Endobrochial cryotherapy: techniques and indications

Endobronchial cryotherapy has seen significant development in France, particularly since 1984. It is a method of relieving obstruction based on the cytotoxicity of low temperatures. Flexible or rigid probes are used with nitrous oxyd. Immediate cytotoxicity is doubled up with a delayed but intense vascular effect explaining the haemostatic efficacy of the technique. Tumour destruction is invariable without risk of perforation but necrosis is delayed occurring within 10 or 15 days. The technique is not adaptable to emergency situations but acts perfectly well on very cellular or vascular tumours. Its indications are complementary to laser assisted resection and enable the treatment of infiltrating lesions, local implantation or early neoplasms. Theoretically the histological and vascular effects should potentiate the effects of radiotherapy and chemotherapy. Randomised protocols are underway to establish the clinical relevance of this.