Abstract

Objectives: At diagnosis about 80% of patients with tracheobronchial carcinoma are in an advanced stage of the disease and one third of these present with a tumour blocking a large bronchial lumen, causing distressing symptoms. Early physical reopening and treatment of the airways is required for symptomatic improvement, and this can be achieved by cryotherapy, the controlled application of extreme cold.

Method: We present a prospective study of 153 consecutive patients, cryotreated between January 1995 and December 1997 with a mean age of 68.8 years and M: F ratio 1.59:1. A temperature of about -70°C is delivered to the tumour site for two three-minute periods causing destruction of the bulk of the tumour. Patients were evaluated clinically and for quality of life indices before and after treatment. Histological composition was; non-small cell 88.2%, small cell 11.1%, malignant melanoma 0.7%. The NSCLC TNM staging at the time of treatment was I & II 7.2%, IIIa 24.4%, IIIb 23.0%, IV 34.2%.

Results: Symptomatic improvements for cough (68.3%), dyspnoea (63.9%), haemoptysis (92.7%) and chest pain (55.5%). Respiratory function tests showed improvements in mean FEW from 1.341 to 1.451 (p = 0.001) and mean FVC from 1.931 to 2.021 (p = 0.035). Improvements in the quality of life scores were found for Karnofsky (54.6%) and WHO scale (39.4%). Kaplan-Meier median survival time (95%cl) was 393 days.

Conclusion: Cryotherapy provides effective and rapid symptom control and improves quality of life for patients with endobronchial carcinoma. It is easy to perform, with minimum complications and the majority of patients are discharged the same day.