الفهرس 
BRONCHOGENIC CARCINOMAOnly 14 pages are availabe for public view
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Abstract
Lung cancer is the leading cause of cancer-related mortality in the world, with almost one million deaths annually. Patients with airway obstruction due to inoperable NSCLC are at a high risk of developing haemoptysis, respiratory failure or post-obstructive pneumonia. In such cases there is usually an urgent need to restore the airway by modes of interventional bronchoscopy such as cryotherapy, electrocautery, laser resection, brachytherapy and endobronchial stent insertion.
New local therapeutic modality for NSCLC chemotherapy was introduced named endobronchial intratumoral chemotherapy (EITC) with intratumoral injection of one or more cytotoxic drugs directly into tumor tissue through a flexible bronchoscope by means of a needle-catheter. EITC is a loco-regional form of chemotherapy that was expected to reduce the tumor burden inside the airway lumen for patients with NSCLC that presents with bronchial lumen obstruction.
EITC differs significantly from conventional intravenous chemotherapy by virtue of the localized non-systemic route of drug delivery. The advantages include: precise delivery of a drug super dose directly to the tumor mass with little or no systemic side effects (in contrast to systemic intravenous drug delivery which is severely dose-limited due to general toxicity).
The current study was done to determine the efficacy of endobronchial intratumoral chemotherapy (EITC) using the 5 Fluorouracil (5 FU) in palliative care for patients with inoperable lung cancer.
In the period between February 2018 and February 2022, 30 patients were recruited to current study from bronchoscopy unit of Ain shams university hospital and Embaba chest hospital with newly diagnosed symptomatic non-life threatening airway obstruction secondary to inoperable NSCLC stage IIIB, IIIC or IV and divided in to two groups:
• group (A): 15 patients received the systemic conventional chemotherapy as usual
• group (B): 15 patients received the systemic conventional chemotherapy as usual in addition to sessions of EITC using 5 FU on weekly bases for 3 sessions.
All patients were evaluated clinically, radiologically and with bronchoscopy before and after the study.
The following results were obtained:
• Mean age of studied patients in our study was 59 years.
• The presenting symptoms were dyspnea in all patients (MMRC 2 in 76.67% and MMRC 1 in 23.33%), cough in 83.3%, hemoptysis in 10% and chest pain in 3.37% and results showed no statistically significant difference between the two groups after treatment, and sessions of EITC using the 5 FU didn’t result in any subjective improvement of the symptoms. Also Karnofosky score for studied patients in both groups didn’t improved after treatment.
• No statistical difference between the two groups as regarding complications during bronchoscopy. Only one patient in group B developed hemoptysis during bronchoscopy and another developed worsening hypoxia that were managed effectively and not resulted in late complications.
• None of group B patients developed complications related to the 5 FU injected intratumoral.
• Concerning the total objective response evaluated via comparison between CT chest before and after treatment and bronchoscopy before and after treatment for all patients and interpreted according to Revised RECIST guidelines, there was no statistically significant difference between the two groups. EITC using 5 FU didn’t result in debulking of the tumor mass, improvement of the bronchial lumen diameter or decrease of the tumor size and so no superiority of using this drug by means of local injection for such patients.
from the current study it was concluded that:
• EITC is a less invasive and relatively cheap has less risk of complications as compared to other interventional therapeutic bronchoscopic procedures and by providing local delivery of cancer drugs, EITC has no systemic toxicity.
• EITC using 5 Fluorouracil is not an effective promising treatment approach for palliative treatment of patients with advanced malignant endobronchial non-small cell lung cancer.
RECOMMENDATIONS
from the present study, it is recommended that:
1. Further researches conducted on a larger number of patients with longer periods of follow up are needed to properly assess the role of EITC in management lung cancer.
2. Future researches are needed based upon selection of local chemotherapeutic agents other than 5 Fluorouracil for EITC.
3. Future researches are needed based upon comparing EITC with other interventional therapeutic bronchoscopic procedures in the same thesis.
4. Future researches are needed based upon the evaluation of combining EITC with other interventional therapeutic bronchoscopic procedures e.g. laser therapy, electrocautery, cryotherapy, photodynamic therapy …etc as regards the effect on tumor size, quality of life and survival rate.