LAUSR

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.