Benign or malignant tracheobronchial obstruction may cause major respiratory difficulties that may sometimes lead to acute respiratory distress or asphyxia and death. In patients, when curative resection is not possible, there is a need for an effective method for palliation. Many endoscopic strategies are now available such as Nd:YAG laser photo-coagulation, which remains the standard procedure particularly in respiratory distress. Other procedures that are essentially palliative in nature include cryotherapy, electrocautery, brachytherapy, stent placement, external beam radiation, and bronchoscopic or balloon dilatation.

Patients with a tracheobronchial lesion often present with one or more symptoms and one or more physical signs; they are, dyspnea, cough, chest discomfort, hemoptysis, stridor, or localized wheeze. The patient's history may reveal known cancer, aspiration of a foreign body, prior airway surgery or intubation, recurrent pneumonia, or other underlying illnesses that may involve the airways, such as sarcoid or tuberculosis. Chest radiography or CT scan may highlight the lesion; however, direct airway visualization with bronchoscopy is often needed to define the problem, and when appropriate, to carry out treatment. At times this may be at the same session; for instance, removing a foreign body or using laser to resect a tracheal tumor, relieves impending respiratory failure. When treatment is nonemergent then therapeutic considerations are based on histology, appropriate curative therapy, properties of the lesion (airway location, endobronchial mass with complete or partial obstruction, extrinsic compression, stenosis, malacia, etc.), patient tolerance and acceptance, and equipment and a skilled operator that are locally available.

This article concentrates on cryotherapy, electrocautery, and brachytherapy as local treatment options for tracheobronchial lesions, using rigid or flexible bronchoscopy (FB) as the means to deliver the therapy. For each therapy a review of its history, theoretical and scientific basis, indications and patient selection, equipment and technique, results, and complications are undertaken, followed by a brief summary.