Objective: Carcinoma of the bronchus is the commonest cause of death in humans and at the time of diagnosis over 80% of patients are inoperable and require palliative treatment. Around one third of these patients present with a tumour blocking the large bronchial lumen. To alleviate the distressing symptoms caused by the tumour requires physical reopening of the bronchial lumen. The standard palliations of external beam radiotherapy or chemotherapy may not be entirely effective at this stage of the disease. Cryotherapy, the controlled application of extreme cold, for endobronchial destruction of tumours was pioneered at Harefield hospital in 1986 and since then over 700 patients have been treated effectively.
Methods: We present here the results of a prospective study of 159 consecutive patients with histologically proven carcinoma of the trachea and bronchi, treated with cryotherapy between January 1994 and December 1997. A clinical evaluation was carried out on each patient before and after cryotherapy including breathing tests, symptom quantification (cough, haemoptysis, breathlessness, and chest pain), weight and quality of life (Karnofsky and WHO) indices. The mean age was 68.8 years (range 36-85) and the male:female ratio was 1.6: 1. Histological composition was as follows: 67.5 % squamous cell, 14.9 % adenocarcinoma, 1.3% large cell, 3.9% undifferentiated 11.7% small cell carcinoma, and 0.7% malignant melanoma. The NSCLC TNM stages at treatment were: I and 11 (8.5%),IIIa (25.3%) IIIb (27.5%) and IV (38.7%)
Results: Symptomatic improvements were found for cough (68%), haemoptysis (89%), dyspnoea (63 %) and chest pain (55%). Breathing tests showed improvements in mean FEV 1 from 1.34 to 1.44 mI/s and mean FVC from 1.94 to 2.03 1. Improvements in quality of life scores were found in 54% of patients measured by Karnofsky index and 63% using the WHO scale. The survival rates were 56.6% at 6 months, 3 2. 1 % at 12 months and 10. 1% at 24 months.
Conclusion: Cryotherapy offers an effective method to control for the symptoms caused by tumours of the airway with minimal complications. It is easy to perform, it is well tolerated by the patients, economical and the majority of the patients are discharged home the same day.