M. O. Maiwand

Lung carcinoma is the most frequently diagnosed malignancy in the world, with the incidence increasing through the 20^th century. Presentation may be as a tumor mass primarily obstructing the central bronchial lumen, or a mass infiltrating lung tissue. Cryosurgery can be used as a method of palliative treatment for both these endobronchial and extra-bronchial presentations. The aim of this study is two-fold: to present data relating to our extensive experience in treating obstructing endobronchial tumors and to present our initial results of direct cryosurgery to infiltrating lung tumor masses. During a nine-year period, 521 consecutive patients (male:female ratio 1.8:1) with a mean age of 67.9 years who had advanced obstructive tracheobronchial malignant tumors underwent cryosurgery with a mean of 2.4 treatments per patient. Hemoptysis, cough, dyspnoea and chest pain improved by at least one class in 76.4%, 69.0%, 59.25% and 42.6% (p<0.01) of symptomatic patients respectively. Quality of life studies showed that the mean Karnofsky score improved from 60 ± 7 to 75 ± 8 and the mean WHO score from 3.04 ± 0.7 to 2.20 ± 0.56. There were 7 (1.2%) in-hospital deaths, and 2-year survival was 15.9%. Direct cryosurgery to carcinoma of the lung was performed on 15 patients at exploratory thoracotomy. Results showed an increase in FEV1 from 1.80 ± 0.6 liters to 1.95 ± 0.8 (8.3%) liters and in FVC from 2.50 ± 0.8 to 2.68 ± 0.8 liters (7.2%). The Karnofsky score improved from 68 ± 9 to 78 ± 10 and the WHO score from 2.63 ± 0.81 to 2.38 ± 0.78 (9.6%). Major symptoms including cough, dyspnoea, and hemoptysis were assessed and showed improvement in 77.8%, 66.7%, and 100% (p<0.01) of symptomatic patients respectively. Patients were followed for a mean period of 18 months (range 4–84 months). Median survival from the date of surgery (Kaplan-Meier, 95%Cl) was 11.6 (6.8 to 18.2) months, range 1 to 84 months. Cryosurgery provides a safe and effective method for the palliation of advanced central bronchial obstructive tumors, and compares favorably with other methods in terms of safety, cost, and complications. Initial experience suggests that similar palliation may be achieved by cryosurgery applied to advanced parenchymal tumor masses.

The use of cryosurgery in the tracheobronchial region has been established for a considerable time, and it has been proved to provide a safe, rapid, and effective method for the restoration of patency in blocked tracheobronchial lumen. It also improves symptoms, respiratory function, and quality of life. The technique is easy to perform, economical, has minimal complications, and is well tolerated by the patient. Cryosurgery often leads to sufficient improvement in the patients' condition such that they can tolerate further treatments, such as radiotherapy or chemotherapy, thus providing a better outcome and improved quality of life and survival.