Original article
Clinical endoscopy
Endoscopic spray cryotherapy for esophageal cancer: safety and efficacy

https://doi.org/10.1016/j.gie.2010.01.042Get rights and content

Background

Few options exist for patients with localized esophageal cancer ineligible for conventional therapies. Endoscopic spray cryotherapy with low-pressure liquid nitrogen has demonstrated efficacy in this setting in early studies.

Objective

To assess the safety and efficacy of cryotherapy in esophageal carcinoma.

Design

Multicenter, retrospective cohort study.

Setting

Ten academic and community medical centers between 2006 and 2009.

Patients

Subjects with esophageal carcinoma in whom conventional therapy failed and those who refused or were ineligible for conventional therapy.

Interventions

Cryotherapy with follow-up biopsies. Treatment was complete when tumor eradication was confirmed by biopsy or when treatment was halted because of tumor progression, patient preference, or comorbid condition.

Main Outcome Measurements

Complete eradication of luminal cancer and adverse events.

Results

Seventy-nine subjects (median age 76 years, 81% male, 94% with adenocarcinoma) were treated. Tumor stage included T1-60, T2-16, and T3/4-3. Mean tumor length was 4.0 cm (range 1-15 cm). Previous treatment including endoscopic resection, photodynamic therapy, esophagectomy, chemotherapy, and radiation therapy failed in 53 subjects (67%). Forty-nine completed treatment. Complete response of intraluminal disease was seen in 31 of 49 subjects (61.2%), including 18 of 24 (75%) with mucosal cancer. Mean (standard deviation) length of follow-up after treatment was 10.6 (8.4) months overall and 11.5 (2.8) months for T1 disease. No serious adverse events were reported. Benign stricture developed in 10 (13%), with esophageal narrowing from previous endoscopic resection, radiotherapy, or photodynamic therapy noted in 9 of 10 subjects.

Limitations

Retrospective study design, short follow-up.

Conclusions

Spray cryotherapy is safe and well tolerated for esophageal cancer. Short-term results suggest that it is effective in those who could not receive conventional treatment, especially for those with mucosal cancer.

Section snippets

Subjects

Patients treated with low-pressure liquid nitrogen endoscopic spray cryotherapy (CryoSpray Ablation System, CSA Medical, Baltimore, Md) at 10 institutions were enrolled. Site data were collected retrospectively. Eligible patients included those with esophageal carcinoma, either adenocarcinoma or squamous cell carcinoma, who received 1 or more treatments with endoscopic spray cryotherapy with either curative or palliative intent. Tumors were staged by EUS and/or endoscopic resection. The goal of

Results

Seventy-nine subjects were enrolled at the participating institutions, with 49 of them eligible for efficacy analysis (Table 1). No patients were lost to follow-up. Median age was 76 years (range 51-93 years, IQR 17), 81% were male, and the histology finding was adenocarcinoma in 94% of patients. The mean (SD) tumor length treated was 4.0 (3.4) cm, with the longest segment measuring 15 cm. The median number of treatments per subject was 3 (range 1-25, IQR 3). Tumor stage included T1–60 (76%),

Discussion

Endoscopic management of superficial esophageal cancer is becoming more common because of the increasing incidence of this disease and the lack of suitability of esophagectomy in the high-risk population in which it is often diagnosed.7, 8 Recent studies comparing survival rates with endoscopic and surgical management have shown comparable results in both population-based studies9 and centers with specialized expertise in managing this condition.7, 8 A recent decision analysis suggests that

Acknowledgment

The authors thank Mark Flasar, M.D., M.S. for statistical assistance.

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    DISCLOSURE:The following authors disclosed financial relationships relevant to this publication: B.D. Greenwald: Research grant from, consultant for, and advisory committee member of CSA Medical. J.A. Dumot: Research grant from and advisory committee member of CSA Medical. C.J. Lightdale: Advisory committee member of CSA Medical. N.J. Shaheen: Research grant from, consultant for, and advisory committee member of CSA Medical; research grant from BÂRRX Medical Inc; research grant from, consultant for, and speaker for Proctor & Gamble; research grant from Oncoscope Inc; research grant from and consultant for Takeda Pharmaceuticals. All other authors disclosed no financial relationships relevant to this publication. CSA Medical supported this study through a grant for statistical analysis and by assisting in data collection at some sites. CSA Medical had no role in study design, analysis, interpretation of the data, or in writing the report.

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