PURPOSE: Malignancy of the parietal pleura is a therapeutic challenge; barriers to pleural treatments have been cost, complex dosimetry, and efficacy. Spray cryotherapy with a liquid nitrogen spray cryocatheter is FDA-certified (K072651) to destroy tissue and has been used with success within the GI tract. We report thirty cases of intra-pleural malignancies treated with this technology.
METHODS: Thirty patients from three institutions with biopsy-proven neoplastic disease in the parietal pleura were treated. The parietal pleura was accessed via either medical thoracoscopy or video-assisted thoracoscopy. Tumor treatment parameters included; duration of spray cycles and freeze cycles as well as the initial clinical response. Six of the thirty patients had follow-up medical thoracoscopies to document long-term response. Follow-up thoracoscopies for the remaining twenty-four were not indicated given the high success rate of pleurodesis. Of the patients not undergoing follow-up thoracoscopy, clinical response was followed by radiographic assessment.
RESULTS: The pleural lesions were easily accessed and full doses of spray cryotherapy to all visible tumors was accomplished. Treatment was applied exactly without any noticeable bystander side effect as defined by lung, vasculature, pericardium, and non-treated parietal pleura. Pleuroscopic re-examination of the first six patients revealed a greater than 50% reduction in the size of the all treated tumors. No adverse events occurred and the patients showed symptomatic improvement over 30 days. Pleurodesis was seen within 24 to 48 hours in greater than 80% of the patients. No radiographic evidence of progression of the pleural disease was seen within the first six months of treatment.
CONCLUSIONS: Pleural metastasis is often a marker of systemic disease and patients usually receive palliative rather than therapeutic modalities. As targeted therapies for cancer expand, exactly defining the burden of pleural disease becomes more relevant. Spray cryotherapy offer a low complexity, relatively low cost therapeutic option for pleural-based malignancies.
CLINICAL IMPLICATIONS: Our first thirty patients’ results suggest that the procedure is safe, feasible, and of low complexity as well as clinically efficacious.
DISCLOSURE: The following authors have nothing to disclose: Adam Wellikoff, Saiyad Sarkar, Dominic DeKartary, Esther Fields, Gordon Downie
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