Prospective cohort study of palliative treatment of esophageal cancer with liquid nitrogen spray cryotherapy.

BACKGROUND AND AIMS: Palliation of dysphagia associated with advanced esophageal cancer is challenging. Previous studies suggest liquid nitrogen spray cryotherapy (LNSC) is effective in palliating obstructive esophageal cancer. We sought to prospectively examine the utility, safety, and efficacy of serial applications of repeated palliative LNSC in this population.

METHODS

We performed a prospective cohort trial of LNSC for persistent esophageal cancer without the possibility of resection for palliation of obstructive symptoms. We used repeated measures and competing risks analyses to study the course of patients treated over 2 years. Efficacy of treatment was assessed using quality-of-life scores 14 days after treatment, using general cancer (Quality of Life Questionnaire [QLQ]-C30) and esophageal cancer-specific (QLQ-esophageal subset [OES]18) quality-of-life questionnaires, as well as ordinal dysphagia scores. Adverse events (AEs) were assessed using structured interviews and classified according to Common Terminology Criteria.

RESULTS

On repeated treatments, each participant (N = 49) improved their QLQ-C30 score by a mean of 1.7 (95% CI, 0.1-3.3) and improved their QLQ-OES18 score by a mean of 1.8 (95% CI, 0.4-3.3). For each subsequent round of treatment, the effect improved 0.1 (95% CI, 0.3-0.4) for the QLQ-C30 score and worsened -0.2 (95% CI, -0.5 to 0.2) for the QLQ-OES18 score. There was no significant improvement in the ordinal dysphagia score. Nineteen (39.6%) of 48 participants with a feeding tube at baseline required a feeding tube or stent at a mean of 8 months. Although unrelated serious AEs were common (38.8%), only 2 patients had events possibly related to LNSC (4.1%, melena and dysphagia).

CONCLUSIONS

Spray cryotherapy had a durable and repeatable benefit for palliation of obstructive symptoms of esophageal cancer and quality of life in the majority of patients, without the need for feeding tube or esophageal stent placement. Treatments were generally well tolerated.