Chest
Volume 120, Issue 1, July 2001, Pages 26-31
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Clinical Investigations
Cancer
Cryotherapy in Early Superficial Bronchogenic Carcinoma

https://doi.org/10.1378/chest.120.1.26Get rights and content

Background

Treatment of early superficial bronchogeniccarcinoma (ESBC) is under debate, and no consensus has been achieved. Different therapeutic methods have been proposed, including surgicalresection and endoscopic methods.

Study objective

Toassess the efficacy of cryotherapy in patients with ESBC.

Patients and methods

Patients included in the study hadhistologically proven ESBC after fiberoptic bronchoscopy. Cryotherapywas performed through a rigid bronchoscope. Efficacy was assessed byendoscopy with multiple biopsies 1 month after treatment and during thefollow-up period. Parameters studied were response to treatment, adverse effects, and survival.

Results

We included 35patients (34 men and 1 woman). The mean age was 61 ± 9 years. Multiple locations of ESBC were observed in seven patients (20%). Complete response rate at both 1 month and 1 year was 91% (32patients). No severe adverse effects were noted. Local recurrence wasobserved within 4 years in 10 patients (28%). A follow-up period of atleast 4 years was available in 22 patients; of them, 11 patients (50%)were long-term survivors.

Conclusion

Our resultssuggest that cryotherapy is an effective method of treatment inpatients with ESBC. Due to its relative tolerance compared to surgery, cryotherapy could be proposed as a first-line therapy in thispopulation with high carcinogenic risk.

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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