ABSTRACT
I. Clinical Background At the time of diagnosis, a good 80% of all lung cancers are inoperable and their treatment is mainly palliative. Obstruction of the major airways is one of the most serious complications of advanced stage tumors and can vary from asymptomatic airway narrowing to life-threatening dyspnea caused by airway occlusion. Significant central airway obstruction (CAO) with imminent suffocation requires immediate action to promptly regain airway passage (1,2). Airway obstruction is caused by intraluminal tumor growth, extraluminal tumor compression, or their combination of both (Fig. 1). Depending on staffing and equipment of the local health care facilities, patients with or without previous treatment are referred to the interventional pulmonologist. In developing countries-usually with limited access to health care-such patients often seek medical aid at an advanced stage of disease, sometimes exhibiting severe CAO, whereas in first world setups they usually present with recurrences after previous surgical treatment or failed chemoradiotherapy. In addition, imminent suffocation and poor physical condition may provide little room for timely and safe intervention, thus immediate action is warranted. Therefore, treatment plans must be diligently considered and executed to obtain an optimal benefit. Tumor coagulation to reduce profuse bleeding followed by debulking, with additional stenting in case of significant residual extraluminal stenosis, is the time-honored accepted strategy (1,2).
