Endoscopic spray cryotherapy for esophageal cancer: safety and efficacy

Greenwald, Bruce D.; Dumot, John A.; Abrams, Julian A.; Lightdale, Charles J.; David, Donald S.; Nishioka, Norman S.; Yachimski, Patrick; Johnston, Mark H.; Shaheen, Nicholas J.; Zfass, Alvin M.; Smith, Jenny O.; Gill, Kanwar Rupinder S.; Burdick, J. Steven; Mallat, Damien; Wolfsen, Herbert C.

doi:10.1016/j.gie.2010.01.042

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Volume 71, Issue 4 , Pages 686-693, April 2010

Endoscopic spray cryotherapy for esophageal cancer: safety and efficacy

Bruce D. Greenwald, MD
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine and Greenebaum Cancer Center, Baltimore, Maryland
- Reprint requests: Bruce D. Greenwald, MD, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, 22 South Greene Street, Room N3W62, Baltimore, MD 21201-1595
John A. Dumot, DO
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
Julian A. Abrams, MD
- Columbia University Medical Center, New York, New York
Charles J. Lightdale, MD
- Columbia University Medical Center, New York, New York
Donald S. David, MD
- Department of Gastroenterology, City of Hope, Duarte, California
Norman S. Nishioka, MD
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
Patrick Yachimski, MD
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee
Mark H. Johnston, MD
- Lancaster Gastroenterology, Inc, Lancaster, Pennsylvania
Nicholas J. Shaheen, MD, MPH
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, North Carolina
Alvin M. Zfass, MD
- Virginia Commonwealth University, Richmond, Virginia
Jenny O. Smith, MD
- Virginia Commonwealth University, Richmond, Virginia
Kanwar Rupinder S. Gill, MD
- Sutter Gould Medical Foundation, Modesto, California
J. Steven Burdick, MD
- Texas Digestive Health Consultants, Dallas, Texas
Damien Mallat, MD
- Digestive Health Associates of Texas, Dallas, Texas
Herbert C. Wolfsen, MD
- Mayo Clinic Jacksonville, Jacksonville, Florida

Received 16 November 2009; accepted 8 January 2010.

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.

Abbreviations: IQR, interquartile range, PDT, photodynamic therapy, SD, standard deviation

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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.

PII: S0016-5107(10)00056-8

doi:10.1016/j.gie.2010.01.042

Refers to article:

Safety and efficacy of endoscopic spray cryotherapy for Barrett's esophagus with high-grade dysplasia
Nicholas J. Shaheen, Bruce D. Greenwald, Anne F. Peery, John A. Dumot, Norman S. Nishioka, Herbert C. Wolfsen, J. Steven Burdick, Julian A. Abrams, Kenneth K. Wang, Damien Mallat, Mark H. Johnston, Alvin M. Zfass, Jenny O. Smith, James S. Barthel, Charles J. Lightdale
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