A prospective multicenter study to evaluate the impact of cryotherapy on dysphagia and quality of life in patients with inoperable esophageal cancer

Abstract

Background and Study Aims: Dysphagia palliation in inoperable esophageal cancer continues to be a challenge. Self-expanding metal stents have been the mainstay for endoscopic palliation but have a significant risk of adverse events (AE). Liquid nitrogen spray cryotherapy is an established modality that can be used with systemic therapy (ST). This study reports the outcomes of cryotherapy including dysphagia and quality of life (QoL) in patients on ST. Materials and Methods: A prospective multicenter cohort study of 55 adult inoperable esophageal cancer patients undergoing cryotherapy. Changes in QoL and dysphagia between pre- and post-cryotherapy were evaluated. Results: 55 patients received a total of 175 cryotherapy procedures. After a mean of 3.2 cryotherapy sessions, the mean QoL improved from 34.9 at baseline to 29 at last follow-up (p<0.001) while mean dysphagia improved from 1.85 to 1.25 (p=0.004). Patients receiving more intensive cryotherapy (at least 2 treatments within 3 weeks) showed a significantly greater improvement in dysphagia compared to those who didn’t (1.2 versus 0.21 points; p=0.003). 13 (21.8%) patients received another intervention (1 botox, 2 stent, 3 radiation, 7 dilation) for dysphagia palliation. Within the 30-day post-procedure period, there were 3 non-cryo related, >grade 3 AE (all deaths). The median overall survival was 16.4 months. Discussion: In patients with inoperable esophageal cancer receiving concurrent systemic therapy, adding liquid nitrogen spray cryotherapy was safe and associated with improvement in dysphagia and QoL without causing reflux. More intensive treatment showed a greater improvement in dysphagia and should be considered as the preferred approach.

Endoscopic spray cryotherapy for dysphagia palliation in esophageal cancer: Systematic review and meta-analysis

“…Preferred Reporting Items for Systematic Reviews and Meta-Analysis describing the details of the review process are shown in Figure 1. Four of the five included studies are available in full-text articles [14,15,17,18], while the one by Eluri et al is available as published abstract [16]. The characteristics of the included studies are given in Table 1.…”

“…1 . Four of the five included studies are available in full-text articles 14 15 17 18 , while the one by Eluri et al is available as published abstract 16 . The characteristics of the included studies are given in Table 1 .…”

“…This is especially relevant as esophageal stenting and radiation which is currently the preferred method for dysphagia palliation have been associated with poor quality of life. Although QOL was evaluated by Kachaamy et al [18], there was paucity of uniform data across the studies for us to formally analyze this in the current study. As endoscopic spray cryotherapy is a relatively new method for dysphagia palliation in esophageal cancer, the number of patients enrolled in the included studies and the total number of available studies are low which could also limit the generalizability of our findings.…”

“…The area of interest is typically treated with 2 to 5 cycles of 20 to 30 seconds of cooling followed by 60 seconds of thawing 14 15 . The duration of cryotherapy application and the number of cycles has not been standardized and they are decided by the performing endoscopist 16 17 18 . Studies have demonstrated the safety and efficacy of liquid nitrogen spray cryotherapy to induce tumor necrosis and have been used to treat Barrettʼs esophagus and superficial esophageal cancer 19 20 21 .…”

“…In 2018, Kachaamy et al reported the safety and efficacy of liquid nitrogen spray cryotherapy as a primary modality for dysphagia palliation in inoperable esophageal cancer 14 . Other studies have subsequently shown that spray cryotherapy can be an effective strategy for managing dysphagia in esophageal cancer 15 16 17 18 . This meta-analysis aimed to synthesize and highlight the current data on spray cryotherapy in managing dysphagia due to advanced esophageal cancer.…”