Nd:YAG laser followed by radiation for treatment of malignant airway lesions.

Patients with malignant obstructive airway lesions often present with total or segmental atelectasis of lung. In spite of prompt initiation of palliative external radiation alone, some patients were unable to complete the planned course of radiation therapy. Since May 1983, 17 patients with malignant obstructive endobronchial lesions have been treated by endoscopic Nd:YAG laser vaporization of the tumor. One to seven days later, fractionated external radiation therapy was initiated. Endoscopic use of the laser was repeated as needed during the course of treatment. Fifteen out of 17 patients successfully completed the planned course of therapy. The improved performance status was sustained in 13 of 15 patients for 2-13 months. A control group was selected from among patients with similarly located lesions who underwent external radiation treatment only prior to the availability of the Nd:YAG laser therapy. One patient developed radiation pneumonitis six weeks after completion of a second course of external radiation, another patient developed bronchopleural fistula after laser treatment which healed following closed chest tube drainage. The others had longer palliation of symptoms and improved quality of life. The results indicate that relief of airway obstruction by use of the Nd:YAG laser improved the patients' ability to tolerate subsequent external radiation treatment.