Tratamento do câncer de pulmão localmente avançado Treatment of locally advanced lung cancer

Lung cancer is the second leading cause of cancer death. Approximately half of all lung cancer patients are diagnosed at an advanced stage (stage III or IV), and the treatment of such patients is aimed primarily at improving quality of life and alleviating symptoms. Most patients with advanced stage lung cancer will die from local complications, primarily from those related to airway obstruction. The objective of this review was to explore practical approaches to airway obstruction, which is the main cause of morbidity and mortality in such patients. We review airway anatomy and describe the various processes of airway obstruction in malignancy. We also discuss methods for alleviating airway obstruction: debridement; endobronchial dilation; laser resection; electrocauterization; core biopsy with forceps and a rigid bronchoscope; and airway stent placement. By alleviating dyspnea and reducing the incidence of pneumonia related to bronchial obstruction, the methods described here can improve quality of life in patients with advanced stage lung cancer. We stress the importance of a multidisciplinary approach in cases of intraluminal tumor invasion or extrinsic airway compression. The multidisciplinary team must include professionals with experience in performing fiberoptic and rigid bronchoscopy, as well as having access to the equipment required in order to provide intensive care. In addition, patients should be referred to specialized facilities as early as possible.