Initial Combined Cryotherapy and Irradiation for Unresectable Non-small Cell Lung Cancer

Vergnon, Jean‐Michel; Schmitt, Thierry; Alamartine, Éric; Barthélémy, Jean‐Claude; Fournel, P.; Emonot, A

doi:10.1378/chest.102.5.1436

Cited by 86 publications

(39 citation statements)

References 13 publications

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“…Therapeutic bronchoscopy procedures, such as endobronchial laser and insertion of airway stents, are commonly used with a goal to relieve respiratory distress, improve quality of life, and potentially prolong survival. Several studies have demonstrated that in patients with unresectable obstructive lung cancer, a preliminary efficient debulking of the airway by laser photoresection or cryotherapy, before irradiation, lessens morbidity by reducing the number of local complications such as postobstructive infection, respiratory insufficiency, and hemoptysis (11,12,(24)(25)(26)(27). Chhajed and colleagues showed that patients with advanced lung cancer and malignant airway obstruction who underwent interventional bronchoscopy and systemic chemotherapy had survival similar to those without malignant airway obstruction who received systemic treatment (28).…”

Section: Original Researchmentioning

confidence: 99%

“…Effective recanalization of obstructed airways reduces postobstructive infections, respiratory insufficiencies, and duration of hospitalization, while improving quality of life (10)(11)(12). Local therapies also enhance the effect of subsequent systemic chemotherapy and/or external radiotherapy and have a favorable effect on survival outcomes (8).…”

mentioning

confidence: 99%

“…Local therapies also enhance the effect of subsequent systemic chemotherapy and/or external radiotherapy and have a favorable effect on survival outcomes (8). In contrast, failure to treat malignant airway obstruction, even if followed by radiotherapy, has been associated in several series with a poor prognosis (11,12).…”

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confidence: 99%

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Restoration of Patency to Central Airways Occluded by Malignant Endobronchial Tumors Using Intratumoral Injection of Cisplatin

et al. 2015

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Rationale: Malignant airway obstruction is commonly found in patients with lung cancer and is associated with significant morbidity and mortality. Relieving malignant obstruction may improve symptoms, quality of life, and life expectancy.Objectives: The objective of this study was to analyze our experience with bronchoscopic endobronchial intratumoral injection of cisplatin for malignant airway obstruction. Methods:We conducted a retrospective analysis of patients with malignant airway obstruction treated with bronchoscopic intratumoral injection of cisplatin. Patient characteristics, histology, degree of airway obstruction, procedural methods, treatment cycles, performance status, and therapeutic outcomes were evaluated. Tumor response was analyzed based on bronchoscopic measurements performed on completion the of final treatment session. Adverse events and overall survival were abstracted. Measurements and Main Results:Between January 2009 and September 2014, 22 patients (10 men, 12 women; mean age 6 SD, 64.4 6 9.5 yr) were treated with one to four injections of 40 mg of cisplatin mixed in 40 ml of 0.9% NaCl. Treatments were completed 1 week apart. The primary etiologies of airway obstruction included squamous cell carcinoma (n = 11), adenocarcinoma (n = 6), small cell carcinoma (n = 2), large cell undifferentiated carcinoma (n = 1), and metastatic endobronchial cancer (n = 2). Twenty-one of 22 patients were evaluable for response. The majority of patients (15/21, 71.4%) responded to therapy, defined as greater than 50% relative reduction in obstruction from baseline. Treatment response was obtained regardless of tumor histology, concurrent systemic therapy, number of treatment cycles administered, performance status, or use of additional ablative interventions. Responders had significantly improved overall survival as compared with nonresponders, although the difference was small. Severe treatment-related side effects or complications were not observed.Conclusions: Subject to the limitations of a single-center retrospective study and a subjective primary outcome measure, we have demonstrated the feasibility of improving the patency of central airways that are largely or completely occluded by endobronchial malignant tumor using intraluminal injection of cisplatin. Additional longer-term, larger-scale safety and comparative effectiveness studies of this palliative treatment modality are warranted.

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Section: Original Researchmentioning

confidence: 99%

mentioning

confidence: 99%

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Restoration of Patency to Central Airways Occluded by Malignant Endobronchial Tumors Using Intratumoral Injection of Cisplatin

et al. 2015

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“…Based on this clinical experience, the techniques and limits of cryotherapy were defined on both bulky tumours and in early stage lesions. The combination of cryotherapy with irradiation or chemotherapy was then tested in humans and produced encouraging results [15,16]. Since 1996, interest in cryotherapy has grown in the USA with the introduction of flexible probes [17].…”

Section: Introductionmentioning

confidence: 99%

Place of cryotherapy, brachytherapy and photodynamic therapy in therapeutic bronchoscopy of lung cancers

Rm²,

Moghissi³

2006

Eur Respir J

172

124

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Cryotherapy, brachytherapy and photodynamic therapy (PDT) are three different methods proposed in the endoluminal treatment of lung cancers. The current article presents an overview of the specific indications and limits of each technique.These three methods were first proposed with palliative intent in inoperable patients with centrally located lung cancers. Now, the best indication is a curative intent in early stage lung cancers.Of the three, cryotherapy is the cheapest method. It induces cell necrosis in a 3-mm radius around the probe, and is suitable for treatment of superficial tumours. However, clinical trials are limited. In contrast, many clinical studies have confirmed the efficacy of PDT in treatment of superficial lung cancers. Brachytherapy can cure more aggressive tumours with deeper invasion into the bronchial wall. Unfortunately, no comparative studies have been published. Each of these methods induces a delayed tumour necrosis, and thus neither is indicated in the treatment of obstructive tumours with acute dyspnoea. In many situations, these methods should be complementary, particularly cryotherapy and brachytherapy or PDT and brachytherapy.The combination of these endoscopic methods with chemotherapy should be widely tested to promote the adjuvant role of the endoscopic methods in the treatment of lung cancers.

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“…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].…”

Section: Discussionmentioning

confidence: 99%

Acute histopathological effects of cryotherapy on lung tissue

Yoldaş¹,

Çakan²,

Çağırıcı³

et al. 2016

Curr Thorac Surg

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Initial Combined Cryotherapy and Irradiation for Unresectable Non-small Cell Lung Cancer

Cited by 86 publications

References 13 publications

Restoration of Patency to Central Airways Occluded by Malignant Endobronchial Tumors Using Intratumoral Injection of Cisplatin

Restoration of Patency to Central Airways Occluded by Malignant Endobronchial Tumors Using Intratumoral Injection of Cisplatin

Place of cryotherapy, brachytherapy and photodynamic therapy in therapeutic bronchoscopy of lung cancers

Acute histopathological effects of cryotherapy on lung tissue

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