Treating cancerous large airway stenosis with staging radioactive particle implantation guided by computed tomography and fiber bronchoscopy: a clinical study

Computed tomography-guided interstitial implantation of I (125) radioactive seeds in the treatment of hilar airway stenosis caused by non-small cell lung cancer

BACKGROUND

Airway stenosis secondary to non-small cell lung cancer (NSCLC) is one of the severe complications that can lead to life-threatening outcomes.

OBJECTIVE

To investigate the clinical utility of computed tomography (CT)-guided interstitial implantation of radioactive I-125 seeds in the treatment of hilar airway stenosis caused by NSCLC.

METHODS

The cases of hilar airway stenosis caused by NSCLC in our hospital from 2017 to 2022 were collected and divided into observation and control groups. Both groups underwent conventional lung cancer treatment, and the observation group was treated with CT-guided interstitial implantation of radioactive I-125 seeds. The mean tumor diameter, hilar airway stenosis, and obstructive pneumonia scores at 3 months after treatment were compared between the two groups.

RESULTS

After 3 months of treatment, the mean tumor diameter (28.8 ± 9.3 mm vs 49.33 ± 16.75 mm, P < 0.001), hilar airway stenosis (20.55 ± 30.36% vs 84.85 ± 26.19%, P < 0.001), and obstructive pneumonia score (2.19 ± 1.41 vs 3.48 ± 1.12, P < 0.001) of the observation group were significantly lower than those of the control group.

CONCLUSION

CT-guided interstitial implantation of I (125) radioactive seeds in the treatment of hilar airway stenosis caused by NSCLC can effectively reduce the tumor volume, relieve airway stenosis, and alleviate the associated obstructive pneumonia and has a certain value of application in the clinic.

Innovative Invasive Loco-Regional Techniques for the Treatment of Lung Cancer

Surgical resection is still the standard treatment for early-stage lung cancer. A multimodal treatment consisting of chemotherapy, radiotherapy and/or immunotherapy is advised for more advanced disease stages (stages IIb, III and IV). The role of surgery in these stages is limited to very specific indications. Regional treatment techniques are being introduced at a high speed because of improved technology and their possible advantages over traditional surgery. This review includes an overview of established and promising innovative invasive loco-regional techniques stratified based on the route of administration, including endobronchial, endovascular and transthoracic routes, a discussion of the results for each method, and an overview of their implementation and effectiveness.

Application of the transosseous approach for computed tomography-guided radioactive 125-iodine seed implantation for the treatment of thoracic and abdominal lymph node metastases

Aim

This study aimed to investigate the technical procedure, safety, and clinical value of the transosseous approach for computed tomography (CT)-guided radioactive 125-iodine (¹²⁵I) seed implantation for the treatment of thoracic and abdominal lymph node metastases.

Subjects and Methods

This was a retrospective study that Nine lymph node metastases in nine patients were treated in our hospital between January 2010 and August 2018. Under CT guidance, at least one puncture path was made through the transosseous approach. The seeds were planted according to the TPS. CT/MRI scans were performed every 2 months after the treatment to evaluate local therapeutic efficacy according to the Response Evaluation Criteria in Solid Tumors.

Results

The transosseous approach was successfully established in all patients. The median follow-up time was 11 months (6-36 months). At 2, 4, 6, 8, 10 and 12 months after operation, the objective effective rate and clinical benefit rate were 66.67%, 77.78%, 77.78%, 71.43%, 66.67% and 50.00%; and 88.89%, 88.89%, 88.89%, 71.43%, 66.67% and 50.00%, respectively. The survival rate of the patients at 6, 12, 18, 24, 30 and 36 months after operation was 53.00%, 26.00%, 26.00%, 13.00%, 13.00% and 13.00%, respectively.

Conclusions

The transosseous approach for CT-guided radioactive ¹²⁵I seed implantation was safe, effective, and minimally invasive for the treatment of thoracic and abdominal lymph node metastases.

Successful rescue using tracheal intubation cannula for severe central airway stenosis after tracheotomy: A CARE compliant case report

INTRODUCTION

Central airway stenosis is a life-threating requiring immediate medical intervention. There are several options for treating central airway stenosis, including rigid bronchoscopy, bronchoscopic high-power laser therapy, high-frequency electric needle knife, and balloon-expanding stents. However, interventional techniques may be unavailable in an emergent situation or at smaller local hospitals. In this case report, we publicly demonstrate for the first time that a tracheal intubation catheter may be applied as a temporary alternative to interventional bronchoscopic treatment.

PATIENT CONCERNS

A 72-year old male patient was admitted with a 1-year history of intermittent dyspnea, which was exacerbated for one day. One day prior to admission to our hospital, the patient presented with cyanosis due to an exacerbation of dyspnea.A tracheotomy was performed and the patient had been carrying a tracheotomy cannula for 6 months.

DIAGNOSIS

The ventilator alarm indicated high airway resistance and the nurses were unable to insert the suction pipes into the airway. Immediate fiberoptic bronchoscopy showed diffuse edema and stenosis of the inferior tracheal airways.

INTERVENTIONS

Tracheal intubation was used to temporarily replace the tracheotomy cannula, which successfully expanded the narrowed airways.

OUTCOMES

The blood oxygen saturation returned to normal, and dyspnea was quickly relieved.

CONCLUSION

In emergent situations, tracheal intubation catheters may be used in patients with post-tracheotomy central airway stenosis, not only for surviving the most dangerous phase but for also prolonging the survival time for further treatments.

Implantation of 125I radioactive seeds via c-TBNA combined with chemotherapy in an advanced non-small-cell lung carcinoma patient

Background

The critical management of advanced non-small-cell lung carcinoma (NSCLC), especially when complicated by severe airway stenosis, is difficult and often leads to high clinical risks and medical costs.

Case presentation

A 51-year-old previously healthy male was admitted to the Department of Respiratory and Critical Care Medicine, Taizhou People’s Hospital, in November 2018 for haemoptysis and difficulty breathing during a 15-d period. Following admission, chest computed tomography (CT) showed a large mass in the left hilum with atelectasis in the left upper lobe and obstructive pneumonia in the left lower lobe. Bronchoscopy revealed that the lesions occurred in the distal segment of the left main trachea, with occlusion of the left upper bronchus and significant narrowing of the lower bronchus. A basal mucosal biopsy of the lump tissue was performed after haemostasis treatment with sub-plasma coagulation (APC), and squamous lung carcinoma was confirmed. Following the final diagnosis, the patient was successfully treated with implantation of ¹²⁵I radioactive seeds via transbronchial needle aspiration (c-TBNA) combined with chemotherapy.

Conclusion

We believe that implantation of ¹²⁵I radioactive seeds via c-TBNA is an effective treatment for patients with advanced lung cancer and those presenting with severe and mixed main bronchus stenosis.