Value of endobronchial cryotherapy in the management of malignant endobronchial obstruction in patients with inoperable NSCLC: A prospective analysis of clinical and survival outcomes

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Abstract Background: Malignant endobronchial obstruction (MEBO) is the most debilitating complication in non-small cell lung cancer (NSCLC). The therapeutic role of cryotherapy and its impact on survival has not been well addressed. This is to clarify whether the combination of endobronchial cryotherapy (EBCT) and chemoradiotherapy (CRT) improved the outcomes in inoperable NSCLC patients with symptomatic MEBO compared to that obtained by CRT alone.Methods: A prospective ranomized cohort study included 60 cases presented to Qena University Hospital, Egypt, between December 2016 and May 2019. Group A included 30 patients were managed with EBCT plus CRT. Group B included 30 patients were managed with CRT alone. The outcomes assessed were symptoms relief, respiratory function tests (RFT), performance status and survival outcomes at baseline and 4 weeks of follow-up.Results: Group A patients showed a highly significant improvement in symptoms, RFT, 6MWD test and arterial blood gases, compared to group B. The mean Karnofsky score increased from 57.33±5.67 % at baseline to 60.67±6.39 % post-EBCT (P=0.036); group A was significantly improved compared to group B (P=0.04). The Kaplan-Meier median survival for all patients was 9.7±0.4 months (95% CI= 8.86-10.54), and group A cases (10.77±0.44 months, 95% CI= 9.9 -11.6) was significantly longer than that of group B cases (8.6±0.68 months, 95% CI= 7.3-9.97; T-test = 2.631, P= 0.011). Conclusion: The use of EBCT with CRT for the management of MEBO in symptomatic patients with inoperable NSCLC is an efficient and safe procedure. EBCT improves the clinical outcomes, RFT, performance status and median survival.

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