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Disorders of the Pleura |

Response to Spray Cryotherapy in Patients With Malignancy on the Parietal Pleura: A Seven-Year Experience

Adam Wellikoff, MD; William Krimsky, MD; Gordon Downie, MD
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LSU Health - Shreveport, Shreveport, LA


Chest. 2015;148(4_MeetingAbstracts):436A. doi:10.1378/chest.2280412
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Abstract

SESSION TITLE: Disorders of the Pleura Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: To evaluate the use of spray cryotherapy (SCT) for the palliation of parietal pleural-based malignancies by reporting safety and efficacy as it relates to pleurodesis and pain control.

METHODS: IRB approval for chart review was obtained for 36 patients over a 7-year period representing 45 separate SCT sessions. Data analyzed included diagnosis, pre/post-procedure pain, ability to achieve pleurodesis, and bystander effects. The technique and dosimetry for treatment within the pleura has been previously reported. Of note, two generations of the devise were used and delivery of the cryotherapy was via either medical pleuroscopy or video-assisted thoracoscopy (VATS) at the discretion of the interventionalist.

RESULTS: Thirty-six patients underwent 45 separate sessions of SCT. The initial 6 patients (12 cases) were previously reported and therefore not included in this review. VATS was employed in 9/33 cases and medical pleuroscopy in twenty-four. Pleurodesis was actively prevented in 6 cases by instilling normal saline in large quantities. Pleurodesis was not achieved or only partially achieved in 7/27 (26%) and achieved in 20/27 (74%). Pre-procedure pain was reported in 28/33 (85%) of which 18 (64%) reported resolution post-procedure. There was no observed bystander side effects and all cases showed a typical cherry-red tissue response indicating necrosis.

CONCLUSIONS: Observations over a seven-year period show that SCT is a safe and technically straightforward procedure no with bystander effects. A significant portion of cases demonstrated rapid pleurodesis with attenuation of pain. A wide spectrum of malignancies were treated within the parietal pleural and all showed signs of tissue necrosis.

CLINICAL IMPLICATIONS: Malignant pleural effusions are a common clinical problem affecting over 150,000 people in the United States annually and are often associated with debilitating symptoms and a poor prognosis. This poses a difficult therapeutic challenge. Debate whether this should be interpreted as a marker of systemic disease with a grim prognosis or if a portion could be treated aggressively with loco-regional ablation and achieve prolonged palliation has been raised. SCT has been used successfully in the aerodigestive tract to palliate advanced disease as well as to treat carcinoma-in-situ and mirco-invasive disease. Seeking alternatives therapies within the pleura, including SCT, seem warranted as the benefits may include tumor ablation, rapid pleurodesis, pain control, and an improved performance status

DISCLOSURE: The following authors have nothing to disclose: Adam Wellikoff, William Krimsky, Gordon Downie

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