Tuberc Respir Dis.  2008 Apr;64(4):272-277. 10.4046/trd.2008.64.4.272.

Clinical Benefits and Complications of Cryotherapy in Advanced Lung Cancer with Central Airway Obstruction

• Jung JY
• Lee SY
• Kim DH
• Lee KJ
• Lee EJ
• Kang EH
• Jung KH
• Kim JH
• Shin C
• Shim JJ
• In KH
• Kang KH
• Yoo SH

• KMID: 1970177
• DOI: http://doi.org/10.4046/trd.2008.64.4.272

Abstract

BACKGROUND: The efficacy of the use of the interventional bronchoscope for palliation of patients with central airway obstruction has been established. In the palliative setting to alleviate central airway obstruction, the use of laser resection, electrocautery, argon plasma coagulation, photodynamic therapy and cryotherapy can provide relief of an airway obstruction. Cryotherapy is the therapeutic application of extreme cold for the local destruction of living tissue. Recently, this technique has been used for endoscopic management of central airway obstructions in Korea. We report the role and complications of the use of cryotherapy for airway obstructions in patients with advanced lung cancer.
METHODS
We used a flexible cryoprobe for cryotherapy using nitrous oxide as a cryogen. The cryoprobe was applied through the working channel of a flexible fiberoptic bronchoscope. The temperature of the tip was approximately -89degrees C, and the icing time was 5~20 seconds.
RESULTS
Four patients with a central airway obstruction from advanced lung cancer were treated with cryotherapy. Three of the four patients were treated successfully and the airway obstruction was improved after the cryotherapy procedure. Dyspnea, hypoxia and atelectais were improved in three cases. Two patients experienced complications-one patient experienced pneumomediastinum and the other patient experienced massive hemoptysis during the cryotherapy procedure. However, these complications resolved and did not influence mortality.
CONCLUSION
This technique is effective and relatively safe for palliation of inoperable advanced lung cancer with a central airway obstruction.

Keyword

Cryotherapy; Central airway obstruction; Lung cancer

MeSH Terms

Airway Obstruction
Anoxia
Argon Plasma Coagulation
Bronchoscopes
Cryotherapy
Dyspnea
Electrocoagulation
Extreme Cold
Hemoptysis
Humans
Korea
Lung
Lung Neoplasms
Mediastinal Emphysema
Nitrous Oxide
Photochemotherapy
Nitrous Oxide

Figure

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  Figure 1 The chest PA and bronchoscopic finding before (A, C) and after (B, D) cryotherapy in case 2. The chest PA shows near completely obstructed left main bronchus and atelectasis of left lung. After cryotherapy, atelectasis of left lung was completely recovered, however pneumomediastinum and subcutaneous emphysema were developed (B, arrow). Bronchoscopic finding shows perforated carina after cryotherapy (D, arrow).

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  Figure 2 The chest PA and bronchoscopic finding before (A, C) and after (B, D) cryotherapy in case 3. The right main bronchus was completely obstructed by the intraluminal ingrowing tumor lesion that was extending to the distal trachea and developed severe airway obstruction (A, C). The ingrowing tumor lesion was disappeared by cryotherapy and also some aeration was noted on right upper area in chest CT scan (B, D).

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