Egyptian Journal of Chest Disease and Tuberculosis (Jan 2019)
Fiberoptic bronchoscopic cryotherapy for endobronchial lung cancer: outcomes and predictors of success
Abstract
Background Endobronchial cryotherapy is used for destruction of intraluminal tumors. Most of the existing studies have elaborated the association of successful cryotherapeutic tumor removal and improved quality of life; however, there is a gap in the knowledge regarding the predictive factors. Objectives To compare the clinical, radiological, bronchoscopic, and functional parameters of patients with endobronchial malignancy before and after cryotherapy as a palliative treatment. In addition, complications and the predictive factors of success of this maneuver were also assessed. Patients and methods A prospective study was conducted on 40 (31 males and nine females) patients with endobronchial tumor. Clinical, radiological, bronchoscopic and functional data were evaluated before and after therapy. Patients were classified according to success of reconstruction of airways patency after cryotherapy into two groups, complete success 21/40 (52.5%) and partial success 19/40 (47.5%). Results There was a significant improvement in symptoms, radiology; pulmonary function tests (PFTs), arterial oxygen tension PaO2 and quality of life after bronchoscopic cryotherapy. Post treatment complications was reported in 2/40 (5%) cases in the form of fever, hemoptysis and infection. There was a significant statistical difference between both groups as regards site of lesion, vascularity of tumor, FEV1, PaO2, and PaCO2 (P<0.05). Logistic regression analysis for variable predictors of complete success revealed that: site of mass (right main bronchus), number of session of cryotherapy, tumor character (highly vascular), PaCO2, PaO2, and FEV1 were independent significant factors of success of reconstruction of airways patency. Conclusion Cryotherapy is effective modality of endobronchial debulking in treatment of central airway obstruction associating endobronchial malignancy. It relieve symptoms, improve PFTs, ABGs parameters, and quality of life in a significant way, more over it is easy, safe of low cost, and minimal complications. Site of endobronchial lesion, number of session of cryotherapy, highly vascular tumor, arterial blood gases (ABG), and PFT are factors that predict central airway obstruction recanalization.
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