Endobronchial radiofrequency ablation for veruccous carcinoma of the trachea
Claus Steppert1, Florian Fuchs2 and Markus Neurath2
1Medizinische Klinik VI, Klinikum Bayreuth, Bayreuth, Germany, 2Medizinische Klinik I, Universitätsklinik Erlangen, Erlangen, Germany
Superficial tumors of the tracheobronchial tree are mostly treated by thermal ablation by argon- plasma coagulation, LASER or cryotherapy.
Advantages of these techniques are that they are widely available but the extension of the energy delivery is not controlled.
In Barrett's disease of the esophagus radio frequency ablation (RFA) is another usable technique for the treatment of this superficial tumor.
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Case: 2011 a 74 year old male patient with a verrucous carcinoma of the trachea was admitted to our hospital. After treating the intraluminal lesion with Nd- YAG- LASER and cryotherapy the patient was recurrence- free until October 2014. Then photodynamic LASER therapy was applied without success. To apply a well- defined amount of energy with well- defined invasion depth, radiofrequency ablation via a planar applicator (BARRX, Covidien, Sunnyvale, CA ) was chosen and the patient informed, that this technique has not been used in the bronchial tree so far. After written consent 45 applications with an energy of 12W/cm2 were given to the posterior membrane during rigid bronchoscopy. Conversely to the photodynamic therapy the treatment was initially successful. Today, 9 months after the treatment there is no evidence of recurrence of the tumor. There is no visible scar at the posterior membrane of the trachea.
Conclusion: in superficial tumors of the tracheobronchial tree RFA is a viable alternative to other thermal ablation techniques. The use of planar or circumferential applicators warrants a defined area of application with a controllable invasion depth.