Local methylprednisolone irrigation and tolerability after PTS-based bronchoscopic treatment for malignant central airway obstruction: a retrospective study.

BACKGROUND: Malignant central airway obstruction (MCAO) is a severe complication of advanced thoracic malignancies. Bronchoscopic intervention combined with intralesional para-toluenesulfonamide (PTS) injection can restore airway patency, but local mucosal inflammation after treatment may cause pain, edema, and poor early tolerability. This study assessed whether local methylprednisolone irrigation after PTS-based bronchoscopic treatment improves short-term outcomes in patients with MCAO. METHODS: We retrospectively analyzed 88 treatment sessions from 35 consecutive patients who underwent bronchoscopic intervention plus intralesional PTS injection between January 2024 and December 2025. According to the irrigation solution used after PTS injection, sessions were divided into methylprednisolone and normal saline groups. Outcomes at 72 h included cough score, mMRC dyspnea score, airway stenosis score, pain score, mucosal edema, and bleeding. Linear mixed-effects models and generalized estimating equations were used to account for repeated treatment sessions, and inverse probability of treatment weighting was applied to adjust for baseline differences. RESULTS: Bronchoscopic intervention plus PTS injection significantly improved cough, dyspnea, and airway stenosis at 72 h. Compared with normal saline, methylprednisolone irrigation did not provide additional improvement in these short-term efficacy outcomes. However, methylprednisolone irrigation was associated with lower post-procedural pain and less mucosal edema, without increasing bleeding risk. These findings remained consistent after weighting, sensitivity analyses, and false discovery rate correction. CONCLUSION: Local methylprednisolone irrigation after PTS-based bronchoscopic treatment may improve early procedural tolerability in patients with MCAO by reducing post-procedural pain and mucosal edema, rather than enhancing short-term airway-opening efficacy. Further prospective studies are needed to confirm these findings.