Malignancy of the parietal pleura is a therapeutic challenge; cost, complex dosimetry, and efficacy have limited available treatment options. Spray cryotherapy with a liquid nitrogen spray cryocatheter has been successfully used to ablate neoplastic tissue and is FDA approved for this purpose. We report the initial safety and feasibility results of 20 patients treated within the pleural space with spray cryoablation.
20 patient charts and outcomes with biopsy-proven neoplastic disease in the parietal pleura treated with spray cryotherapy are reported. The parietal pleura was accessed in OR or procedure rooms; all patients had lesion biopsies for diagnostic confirmation. Once confirmed, tumors were treated and parameters included; duration of spray, thaw cycles and freeze cycles. Pleura were re-examined for clinical response, re-treatment and biopsies on day 1–3.
The pleural lesions were easily accessed and full dose of spray cryotherapy to a majority of visible tumors was accomplished. Treatment was applied exactly without any noticeable bystanders’ side effect. Pleuroscopic reexamination revealed a greater than 50% reduction in the size of the all treated tumors. No adverse events or bystanders normal tissue injury occurred and the patients showed symptomatic improvement over 30 days.
Spray cryotherapy offer a low complexity, relatively low cost therapeutic option for pleural- based malignancies. The first 20 patients’ results suggest that this technique is safe and feasible with encouraging tumor ablation.
Pleural neoplasm is a marker of systemic disease; often patient's receive palliative rather than therapeutic modalities. As targeted therapies for cancer expand, exactly defining the burden of pleural disease and having treatment options to reduce tumor burden rather than just decreasing symptoms becomes more relevant. Our initial findings suggest a multi-center prospective trial is warranted.
Gordon Downie, Consultant fee, speaker bureau, advisory committee, etc. Traveling expenses for being a member of CSA's advisory board; No Product/Research Disclosure Information