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Zhang H, Zhu X, Zeng Z, Gao X. Interventional therapy combined with radiotherapy for pancreatic carcinoma. INTEGRATIVE PANCREATIC INTERVENTION THERAPY 2021:523-539. [DOI: 10.1016/b978-0-12-819402-7.00023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Shepherd RW, Radchenko C. Bronchoscopic ablation techniques in the management of lung cancer. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:362. [PMID: 31516908 DOI: 10.21037/atm.2019.04.47] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Central airway involvement is a common manifestation of lung cancer during the disease course. Some patients will require bronchoscopic therapeutic interventions to palliate symptoms, or less commonly to provide more definitive therapy of airway involvement. We describe an overview specifically of bronchoscopic ablative techniques that are available for use in malignant airway obstruction. Techniques that are more commonly used include bronchoscopic application of laser, electrocautery, argon plasma coagulation (APC), cryotherapy and mechanical debulking techniques. Less commonly employed are brachytherapy and photodynamic therapy. These techniques may be applied via flexible or rigid bronchoscopy depending upon the clinical scenario. The choice of technique depends on available tools and expertise, the urgency of the clinical scenario, and whether the lesion is predominately endobronchial, extrinsic compression, or a combination of both. Malignant airway obstruction is a common finding in lung cancer and there are a number of effective bronchoscopic ablative techniques that may be employed safely to palliate patients with a significant symptom burden.
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Affiliation(s)
- Ray W Shepherd
- Division of Pulmonary and Critical Care, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Christopher Radchenko
- Division of Pulmonary and Critical Care, University of Cincinnati Health System, Cincinnati, OH, USA
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He L, Niu L, Korpan NN, Sumida S, Xiao Y, Li J, Sutedja B, Lu Y, Zuo J, Liu J, Xu K. Clinical Practice Guidelines for Cryosurgery of Pancreatic Cancer: A Consensus Statement From the China Cooperative Group of Cryosurgery on Pancreatic Cancer, International Society of Cryosurgery, and Asian Society of Cryosurgery. Pancreas 2017; 46:967-972. [PMID: 28742542 PMCID: PMC5555970 DOI: 10.1097/mpa.0000000000000878] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/08/2017] [Indexed: 12/12/2022]
Abstract
Pancreatic cancer (PC), one of the most lethal malignancies, accounts for 8% to 10% of digestive system cancers, and the incidence is increasing. Surgery, chemotherapy, and radiotherapy have been the main treatment methods but are not very effective. Cryosurgery was first used in 1984 for treatment of locally advanced PC and has since become a considerable treatment for most cases of unresectable PC. During the past decade, cryosurgery has been applied in some hospitals in China, and the newly developed technique of computed tomography- and/or ultrasound-guided percutaneous cryosurgery has shown better results than chemotherapy in cases of unresectable locally advanced PC, with the 1-year survival rate reported to be more than 50%. To develop standardized criteria for the application of cryosurgery in PC, the International Society of Cryosurgery and Asian Society of Cryosurgery assembled experts from Austria, Japan, and China to discuss treatment methods and arrive at a consensus on the indications, contraindications, and preferred techniques of PC cryosurgery.
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Affiliation(s)
- Lihua He
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Lizhi Niu
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Nikolai N. Korpan
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Sajio Sumida
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yueyong Xiao
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Jiaping Li
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Barlian Sutedja
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Youyong Lu
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Jiansheng Zuo
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Jianguo Liu
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Kecheng Xu
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
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Guibert N, Mhanna L, Droneau S, Plat G, Didier A, Mazieres J, Hermant C. Techniques of endoscopic airway tumor treatment. J Thorac Dis 2016; 8:3343-3360. [PMID: 28066616 DOI: 10.21037/jtd.2016.11.49] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Interventional bronchoscopy has a predominant role in the management of both early and advanced-stage airway tumors. Given the very poor prognosis of lung cancer, there is a need for new tools to improve early detection and bronchoscopic treatment of endo-bronchial precancerous lesions. In more advanced stages, interventional bronchoscopy plays an important role, as nearly a third of lung cancers lead to proximal airway obstruction. This will cause great discomfort or even life-threatening symptoms related to local extension, such as dyspnea, post-obstructive pneumonia, and hemoptysis. Surgery for very locally advanced disease is only effective for a limited number of patients and the effects of conventional antitumor therapies, like radiation therapy or chemotherapy, are inconstant and are too delayed in a palliative context. In this review, we aim to provide pulmonologists with an exhaustive technical overview of (I) the bronchoscopic management of benign endobronchial lesions; (II) the bronchoscopic management of malignant tumors, including the curative treatment of localized lesions and palliative management of malignant proximal airway stenosis; and (III) descriptions of the emerging endoscopic techniques used to treat peripheral lung tumors.
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Affiliation(s)
- Nicolas Guibert
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Laurent Mhanna
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Sylvain Droneau
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Gavin Plat
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Alain Didier
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Julien Mazieres
- Pulmonology Department, Larrey University Hospital, Toulouse, France
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Bronchoscopic Cryotherapy. Clinical Applications of the Cryoprobe, Cryospray, and Cryoadhesion. Ann Am Thorac Soc 2016; 13:1405-15. [DOI: 10.1513/annalsats.201601-062fr] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Le Pivert P, Haddad RS, Aller A, Titus K, Doulat J, Renard M, Morrison DR. Ultrasound Guided Combined Cryoablation and Microencapsulated 5-Fluorouracil Inhibits Growth of Human Prostate Tumors in Xenogenic Mouse Model Assessed by Luminescence Imaging. Technol Cancer Res Treat 2016; 3:135-42. [PMID: 15059019 DOI: 10.1177/153303460400300206] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Modern approaches to minimally invasive ablative treatment of solid tumors involve the use of miniature instruments and combined treatments. These can be enhanced with ultrasound imaging that depicts tumor margins; facilitates guidance, delivery, and dosage of local chemotherapy; and can monitor the effectiveness of the treatment. This paper describes the advantages of ultrasound guided cryosurgery combined with local chemotherapy delivered in multilamellar, echogenic microcapsules of 5-FU (“μcaps”) using a xenograft tumor model. Genetically engineered bioluminescent human prostate tumor cells, DU-145Luc+, were implanted subcutaneously into athymic nude mice. Experiments were designed to mimic the situation where palliative cryoablation spares a portion of the tumor so that the combined effect of cryosurgery and focal injections of chemotherapeutic microcapsules could be evaluated. Eighteen (18) tumors were treated with percutaneous partial cryoablation or interstitial chemoablation, or a combination of both. A single F/T cycle was applied to tumor and micro-encapsulated chemotherapy is delivered at outer margin of frozen tumor in two opposite sites. Results show that the tumor and cryosurgical kill zone contours were seen with both the bio-luminescence assay (BLI) and ultrasonography (US). US can easily detect as little as 2 μl of echogenic μcaps, and monitor their lifetime in the tumor tissue. BLI was determinant in showing that minute amounts of microcapsule chemotherapy (38.7 ng of 5-FU/g tumor) dramatically inhibited tumor growth starting within two days after injection. The mean BLI emitted by control tumors was 5.6 times greater at Day 4 than the BLI measurements from tumors treated with 5-FU μcaps (p=0.036). By Day 7, BLI values from the control tumors were still 2.7 times greater than those treated with 5-FU μcaps (p<0.01). In tumors treated by partial cryoablation, the mean BLI of viable tumor cells was 20 times less at day 3 (p=0.05) and 46% less at day 7 than the non-treated tumors. The combined treatment produced a dramatic inhibition of tumor growth that lasted throughout the 7-day study. The BLI measured from viable tumor cells in non-treated tumors was 34 times greater at day 3 and more than 350 times greater at day 7 than those treated by combined cryoablation and 5-FU μcaps. The results demonstrated, for the first time, that a single moderate freeze of a human prostate tumor combined with bi-focal peripheral microcapsule chemotherapy (5-FU) has a better and longer inhibitory effect on tumor growth compared to the growth inhibition rendered by cryosurgery or local microcapsule chemo-therapy alone. This shows promise for a new, focal, combined ablative modality using US guided deposition of microencapsulated drug(s) and echogenic markers deposited in the hypothermic margin of tumors which could enhance the efficacy of cryoablation of prostate cancers.
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Affiliation(s)
- Patrick Le Pivert
- Medical Affairs, Critical Care Innovation, Chantilly, VA 20151, USA.
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Abstract
Cryosurgery for diverse neoplastic and non-neoplastic diseases has expanded in applicability in recent years, especially since intraoperative ultrasound became available as a method of monitoring the process of tissue freezing. However, persistence of disease after presumably adequate cryosurgical treatment has disclosed deficiencies in the technique, perhaps due to faulty application of the freeze-thaw cycles or due to shortcomings in the imaging method. Clearly cryosurgical technique is less than optimal. The optimal dosimetry for tissue freezing, the recent improvements in imaging techniques, and the need for adjunctive therapy are defined in this review, which assesses the progress toward improving the efficacy of cryosurgery.
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Affiliation(s)
- J G Baust
- Institute of Biomedical Technology, State University of New York, Binghamton, NY 13902 USA.
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Guibert N, Mazieres J, Marquette CH, Rouviere D, Didier A, Hermant C. Integration of interventional bronchoscopy in the management of lung cancer. Eur Respir Rev 2016; 24:378-91. [PMID: 26324799 DOI: 10.1183/16000617.00010014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Tracheal or bronchial proximal stenoses occur as complications in 20-30% of lung cancers, resulting in a dramatic alteration in quality of life and poor prognosis. Bronchoscopic management of these obstructions is based on what are known as "thermal" techniques for intraluminal stenosis and/or placement of tracheal or bronchial prostheses for extrinsic compressions, leading to rapid symptom palliation in the vast majority of patients. This invasive treatment should only be used in cases of symptomatic obstructions and in the presence of viable bronchial tree and downstream parenchyma. This review aims to clarify 1) the available methods for assessing the characteristics of stenoses before treatment, 2) the various techniques available including their preferred indications, outcomes and complications, and 3) the integration of interventional bronchoscopy in the multidisciplinary management of proximal bronchial cancers and its synergistic effects with the other specific treatments (surgery, radiotherapy or chemotherapy).
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Affiliation(s)
- Nicolas Guibert
- Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France
| | - Julien Mazieres
- Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France
| | - Charles-Hugo Marquette
- Hospital Pasteur and Institute for Research on Cancer and Ageing (IRCAN) (Inserm U10181/UMR CNRS 7284) University Nice Sophia Antipolis, Nice, France
| | - Damien Rouviere
- Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France
| | - Alain Didier
- Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France
| | - Christophe Hermant
- Service de Pneumologie-Allergologie, Hôpital Larrey - CHU de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse, France
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Sachdeva A, Pickering EM, Lee HJ. From electrocautery, balloon dilatation, neodymium-doped:yttrium-aluminum-garnet (Nd:YAG) laser to argon plasma coagulation and cryotherapy. J Thorac Dis 2016; 7:S363-79. [PMID: 26807284 DOI: 10.3978/j.issn.2072-1439.2015.12.12] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Over the past decade, there has been significant advancement in the development/application of therapeutics in thoracic diseases. Ablation methods using heat or cold energy in the airway is safe and effective for treating complex airway disorders including malignant and non-malignant central airway obstruction (CAO) without limiting the impact of future definitive therapy. Timely and efficient use of endobronchial ablative therapies combined with mechanical debridement or stent placement results in immediate relief of dyspnea for CAO. Therapeutic modalities reviewed in this article including electrocautery, balloon dilation (BD), neodymium-doped:yttrium-aluminum-garnet (Nd:YAG) laser, argon plasma coagulation (APC), and cryotherapy are often combined to achieve the desired results. This review aims to provide a clinically oriented review of these technologies in the modern era of interventional pulmonology (IP).
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Affiliation(s)
- Ashutosh Sachdeva
- 1 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, University Maryland, Baltimore, MD 21201, USA ; 2 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Edward M Pickering
- 1 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, University Maryland, Baltimore, MD 21201, USA ; 2 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Hans J Lee
- 1 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, University Maryland, Baltimore, MD 21201, USA ; 2 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
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Luo XM, Niu LZ, Chen JB, Xu KC. Advances in cryoablation for pancreatic cancer. World J Gastroenterol 2016; 22:790-800. [PMID: 26811625 PMCID: PMC4716077 DOI: 10.3748/wjg.v22.i2.790] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 07/07/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
Pancreatic carcinoma is a common cancer of the digestive system with a poor prognosis. It is characterized by insidious onset, rapid progression, a high degree of malignancy and early metastasis. At present, radical surgery is considered the only curative option for treatment, however, the majority of patients with pancreatic cancer are diagnosed too late to undergo surgery. The sensitivity of pancreatic cancer to chemotherapy or radiotherapy is also poor. As a result, there is no standard treatment for patients with advanced pancreatic cancer. Cryoablation is generally considered to be an effective palliative treatment for pancreatic cancer. It has the advantages of minimal invasion and improved targeting, and is potentially safe with less pain to the patients. It is especially suitable in patients with unresectable pancreatic cancer. However, our initial findings suggest that cryotherapy combined with 125-iodine seed implantation, immunotherapy or various other treatments for advanced pancreatic cancer can improve survival in patients with unresectable or metastatic pancreatic cancer. Although these findings require further in-depth study, the initial results are encouraging. This paper reviews the safety and efficacy of cryoablation, including combined approaches, in the treatment of pancreatic cancer.
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Lyu J, Song JW, Hong SB, Oh YM, Shim TS, Lim CM, Lee SD, Koh Y, Kim WS, Kim DS, Choi CM. Bronchoscopic Cryotherapy in Patients with Central Airway Obstruction. Tuberc Respir Dis (Seoul) 2010. [DOI: 10.4046/trd.2010.68.1.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jiwon Lyu
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Woo Song
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Bum Hong
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon-Mok Oh
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Sun Shim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chae-Man Lim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Do Lee
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Younsuck Koh
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Sung Kim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Soon Kim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Min Choi
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Gage AA, Baust JM, Baust JG. Experimental cryosurgery investigations in vivo. Cryobiology 2009; 59:229-43. [PMID: 19833119 DOI: 10.1016/j.cryobiol.2009.10.001] [Citation(s) in RCA: 182] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 09/30/2009] [Accepted: 10/01/2009] [Indexed: 12/16/2022]
Abstract
Cryosurgery is the use of freezing temperatures to elicit an ablative response in a targeted tissue. This review provides a global overview of experimentation in vivo which has been the basis of advancement of this widely applied therapeutic option. The cellular and tissue-related events that underlie the mechanisms of destruction, including direct cell injury (cryolysis), vascular stasis, apoptosis and necrosis, are described and are related to the optimal methods of technique of freezing to achieve efficacious therapy. In vivo experiments with major organs, including wound healing, the putative immunological response following thawing, and the use of cryoadjunctive strategies to enhance cancer cell sensitivity to freezing, are described.
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Affiliation(s)
- A A Gage
- Department of Surgery, SUNY Buffalo, Buffalo, NY, USA
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Optimisation and molecular signalling of apoptosis in sequential cryotherapy and chemotherapy combination in human A549 lung cancer xenografts in SCID mice. Br J Cancer 2009; 100:1896-902. [PMID: 19455143 PMCID: PMC2714231 DOI: 10.1038/sj.bjc.6605046] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We define the optimal parameters for combination of cryotherapy (nitrous oxide) with chemotherapy (vinorelbine ditartrate, VNB) treatment and characterise some of the signals involved for apoptosis activation. No advantage appeared when cryotherapy and VNB were combined simultaneously compared to cryosurgery alone. In contrast, tumour volumes were reduced after a sequential treatment schedule, where each individual treatment was separated by 48 h. No significant benefit appeared when the sequential treatment was separated by 24 h, although some individual mice showed a good response. The sequence of treatment had no impact on the observed tumour growth inhibition in mice. The number of apoptotic cells was significantly augmented in the sequential treatment schedule where VNB was administered 48 h before cryotherapy. In this sequential treatment, the number of apoptotic cells correlated with heightened expression of the BH3-only Puma, Noxa and Bim-EL, at both the mRNA and protein levels. No significant change in Bax, Bcl-xL and Bcl-2 mRNA expression was apparent, whereas Mcl-1 expression increased only slightly to a much lower level than BH3-only mRNAs. Our data indicate that 48 h sequential rather than simultaneous cryotherapy with VNB in future cancer cryochemotherapy schedules will enhance the tumour response, and argue that VNB administration, 48 h before cryotherapy, will provoke apoptosis more efficiently.
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Xu KC, Niu LZ, Hu YZ, He WB, He YS, Li YF, Zuo JS. A pilot study on combination of cryosurgery and 125iodine seed implantation for treatment of locally advanced pancreatic cancer. World J Gastroenterol 2008; 14:1603-11. [PMID: 18330956 PMCID: PMC2693760 DOI: 10.3748/wjg.14.1603] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the therapeutic value of combination of cryosurgery and 125iodine seed implantation for locally advanced pancreatic cancer.
METHODS: Forty-nine patients with locally advanced pancreatic cancer (males 36, females 13), with a median age of 59 years, were enrolled in the study. Twelve patients had liver metastases. In all cases the tumors were considered unresectable after a comprehensive evaluation. Patients were treated with cryosurgery, which was performed intraoperatively or percutaneously under guidance of ultrasound and/or computed tomography (CT), and 125iodine seed implantation, which was performed during cryosurgery or post-cryosurgery under guidance of ultrasound and/or CT. A few patients received regional celiac artery chemotherapy.
RESULTS: Thirteen patients received intraoperative cryosurgery and 36 received percutaneous cryosurgery. Some patients underwent repeat cryosurgery. 125Iodine seed implantation was performed during freezing procedure in 35 patients and 3-9 d after cryosurgery in 14 cases. Twenty patients, 10 of whom had hepatic metastases received regional chemotherapy. At 3 mo after therapy, CT was repeated to estimate tumor response to therapy. Most patients showed varying degrees of tumor necrosis. Complete response (CR) of tumor was seen in 20.4% patients, partial response (PR), in 38.8%, stable disease (SD), in 30.6%, and progressive disease (PD), in 10.2%. Adverse effects associated with cryosurgery included upper abdomen pain and increased serum amylase. Acute pancreatitis was seen in 6 patients one of whom developed severe pancreatitis. All adverse effects were controlled by medical management with no poor outcome. There was no therapy-related mortality. During a median follow-up of 18 mo (range of 5-40), the median survival was 16.2 mo, with 26 patients (53.1%) surviving for 12 mo or more. Overall, the 6-, 12-, 24- and 36-mo survival rates were 94.9%, 63.1%, 22.8% and 9.5%, respectively. Eight patients had survival of 24 mo or more. The patient with the longest survival (40 mo) is still living without evidence of tumor recurrence.
CONCLUSION: Cryosurgery, which is far less invasive than conventional pancreatic resection, and is associated with a low rate of adverse effects, should be the treatment of choice for patients with locally advanced pancreatic cancer. 125Iodine seed implantation can destroy the residual surviving cancer cells after cryosurgery. Hence, a combination of both modalities has a complementary effect.
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Korpan NN. A history of cryosurgery: its development and future. J Am Coll Surg 2007; 204:314-24. [PMID: 17254936 DOI: 10.1016/j.jamcollsurg.2006.11.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2006] [Revised: 11/03/2006] [Accepted: 11/08/2006] [Indexed: 01/26/2023]
Affiliation(s)
- Nikolai N Korpan
- Vienna International Institute for Cryosurgery, Department of Surgery, Rudolfinerhaus, Vienna, Austria.
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17
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Wang H, Littrup PJ, Duan Y, Zhang Y, Feng H, Nie Z. Thoracic Masses Treated with Percutaneous Cryotherapy: Initial Experience with More than 200 Procedures. Radiology 2005; 235:289-98. [PMID: 15798173 DOI: 10.1148/radiol.2351030747] [Citation(s) in RCA: 171] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To perform and report initial experience with percutaneous cryotherapy (PCT) of the thorax. MATERIALS AND METHODS A human investigation committee approved the study protocol, and all patients gave informed consent. One hundred eighty-seven patients who were not surgical candidates underwent computed tomography (CT)-guided PCT for treatment of thoracic cancer masses. CT-visualized low-attenuating ice formation after PCT was compared with initial tumor size and location. At 1 week and at 1, 3, 6, and 12 months after PCT, the various findings seen on available CT scans and any complications were noted. chi(2) and Student t tests were used to identify significant differences in frequencies and mean values of imaging observations, respectively. RESULTS Ice formation was identified at CT as reduced attenuation values (in Hounsfield units) within soft-tissue masses, the mean sizes of which were 4.3 cm +/- 0.2 (standard deviation) in peripheral locations and 6.4 cm +/- 0.3 in central locations. Tumor size and location were independent predictors of tumor coverage by low-attenuating ice: Mean coverage was 99% for peripheral masses 4 cm or smaller (n = 101) and 80% for central masses larger than 4 cm (n = 58) (P < .001). An area of necrotic cavitation larger than the original mass developed in 80% (77 of 96) of masses within 1 week and was nearly resolved by 3 months in 7% (five of 76) of masses. By 6 months, minimal pulmonary scarring was noted in 56 patients and 86% of masses showed reduced or stable size. The overall rate of pneumothorax was only 12% (22 of 187 patients), and other side effects appeared to be self limited. No major bleeding or bronchial damage was noted. Two deaths in debilitated patients were temporally related, and two complications involved brachial and recurrent laryngeal nerve damage. The patient with laryngeal nerve damage regained speech within 2 months. CONCLUSION CT-guided PCT yielded low procedural morbidity given the extent of freezing, even near mediastinal structures. Ongoing advances in cryotechnology, imaging guidance, and treatment planning may help to avoid the degree of undertreatment of larger central masses observed in this study.
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Affiliation(s)
- Hongwu Wang
- Tumor Targeted Cryotherapy Center, PLA General Navy Hospital, Beijing, China
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18
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Abstract
Central airway obstruction is a problem facing all medical and surgical subspecialists caring for patients with chest diseases. The incidence of this disorder appears to be rising because of the epidemic of lung cancer; however, benign causes of central airway obstruction are being seen more frequently as well. The morbidity is significant and if left untreated, death from suffocation is a frequent outcome. Management of these patients is difficult, but therapeutic and diagnostic tools are now available that are beneficial to most patients and almost all airway obstruction can be relieved expeditiously. This review examines current approaches in the workup and treatment of patients suffering from airway impairment. Although large, randomized, comparative studies are not available, data show significant improvement in patient outcomes and quality of life with treatment of central airway obstruction. Clearly, more studies assessing the relative utility of specific airway interventions and their impact on morbidity and mortality are needed. Currently, the most comprehensive approach can be offered at centers with expertise in the management of complex airway disorders and availability of all endoscopic and surgical options.
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Affiliation(s)
- Armin Ernst
- Pulmonology and Critical Care Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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Chan AL, Yoneda KY, Allen RP, Albertson TE. Advances in the management of endobronchial lung malignancies. Curr Opin Pulm Med 2003; 9:301-8. [PMID: 12806244 DOI: 10.1097/00063198-200307000-00010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The effective palliation of endobronchial malignancies often involves the use of multiple modalities including surgery, external beam radiation, chemotherapy, or a variety of interventional bronchoscopic techniques. The authors discuss in detail recent advances in interventional bronchoscopy that enhance local tumor control. An integrated and individualized approach to the use of these complementary modalities can provide rapid palliation and may improve survival in a subset of patients.
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Affiliation(s)
- Andrew L Chan
- Department of Internal Medicine, School of Medicine, University of California, Davis, USA.
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21
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Noppen M, Meysman M, Van Herreweghe R, Lamote J, D'Haese J, Vincken W. Bronchoscopic cryotherapy: preliminary experience. Acta Clin Belg 2001; 56:73-7. [PMID: 11383315 DOI: 10.1179/acb.2001.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Our preliminary experience with the bronchoscopic application of cryotherapy using rapid decompression of liquid nitrous oxide as cooling agent is reported. Seventeen applications through rigid bronchoscopy in twelve patients were performed. A single cryotherapy session was successful in the debulking of obstructive malignant lesions of the central airways in five patients (four non-small cell carcinoma, one renal cell cancer metastasis), and in the treatment of a capillary haemangioma (one patient). Two sessions were successful in the treatment of a metastatic melanoma (one patient) and benign granulation tissue (one patient). Cryotherapy was also successful in the treatment of early bronchial cancer (carcinoma in situ) in four patients, requiring repetitive sessions in two. There were no complications or side-effects. These preliminary findings confirm the safety and efficacy of bronchoscopic cryotherapy in a variety of airway lesions.
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Affiliation(s)
- M Noppen
- Interventional Endoscopy Clinic, Respiratory Division, Academic Hospital AZ-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium.
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Abstract
OBJECTIVE Carcinoma of the lung is the commonest cause of death from malignant disease in humans. At diagnosis, about 85% of patients are in an advanced stage of the disease and approximately 30% present with a tumour blocking a large bronchial lumen, causing distressing and life threatening symptoms. Early reopening and treatment of the blocked airways is required to improve symptoms and quality of life. There are a number of methods available to achieve this aim including cryotherapy, the controlled application of extreme cold. METHODS 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 a male:female ratio of 1.59:1. The procedure can be performed under general or local anaesthetic using a rigid or flexible cryoprobe. A temperature of about - 70 degrees C is delivered to the tumour site for two 3-min periods causing destruction of the tumour mass. Patients were evaluated clinically and for performance status before and after treatment. Histological composition was: non-small cell 88.2%, small cell 11.1% and malignant melanoma 0.7%. The TNM staging for NSC patients, at the time of treatment was stage II 8.2%, IIIa 27.4%, IIIb 25.9%, IV 38.5%. RESULTS Subjective symptomatic improvement for cough was 68.3%, dyspnoea 63.9%, haemoptysis 92.7% and chest pain 55.5%. Respiratory function tests showed improvements in mean FEV1 from 1.34 l to 1.45 l (P = 0.001) and mean FVC from 1.93 to 2.02 l (P = 0.035). The Karnofsky performance status increased by 54.6%. Kaplan-Meier median survival time was 12.9 months. Complications were found with 11 patients (7.2%) and there was no operative mortality. CONCLUSIONS Cryotherapy provides effective and rapid control of symptoms caused by tracheobronchial carcinoma and improves quality of life and survival. It is easy to perform, with minimum complications and the majority of patients are discharged the same day.
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Abstract
Since it was first used 70 years ago, brachytherapy has become an effective tool in the treatment with tracheal bronchial malignancy including primary and recurrent bronchogenic carcinoma and metastatic carcinoma. The technique has evolved from interstitial implantation of radioactive sources directly to the tumor using rigid bronchoscopy to intraluminal placement of a radioactive source into a polyethylene afterloading catheter placed using FB. Intraluminal brachytherapy is effective in palliating complications caused by malignant endobronchial tumors such as dyspnea, hemoptysis, intractable cough, atelectasis, and postobstructive pneumonia. Brachytherapy may be combined with external beam radiation, Nd:YAG laser therapy, and chemotherapy to enhance the palliative treatments of patients. The risk of severe complications from brachytherapy may be caused more by location of tumor being treated rather than those fractionations scheme. When tumor involves the mainstem bronchi and upper lobes, it seems prudent to obtain CT to exclude tumor invasion of the pulmonary arteries or considerable destruction of the bronchial wall and mediastinal invasion of the tumor. Patients with findings such as these should not be treated with endobronchial brachytherapy or treated with LDR brachytherapy. Brachytherapy is proved to be effective and a safe palliative treatment for endobronchial malignancies, but further investigations are necessary to determine the optimal dose scheme and its efficiency in bronchogenic carcinoma and combined with external beam radiation therapy or surgery or other endobronchial procedures such as Nd:YAG laser or cryotherapy.
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Affiliation(s)
- F D Sheski
- Division of Pulmonary, Allergy, Occupational, and Critical Care Medicine, Indiana University School of Medicine, Indianapolis, USA
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Marasso A, Bernardi V, Gai R, Gallo E, Massaglia GM, Onoscuri M, Cardaci SB. Radiofrequency resection of bronchial tumours in combination with cryotherapy: evaluation of a new technique. Thorax 1998; 53:106-9. [PMID: 9624294 PMCID: PMC1758712 DOI: 10.1136/thx.53.2.106] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND A number of treatments, including Nd-YAG laser therapy, brachytherapy, cryotherapy, electrocautery, and photodynamic therapy, can re-open the obstructed bronchial lumen in patients with inoperable obstructive bronchial tumours. None of these is considered to be a "gold standard". METHODS The results of a retrospective study of 98 patients treated by radiofrequency tissue ablation and subsequent cryotherapy between January 1994 and June 1995 are reported. The patients were divided in two groups according to whether they were treated either after (group 1, n = 50) or before (group 2, n = 48) radiotherapy and/or chemotherapy. Bronchoscopic follow up was performed. The intervention was considered successful if the lumen was opened by > 80% and partially successful if it was opened by > 50%. RESULTS In group 1 treatment was successful in 60%, partially successful in 32%, and unsuccessful in 8%. The median survival time was five months from the time of bronchoscopic surgery. In group 2 treatment was successful in 66%, partially successful in 21.5%, and unsuccessful in 12.5%, with a median survival time of 14 months from the time of bronchoscopic treatment. Forty patients (24 in group 1 and 16 in group 2) received a Dumon stent. CONCLUSIONS Radiofrequency bronchoscopic surgery with cryotherapy appears to be a useful technique in the treatment of tracheobronchial obstruction.
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Affiliation(s)
- A Marasso
- Division of Bronchology and Pulmonology, Azienda Ospedaliera San Luigi Gonzaga, Orbassano, Torino, Italy
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Mathur PN, Wolf KM, Busk MF, Briete WM, Datzman M. Fiberoptic bronchoscopic cryotherapy in the management of tracheobronchial obstruction. Chest 1996; 110:718-23. [PMID: 8797417 DOI: 10.1378/chest.110.3.718] [Citation(s) in RCA: 146] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Cryotherapy is used for endoscopic management of tracheobronchial obstruction (TBO). This study describes the use of a flexible cryoprobe for cryotherapy using nitrous oxide as a cryogen through a fiberoptic bronchoscope. The study group consisted of 22 patients, ages ranging from 28 to 82 years. Twenty patients had malignant TBO and two had bronchial obstruction (BO) following lung transplantation. Benign BO was first dilated with a balloon and followed with cryotherapy. Eighteen of the 20 malignant endobronchial lesions were completely removed. In three of these patients, the airway remained occluded due to extrinsic compression. Cryotherapy offers an alternative to Nd:YAG laser in the management of TBO. Cryotherapy offers other advantages such as being inexpensive, safe for the operator, and safe for other members of the team. Similarly for the patient, there is no danger of bronchial wall perforation or endobronchial fires, cryotherapy can be done under local anesthesia with conscious sedation, and it can be performed in an endoscopy suite.
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Affiliation(s)
- P N Mathur
- Department of Medicine, Indiana University Medical Center, Indianapolis 46202-2879, USA
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27
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Affiliation(s)
- G Onik
- Department of Minimally Invasive Therapy, Princeton Hospital, University of Florida School of Medicine, Orlando 32808, USA
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