Safety of Cryotherapy in Advanced Stage Esophageal Cancer, A Very Cool Treatment Option

Abstract

Introduction: Cryotherapy is a relatively new modality approved for tissue destruction in the gastrointestinal tract and has been shown to be safe in early esophageal cancer with efficacy in eradicating the cancer in some patients. There is, however, very limited data on cryotherapy in advanced esophageal cancer when used for palliation of dysphagia. Objective: To assess the safety of cryotherapy in advanced esophageal cancer as defined by T stage more than T2. Methods: Design: Single center retrospective cohort study. Setting: Tertiary care academic medical centers between 2006 and 2013. Patients: Subjects with esophageal cancer who were not surgical candidates and in whom conventional therapy failed, and those who refused or were ineligible for conventional therapy. Interventions: Cryotherapy with liquid nitrogen or carbon dioxide performed every 6 weeks for relief of dysphagia. The duration of freeze and number of cycles were determined based on the endoscopist impression of tumor and symptom response to the prior treatment session. Main Outcome Measurements: Complications.Figure 1Results: Thirty-two cryotherapy sessions were performed on patients with T3 esophageal cancer, including adenocarcinoma and squamous cell carcinoma in both the upper and lower third of the esophagus. If a decompression tube could be placed into the stomach, treatment with liquid nitrogen was performed and consisted of 3 to 4 cycles of 20 to 30 seconds of freeze and 45 seconds of thaw. If a decompression tube could not be placed because of the inability to traverse the tumor, then carbon dioxide was used with 7 to 12 cycles of 10 to 30 seconds of freeze and 45 to 60 minutes of thaw time. No immediate adverse events other that mild chest pain were reported. One patient developed a trachea-esophageal fistula in between cryotherapy cycles and required stenting. Conclusion: Spray cryotherapy appears to be safe and well-tolerated in patients with advanced stage esophageal cancer. Prospective well-designed studies to determine the efficacy of cryotherapy in this setting are needed. If proven effective, cryotherapy for dysphagia palliation in patients with advanced esophageal cancer will be a good treatment option for these patients with limited options.