Les traitements endoscopiques du cancer bronchique

Interventional bronchoscopy is indicated both in advanced stages of lung cancer with severe airway obstruction or in early stages. In the first situation, the goal is palliative and the treatment is based on a mechanical debulking with a rigid bronchoscope to core out the tumour and/or to insert stent in cases of external compression. A dramatic improvement is currently observed. Interventional bronchoscopy is mandatory before chemotherapy or radiotherapy in patients either with a symptomatic airway obstruction or with an obstruction more than 50% of the lumen of a major bronchus. In some cases, a synergic action between therapeutic bronchoscopy and conventional radio-chemotherapy is observed. In early stages (superficial lung cancers) the treatment can be curative with methods sparing the bronchial wall, such as cryotherapy, electrocautery in soft mode, photodynamic therapy or brachytherapy. In these superficial lesions, synchronous tumours are frequent and 5% per year of metachronous lesions are observed in the follow-up. Thus, sparing lung parenchyma can be crucial and explains the growing role of therapeutic bronchoscopy as alternative to surgery. A curative result is obtained in about 80% of cases with these methods but a prolonged and careful bronchoscopic follow-up is mandatory.