The patients in this study first had laser and stent treatment followed by percutaneous or endobronchial radiotherapy. This permitted immediate normalization of ventilation distal to the obstruction and clearance of retained secretions and pus. In a previous group of patients with endobronchial tumor, who were first treated with full-dose percutaneous radiotherapy and then referred for endoscopic laser resection or stent-ing, the anatomy of the airways was often distorted rendering laser resection difficult. Similar results were reported by Jain et al. We therefore prefer to delay both percutaneous or endobronchial radiotherapy until after endoscopic palliation in all patients for whom stent insertion was considered necessary at the initial bronchoscopic evaluation.
In summary, the use of silicone stents designed by Dumon in the management of inoperable stenoses of the central airways is technically easy; their tolerance and efficacy are excellent. Due to their cylindrical shape, however, they tend to migrate when inserted into short and conical stenoses for which their use should be avoided. In malignant disease, local stent insertion should be followed by percutaneous radiotherapy or brachytherapy for patients with previous full-dose percutaneous irradiation. This treatment combination prolongs stent patency. Further studies with bigger sample sizes are needed to assess its effect on patient survival.