Bronchoscopic curative therapy.

Early stage central lung cancer is a malignant tumour defined as: radiographically occult squamous cell carcinoma that is <2 cm in surface area, appears superficial endoscopically, has clearly visible margins and has no invasion beyond the bronchial cartilage assessed either by pathologic assessment or by available imaging including high-resolution computed tomography (HRCT) or endobronchial ultrasound (EBUS) bronchoscopy. Mediastinal lymphoadenopathy or distant metastasis are absent. Early stage central type lung cancer can be detected by using ‘White Light” bronchoschopy and Autofluorescence bronchoscopy. EBUS bronchoscopy is useful in confirming the thickness of the lesions, non invading the wall beyond the cartilage. Even though these cancers are small, in 70% of cases a lobectomy is required and in the remaining 30% either a bilobectomy or pneumonectomy [1] is required. In addition 1-4% of these patients will have a synchronous lung cancer and the risk of acquiring a second lung cancer after surgery is 14% per year [2]. Disease-free survival after surgical resection is 70% after 5 years in the Stage IA of non-small cell lung cancer (NSCLC) and over 90% in case of Carcinoma in situ. “If bronchoscopic treatments of early-stage lung cancer can provide similar disease-free survival with less perioperative mortality, morbidity and cost, then they may be alternative front-line therapies. Other than resection, Photodynamic Therapy (PDT) may represent the best approach at this time” [3]. Other bronchoscopic options of therapy are Nd:YAG-Laser, Electrocauthery and Argon coagulator, Cryotherapy and Brachitherapy. Photodynamic Therapy