Journal of Endocrinological Investigation

, Volume 29, Issue 2, pp 131–135 | Cite as

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

  • A. Ribechini
  • V. Bottici
  • A. Chella
  • R. Elisei
  • P. Vitti
  • A. Pinchera
  • N. AmbrosinoEmail author
Original Articles


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.


Advanced thyroid cancer airway obstruction bronchoscopy tracheal infiltration airway stent 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hay ID, Bergstralh EJ, Goellner JR, Ebersold JR, Grant CS. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1 779 patients surgically treated at one institution during 1940 through 1989. Surgery 1993, 114: 1050–7.PubMedGoogle Scholar
  2. 2.
    Kebebew E, Clark OH. Locally advanced differentiated thyroid cancer Surg Oncol 2003; 12: 91–9.PubMedCrossRefGoogle Scholar
  3. 3.
    McCarty TM, Kuhn JA, Williams WL Jr, et al. Surgical management of thyroid cancer invading the airway. Ann Surg Oncol 1997, 4: 403–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Machens A, Hinze R, Dralle H. Surgery on the cervicovisceral axis for invasive thyroid cancer. Langenbecks Arch Surg 2001, 386: 318–23.PubMedCrossRefGoogle Scholar
  5. 5.
    Mazzarotto R, Cesaro MG, Lora O, Rubello D, Casara D, Sotti G. The role of external beam radiotherapy in the management of differentiated thyroid cancer. Biomed Pharmacother 2000, 54: 345–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Santini F, Bottici V, Elisei R, et al. Cytotoxic effects of carboplatinum and epirubicin in the setting of an elevated serum thyrotropin for advanced poorly differentiated thyroid cancer. J Clin Endocrinol Metab 2002, 87: 4160–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Ain KB. Anaplastic thyroid carcinoma: behavior, biology, and therapeutic approaches. Thyroid 1998, 8: 715–26.PubMedCrossRefGoogle Scholar
  8. 8.
    Pacini F, Pinchera A, Mancusi F, et al. Anaplastic thyroid carcinoma: a retrospective clinical and immunohistochemical study. Oncology Reports 1994, 1: 921–5.PubMedGoogle Scholar
  9. 9.
    Pierie J P, Muzikansky A, Gaz RD, Faquin WC, Ott MJ. The effect of surgery and radiotherapy on outcome of anaplastic thyroid carcinoma. Ann Surg Oncol 2002, 9: 57–64.PubMedCrossRefGoogle Scholar
  10. 10.
    Busnardo B, Daniele O, Pelizzo MR, et al. A multimodality therapeutic approach in anaplastic thyroid carcinoma: study on 39 patients. J Endocrinol Invest 2000, 23: 755–61.PubMedGoogle Scholar
  11. 11.
    McIver B, Hay ID, Giuffrida DF, et al. Anaplastic thyroid carcinoma: a 50-year experience at a single institution. Surgery 2001, 130: 1028–34.PubMedCrossRefGoogle Scholar
  12. 12.
    Shiraishi T, Kawahara K, Shirakusa T, Inada K, Okabayashi K, Iwasaki A. Stenting for airway obstruction in the carinal region. Ann Thorac Surg 1998, 101: 1 925–9.Google Scholar
  13. 13.
    McCaffrey JC. Evaluation and treatment of aerodigestive tract invasion by well-differentiated thyroid carcinoma. Cancer Control 2000, 7: 246–52.PubMedGoogle Scholar
  14. 14.
    Tanigawa N, Sawada S, Okuda Y, Kobayashi M, Mishima K. Symptomatic improvement in dyspnea following tracheobronchial metallic stenting for malignant airway obstruction. Acta Radiol 2000, 41: 425–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Noppen M, Poppe K, D’Haese J, Meysman M, Velkeniers B, Vincken W. Interventional bronchoscopy for treatment of tracheal obstruction secondary to benign or malignant thyroid disease. Chest 2004, 125: 723–30.PubMedCrossRefGoogle Scholar
  16. 16.
    Vitacca M, Natalini G, Cavaliere S, Clini E, Candiani A, Ambrosino N. Breathing pattern and arterial blood gases during Nd:YAG laser photoresection of endobronchial tumors under general anaesthesia. Use of intermittent negative pressure ventilation: a preliminary study. Chest 1997, 112: 1466–73.Google Scholar
  17. 17.
    Natalini G, Cavaliere S, Vitacca M, Amicucci G, Ambrosino N, Candiani A. Negative pressure ventilation vs spontaneous assisted ventilation during rigid bronchoscopy. A controlled randomized trial. Acta Anesthesiol Scand 1998, 42: 1063–9.CrossRefGoogle Scholar
  18. 18.
    Miyazawa T, Yamakido M, Ikeda S, et al. Implantation of ultraflex nitinol stents in malignant tracheobronchial stenoses. Chest 2000, 118: 959–65.PubMedCrossRefGoogle Scholar
  19. 19.
    Wartofsky L, Sherman SI, Gopal J, Schlumberger M, Hay ID. The use of radioactive iodine in patients with papillary and follicular thyroid cancer. J Clin Endocrinol Metab 1998, 83: 4195–203.PubMedCrossRefGoogle Scholar
  20. 20.
    Tubiana M, Schlumberger M, Rougier P, et al. Long-term results and prognostic factors in patients with differentiated thyroid carcinoma. Cancer 1985, 55: 794–804.PubMedCrossRefGoogle Scholar
  21. 21.
    Barzon L, Bonaguro R, Castagliuolo I, et al. Gene therapy of thyroid cancer via retrovirally-driven combined expression of human interleukin-2 and herpes simplex virus thymidine kinase. Eur J Endocrinol 2003, 148: 73–80.PubMedCrossRefGoogle Scholar
  22. 22.
    Portella G, Scala S, Vitagliano D, Vecchio G, Fusco A. ONYX-015, an E1B gene-defective adenovirus, induces cell death in human anaplastic thyroid carcinoma cell lines. J Clin Endocrinol Metab 2002, 87: 2525–31.PubMedCrossRefGoogle Scholar
  23. 23.
    Schiff BA, McMurphy AB, Jasser SA, et al. Epidermal growth factor receptor (EGFR) is overexpressed in anaplastic thyroid cancer, and the EGFR inhibitor gefitinib inhibits the growth of anaplastic thyroid cancer. Clin Cancer Res 2004, 10: 8594–602.PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2006

Authors and Affiliations

  • A. Ribechini
    • 1
  • V. Bottici
    • 2
  • A. Chella
    • 1
  • R. Elisei
    • 2
  • P. Vitti
    • 2
  • A. Pinchera
    • 2
  • N. Ambrosino
    • 1
    Email author
  1. 1.Cardio-Thoracic DepartmentPulmonary UnitPisaItaly
  2. 2.Department of Endocrinology and MetabolismUniversity Hospital of PisaPisaItaly

Personalised recommendations