PURPOSE: Tracheobronchial obstructions due to malignant tumors are difficult to manage. Spray cryotherapy (SCT) delivers liquid nitrogen via an endoscopic catheter causing tissue destruction, but is also hemostatic. We report the safety and efficacy of SCT for the treatment of malignant airway obstruction (MAO).
METHODS: Via bronchoscopy, SCT was performed on patients with MAO. Demographics, tumor location, intraoperative events and % obstruction pre and post treatment were analyzed.
RESULTS: 41 treatments were performed in 34 patients. Median age was 60 yrs (range 15-88). There were 11 tracheal tumors, and 30 treatments were for tumors > 75% occlusive. All but one patient had improved luminal patency. 16 tumors were primary lung cancer, 16 metastatic lesions and 2 aggressive benign tumors. Median procedure length was 74 minutes (15-167 min) and 59% of the cases were outpatient with 3 post-procedure admissions. Eleven patients had transient intraoperative events, including hypotension, brady- and tachycardia. 5 patients had major intraoperative events including 3 cardiac arrests (resulting in one myocardial infarction, one death, and one delayed discharge at 4 days later with no sequelae), and two pneumothoraces (one requiring emergent tube thoracostomy).
CONCLUSIONS: SCT yielded good results but a higher than expected morbidity and mortality, including one intraoperative death and MI. These cardiac events may involve either direct or indirect cardiac injury or some other mechanism. Further animal studies are required to determine the etiology of these events, and possible solutions to correct them, prior to advocating use of SCT for treatment of MAO.
CLINICAL IMPLICATIONS: Spray cryotherapy is currently used to treat early esophageal cancer and Barrett's and has been used to treat a variety of airway disorders. Serious cardiac events have occurred with the use of SCT in the airway and further study is needed to elucidate the cause prior to widespread use of SCT in the airway.
DISCLOSURE: The following authors have nothing to disclose: David Finley, Joseph Dycoco, James Huang, Mohit Chawla, Nabil Rizk, Inderpal Sarkaria, Manjit Bains, Valerie Rusch
Spray Cryotherpay is approved for the destruction of unwanted tissue via an endoscope. It does not have FDA approval for use in the airway, so this is considered an off-label use of the device.