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Jung, Lee, Kim, Lee, Lee, Kang, Jung, Kim, Shin, Shim, In, Kang, and Yoo: Clinical Benefits and Complications of Cryotherapy in Advanced Lung Cancer with Central Airway Obstruction
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2008; 64(4): 272-277.

Published online: 30 April 2008

DOI: https://doi.org/10.4046/trd.2008.64.4.272

Clinical Benefits and Complications of Cryotherapy in Advanced Lung Cancer with Central Airway Obstruction

Jin Yong Jung, M.D.1, Sung Yong Lee, M.D.1, Dae Hyun Kim2, Kyung Joo Lee, M.D.1, Eun Joo Lee, M.D.1, Eun Hae Kang, M.D.1, Ki Hwan Jung, M.D.1, Je Hyeong Kim, M.D.1, Chol Shin, M.D.1, Jae Jeong Shim, M.D.1, Kwang Ho In, M.D.1, Kyung Ho Kang, M.D.1, Se Hwa Yoo, M.D.1

1Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

2Guro Hospital, Korea University Medical Center, Seoul, Korea.

Address for correspondence: Sung Yong Lee, M.D., Ph.D. Department of Internal Medicine, Korea University College of Medicine, 80, Guro-dong, Guro-gu, Seoul 152-703, Korea. Phone: 82-2-2626-3021, Fax: 82-2-865-6605, pusarang@gmail.com

Received 4 February 2008       Accepted 24 March 2008

Copyright © 2008 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Background

The efficacy of the use of the interventional bronchoscope for palliation of patients with central airway obstruction has been established. In the palliative setting to alleviate central airway obstruction, the use of laser resection, electrocautery, argon plasma coagulation, photodynamic therapy and cryotherapy can provide relief of an airway obstruction. Cryotherapy is the therapeutic application of extreme cold for the local destruction of living tissue. Recently, this technique has been used for endoscopic management of central airway obstructions in Korea. We report the role and complications of the use of cryotherapy for airway obstructions in patients with advanced lung cancer.

Methods

We used a flexible cryoprobe for cryotherapy using nitrous oxide as a cryogen. The cryoprobe was applied through the working channel of a flexible fiberoptic bronchoscope. The temperature of the tip was approximately -89℃, and the icing time was 5~20 seconds.

Results

Four patients with a central airway obstruction from advanced lung cancer were treated with cryotherapy. Three of the four patients were treated successfully and the airway obstruction was improved after the cryotherapy procedure. Dyspnea, hypoxia and atelectais were improved in three cases. Two patients experienced complications-one patient experienced pneumomediastinum and the other patient experienced massive hemoptysis during the cryotherapy procedure. However, these complications resolved and did not influence mortality.

Conclusion

This technique is effective and relatively safe for palliation of inoperable advanced lung cancer with a central airway obstruction.

Keywords: Cryotherapy, Central airway obstruction, Lung cancer

Figures and Tables

Figure 1
The chest PA and bronchoscopic finding before (A, C) and after (B, D) cryotherapy in case 2. The chest PA shows near completely obstructed left main bronchus and atelectasis of left lung. After cryotherapy, atelectasis of left lung was completely recovered, however pneumomediastinum and subcutaneous emphysema were developed (B, arrow). Bronchoscopic finding shows perforated carina after cryotherapy (D, arrow).
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Figure 2
The chest PA and bronchoscopic finding before (A, C) and after (B, D) cryotherapy in case 3. The right main bronchus was completely obstructed by the intraluminal ingrowing tumor lesion that was extending to the distal trachea and developed severe airway obstruction (A, C). The ingrowing tumor lesion was disappeared by cryotherapy and also some aeration was noted on right upper area in chest CT scan (B, D).
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Table 1
Basal characteristics of the patients
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