Our findings indicate that FBE may be competitive with Nd:YAG laser treatment for this category of patients. A randomized phase III study is underway.

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