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Interventional bronchoscopy in the treatment of tracheal obstruction secondary to advanced thyroid cancer

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Abstract

Background: Surgery is the choice treatment for symptomatic tracheal obstruction due to malignant thyroid disease. Few additional therapeutic alternatives are available: radiotherapy (RT), chemotherapy (CT) or radioiodine therapy (131I). Only few studies on interventional bronchoscopy (IB) as well as alternative or palliative procedures have been reported so far. This study is a retrospective report of results of IB performed in patients with severe tracheal obstruction due to advanced thyroid cancer. Setting: Pulmonary and Endocrinology Units of a University Hospital. Patients and interventions: From January 2, 2000 to March 1, 2004 14 consecutive patients [5 males, mean age: 62.2±10.7 (SD) yr] underwent IB due to tracheal obstruction for anaplastic (ATC: 7 patients), differentiated (DTC: 5), medullary (MTC: 1) and non-epithelial malignant (NEMN: 1) thyroid cancer. Eight out of 14 patients had local advanced inoperable disease, 6 had local relapse after surgery, 131I or RT. Ten out of 14 patients sufferedfrom severe dyspnea. In 4 patients airway patency was maintained by insertion of a stent; in 3 the tracheal lesion was removed by Nd-YAG laser; in 7 both procedures were performed. Results: All 10 patients with dyspnea showed an improvement in symptoms. Early and late complications were observed in 4 and in 3 patients, respectively. All but 4 DTC patients died 11.9±14.2 months after the diagnosis (4.20±5.1 after IB). In 4 DTC patients still alive 90.7±59.2 since diagnosis and 16.7±9.2 months since IB, the airway dilatations allowed further treatments like 131-I and/or RT. Conclusions: Interventional bronchoscopy, including Nd-YAG laser and airways stenting are alternatives to surgery in inoperable thyroid-induced tracheal obstruction. Moreover, airway dilatation improves dyspnea and may allow further treatment.

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Authors and Affiliations

  1. Cardio-Thoracic Department, Pulmonary Unit, Pisa, Italy

    A. Ribechini, A. Chella & N. Ambrosino MD

  2. Department of Endocrinology and Metabolism, University Hospital of Pisa, Pisa, Italy

    V. Bottici, R. Elisei, P. Vitti & A. Pinchera

Authors
  1. A. Ribechini
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  2. V. Bottici
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  3. A. Chella
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  4. R. Elisei
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  5. P. Vitti
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  6. A. Pinchera
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  7. N. Ambrosino MD
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Corresponding author

Correspondence to N. Ambrosino MD.

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Ribechini, A., Bottici, V., Chella, A. et al. Interventional bronchoscopy in the treatment of tracheal obstruction secondary to advanced thyroid cancer. J Endocrinol Invest 29, 131–135 (2006). https://doi.org/10.1007/BF03344085

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  • DOI: https://doi.org/10.1007/BF03344085

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