AOS7 Role of cryotherapy in multidisciplinary management of endobronchial metastases

Abstract

Background Metastases to the bronchial tree from extrapulmonary malignancies can cause significant symptoms that preclude systemic treatment of the primary disease. The aim in this study was to assess the role of cryotherapy as part of a multidisciplinary treatment in patients with endobronchial metastases. Methods Between 1995 and 2011, 35 patients (23 men; age range 22–80 years) with endobronchial metastases (11 colorectal, 11 renal, 4 oesophageal, 9 other) received endobronchial cryotherapy under general anaesthetic via a rigid and fiberoptic bronchoscope (temperature 70 °C; exposure to probe 240 s, number of freezing cycles 1–4, number of procedures 1–5) as part of the multidisciplinary treatment for the primary tumour. The main presenting symptom was dyspnoea in 14, stridor in 9, haemoptysis in 7, and cough in 5 patients. Findings There were no peri-operative or in-patient deaths. Endobronchial cryotherapy was undertaken as a day-case procedure in more than 80% of cases. Survival from starting cryotherapy was from 10 days to 4 years and 8 months, with a median of 34 weeks. Twenty-two patients reported a significant improvement in their main presenting symptom. In half the patients, endoluminal patency was increased by 50% or more after cryotherapy. Improvement allowed the majority of the patients to continue systemic treatment of their primary tumour. Interpretation Endolumenal cryotherapy is a safe and effective treatment modality in patients with symptoms secondary to endobronchial metastases. Cryotherapy gives rapid resolution of symptoms and can be undertaken as a day-case procedure in most patients. It improves the patient’s condition, permitting systemic treatment of the primary tumour. The authors declared no conflicts of interest.