Cryosurgery for Lung Cancer: Clinical Results and Technical Aspects

Abstract

Lung carcinoma is the most frequently diagnosed malignancy in the world, with the incidence increasing through the 20 th century. Presentation may be as a tumor mass primarily obstructing the central bronchial lumen, or a mass infiltrating lung tissue. Cryosurgery can be used as a method of palliative treatment for both these endobronchial and extrabronchial presentations. The aim of this study is two-fold: to present data relating to our extensive experience in treating obstructing endobronchial tumors and to present our initial results of direct cryosurgery to infiltrating lung tumor masses.During a nine-year period, 521 consecutive patients (male:female ratio 1.8:1) with a mean age of 67.9 years who had advanced obstructive tracheobronchial malignant tumors underwent cryosurgery with a mean of 2.4 treatments per patient. Hemoptysis, cough, dyspnoea and chest pain improved by at least one class in 76.4%, 69.0%, 59.25% and 42.6% (p<0.01) of symptomatic patients respectively. Quality of life studies showed that the mean Karnofsky score improved from 60 ± 7 to 75 ± 8 and the mean WHO score from 3.04 ± 0.7 to 2.20 ± 0.56. There were 7 (1.2%) in-hospital deaths, and 2-year survival was 15.9%.Direct cryosurgery to carcinoma of the lung was performed on 15 patients at exploratory thoracotomy. Results showed an increase in FEV1 from 1.80 ± 0.6 liters to 1.95 ± 0.8 (8.3%) liters and in FVC from 2.50 ± 0.8 to 2.68 ± 0.8 liters (7.2%). The Karnofsky score improved from 68 ± 9 to 78 ± 10 and the WHO score from 2.63 ± 0.81 to 2.38 ± 0.78 (9.6%).Major symptoms including cough, dyspnoea, and hemoptysis were assessed and showed improvement in 77.8%, 66.7%, and 100% (p<0.01) of symptomatic patients respectively.Patients were followed for a mean period of 18 months (range 4-84 months). Median survival from the date of surgery (Kaplan-Meier, 95%Cl) was 11.6 (6.8 to 18.2) months, range 1 to 84 months.Cryosurgery provides a safe and effective method for the palliation of advanced central bronchial obstructive tumors, and compares favorably with other methods in terms of safety, cost, and complications. Initial experience suggests that similar palliation may be achieved by cryosurgery applied to advanced parenchymal tumor masses.

Acute histopathological effects of cryotherapy on lung tissue

“…They inserted cryoprobes although the lung was ventilated and performed the therapy. By 6 months 86% of the treated areas were stable or smaller than the original tumor [10]. Pneumothorax due to the procedure occurred in 12% of the patients and only a few of them required tube thoracostomy.…”

“…It is a treatment option for patients with an airway obstruction, alternative to laser, diathermia, photodynamic therapy and stent applications [10][11][12][13][14][15][16]. Cryotherapy with minimal complication ratios were reported to be a good tolerated method by Maiwant et al [17][18].…”

Integration of interventional bronchoscopy in the management of lung cancer

“…With cryo-recanalisation, a normal bronchial calibre can be recovered in 61-91% of cases [34,43,44], allowing for the removal of 57% and 76% of total and lobar atelectasis, respectively [32]. A 54.6% improvement in the Karnofsky performance status index is due to a significant functional benefit, with an improvement in FEV1 and FVC of 65.2% and 57.8%, respectively [42], and of partial pressure of oxygen (71% of cases) [32].…”

“…This process requires a console, a cryoprobe [34,35] and cryogenic gas (N 2 O, N 2 , CO 2 [9,34]). The destructive damage inflicted by cryotherapy is both immediate (dehydration and cellular crystallisation) [7,[36][37][38][39] and delayed, involving apoptosis and ischaemia (microthrombi formation) [40], leading to a delayed yet prolonged result [7,36].…”

Feasibility and Safety of Pleuroscopic Cryobiopsy of the Pleura: A Prospective Study

“…Biopsy via cryoprobe, rst used in 1968, has mainly been employed in the management of obstructive endobronchial tumors. Recently, cryotherapy in bronchoscopy has been used for several purposes including management of endobronchial tuberculosis [10], endobronchial tumors [11][12][13], for diagnosis of interstitial lung disease (ILD) [14][15][16][17], and peripheral lung lesion [18]. ese studies have demonstrated that the cryoprobe is feasible and a more e cient diagnostic tool with a superior diagnostic rate and ability to obtain a larger specimen with better preserved cellular architecture than forceps biopsy.…”