Interventional bronchoscopic therapy in adult patients with tracheobronchial schwannoma

BACKGROUND Tracheobronchial schwannomas are extremely rare tumors of neurogenic origin. Treatment includes surgery and interventional bronchoscopic therapy. Studies that have described interventional bronchoscopic therapy for tracheobronchial schwannoma have been reported in the published literature, but most of them are individual case reports, in which the long-term efficacy and recurrence are poorly understood. This study aimed to explore the feasibility, efficacy, and safety of interventional bronchoscopic therapy in adult patients with tracheobronchial schwannoma. METHODS Patients with pathologically diagnosed tracheobronchial schwannoma between January 2007 and December 2020 who underwent interventional bronchoscopic therapy in a single center in China were retrospectively reviewed. The clinical features, interventional bronchoscopic therapy procedures, complications, and follow-up results were analyzed. RESULTS A total of 7 patients (5 men and 2 women; median age, 56 years; age range, 26-63 years) were enrolled. Patients' symptoms were all significantly relieved after interventional bronchoscopic therapy, with mean American Thoracic Society Dyspnea Index score decreasing from 2.29±0.76 to 0.29±0.49 (t=6.481; P=0.001). No severe procedure-related complications were observed. Intraluminal tumors were found subsequently in three cases during a short-term follow-up (4 days to 1 month). One patient underwent surgery; thereafter got lost to follow-up, while the other 2 patients underwent a second endoscopic resection with good prognosis. Six patients received long-term follow-up (range, 2-12 years; median period, 6 years), with all patients being in stable conditions. CONCLUSIONS Interventional bronchoscopic therapy is an acceptable approach in the management of tracheobronchial schwannoma, and is a useful alternative to surgical resection, especially for those who are at a high risk of surgery or unwilling to undergo surgery. However, long-range bronchoscopic surveillance is necessary because of the possibility of tumor recurrence. Due to its benign nature, repeat endoscopic resection can still be considered after recurrence.