Chest
Clinical InvestigationsCancerCryotherapy in Early Superficial Bronchogenic Carcinoma
Section snippets
Patient Selection Criteria
All patients with an exclusive diagnosis of ESBC detected by conventional white-light flexible bronchoscopy (FB) were eligible for the protocol. These lesions presented as irregular and well-limited zones of thickening. The ESBC features defined on criteria previously described3,4 were further proven on multiple biopsies, with negative radiographic and CT scans findings. After informed consent, these patients underwent cryotherapy alone (even when operable).
Population
Thirty-five patients (34 men and 1
Tolerance
Tolerance to cryotherapy was judged excellent. There was neither hemoptysis nor bronchial wall perforation. There were no severe adverse effects due to general anesthesia. We did observe transient fever following cryotherapy in the first patients; this was prevented later by preventive corticosteroid administration. Necrotic slough never caused significant cough or dyspnea as is sometimes observed when cryotherapy is used as a debulking method.13
Local Tumor Control
Results were available for all patients at 1
Discussion
The outcome of bronchogenic CIS is now clearly demonstrated as unfavorable, with progression to invasive carcinoma.15This is confirmed by our results, since six of our seven recurrences were invasive lesions; therefore, ESBC must be treated aggressively.
The choice of therapy for ESBC is under debate.4 Surgical resection remains frequently recommended, while reports published are limited, present contradictory data, and include few patients.16,17,18 When the surgery concerns more than one lobe,
Conclusion
For ESBC, we think that conservative therapy could be proposed as first-line treatment, sparing the pulmonary parenchyma and allowing surgical salvage when necessary. A frequent endoscopic control is recommended to detect recurrence or other locations. Based first on the efficacy-tolerance ratio and then on the favorable cost of each method, we suggest that cryotherapy should be the best first choice. Randomized trials with long-term follow-up are needed to compare results of cryotherapy to
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