Laser therapy for an obstructing primary tracheal lymphoma in a patient with AIDS: DISCUSSION (3)
Endoscopy represents the remaining alternative for local airway control. Rigid bronchoscopy to resect or ‘core-out’ the tumour with or without Nd:YAG assistance to control any bleeding is an excellent option for obstructing endobronchial tumours. However, because our centre has developed considerable experience using the laser via flexible bronchoscopy for palliate obstructing tumours of the tracheal-bronchial tree, we now favour this approach. The Nd:YAG laser via bronchoscopy has been used for palliation of tracheobronchial tumours since reports began appearing in the 1970s. Shapshay et al reported a series of 11 patients with secondary involvement of the subglottic larynx and cervical trachea treated with laser therapy as a bridge to definitive therapy. They concluded that using a laser was safe in this setting. The tumour from the current case was easily debulked with no bleeding despite its friable nature. Recanalization of the trachea allowed successful extubation of the patient. buy diabetes drugs
Early bronchoscopic examination should be considered in patients with HIV/AIDS who present with wheezing, dyspnea, cough and, particularly, stridor, and who do not improve with initial therapy. Although primary tracheal lymphoma remain rare, 27% of reported cases have occurred in patients with HIV/AIDS. Airway management should include simple measures such as bronchodilators, humidified O2 and Heliox. Chemotherapy and/or radiation therapy remain definitive therapy, but local symptoms from tumour obstruction can be easily and safely palliated with endoscopic Nd:YAG laser therapy as a bridge to definitive therapy.