Further migrations did not occur after we excluded the abovementioned type of stenosis as an indication for the Dumon stent. Lethal hemoptysis in terminally ill patients may be more frequent if the central airways are kept patent by endobronchial palliation but in our series only one death (1/30) was directly related to endobronchial treatment; the other three fatal hemoptyses were caused by terminal hemorrhages not originating in the vicinity of the stents.
The efficacy of the stents in relieving respiratory symptoms was excellent in most patients. Our three patients who did not benefit from reopening of the airways, although results of their lung function tests had improved significantly, all had additional causes preventing them from leaving their beds.
Apart from the immediate effects, we were particularly interested in the long-term efficacy of stents to prevent reocclusion of airways. Of all patients with malignant disease, the subgroup with bronchogenic carcinoma principally qualified for adjuvant radiotherapy. The 75 percent (6/8) reocclusion rate of the stented airways in the patients without adjuvant radiotherapy after a median follow-up of only 2 months was disappointing. Our change in treatment policy to immediately (ie, within 2 weeks after stent insertion) irradiate the endobronchially treated airway irrespective of previous radiotherapy prevented local tumor recurrence in all 12 patients in group В during the median follow-up of 4 months (1 patient alive at the time of writing).