Can Recurrence of Hamartomas be Prevented?
Condition: Airway Obstruction; Hamartoma of Lung
MeSH terms: Hamartoma; Airway Obstruction; Recurrence
Study type: Interventional

Summary: 
      Background. Recently, treatment of endobronchial hamartomas with interventional bronchoscopic
      methods has become possible. Although there are several reports of therapeutic benefits, the
      protocol of administration varies between centers and high recurrence rates continue to be a
      problem. In this study, the investigators aimed to show that cryotherapy applied to the root
      of the bronchial wall after removal of the intraluminal portion of endobronchial hamartoma
      with interventional bronchoscopic methods can prevent recurrences.

      Methods. Between 2012 and 2016, the treatment outcomes and long-term follow-up data of 21
      consecutive patients with symptomatic endobronchial hamartomas treated by interventional
      bronchoscopic methods were prospectively recorded. After debulking, cryotherapy was applied
      to the root of the bronchial wall of all lesions. The data were analyzed retrospectively.
    

Detailed description: 
      Introduction:

      Hamartomas are the most common benign pulmonary tumors. The incidence varies between 0.025%
      and 0.032%. Endobronchial hamartomas constitute 10-20% of all pulmonary hamartomas. Pulmonary
      hamartomas are usually asymptomatic and are diagnosed incidentally. In endobronchial
      hamartomas, at least one of the symptoms of airway obstruction such as cough, hemoptysis and
      dyspnea are most commonly seen (80%). The results of bronchoscopic removal of symptomatic
      endobronchial hamartomas and recurrence rates have been the subject of several studies.

      Cryotherapy is an endobronchial therapy based on the cytotoxic effects of extreme cold on
      tumor tissues. Excessive cold causes intracellular and extracellular ice crystals to form in
      the affected tissue. These crystals damage intracellular organelles, especially mitochondria.
      The most lethal effect is the formation of intracellular ice crystals. This effect results
      from fast freezing and slow thawing cycles. In clinical practice, cryotherapy is used as an
      endobronchial treatment method capable of destroying tumor cells at a depth of 10 mm with a
      rigid probe and at a depth of 3 mm with a flexible probe.

      The investigators investigated the treatment and long-term follow-up results of patients who
      underwent cryotherapy to the site of origin on the airway wall after the luminal part of the
      symptomatic endobronchial hamartomas was removed by interventional bronchoscopic methods. We
      aimed to determine the benefit of cryotherapy to conventional endobronchial debulking at the
      sites of origin of hamartomas.

      Material and Methods:

      General anesthesia was administered by an intravenous anesthesia technique. Patients were
      intubated with a rigid bronchoscope (Effer-Dumon, 11 mm diameter, 43 cm length, Efer
      Endoscopy, Marseille, France). Debulking procedures were performed by mechanical tumor
      resection (MTR) using the tip of the rigid bronchoscope, rigid pliers or argon plasma
      coagulation assisted MTR (ERBE ICC 200/APC 300 electrosurgical unit, rigid APC probe, 50 cm
      length, 2.3 mm diameter; ERBE, Medizintechnik, GmbH, Tübingen, Germany) or cryorecanalization
      (ERBOKRYO® CA unit, ERBE flexible cryoprobe 2.4 mm diameter, 90 cm length or ERBE rigid
      cryoprobe 3 mm diameter, 53 cm length; ERBE, Medizintechnik, GmbH, Tübingen, Germany) or
      electrocautery - snare probe (Erbotom ICC 200 electrosurgical unit ERBE, Medizintechnik GmbH,
      Tübingen, Germany and Electrosurgical snare probe SD-7C-1, loop diameter 23 mm, length 1050
      mm, Olympus EndoTherapy, Tokyo, Japan). An innovation of study was that cryotherapy (Using
      the same equipment as cryorecanalization) was performed in the regions where the lesions
      originated after debulking.

      Descriptive statistics were expressed as the mean ± standard deviation for intermittent and
      continuous numerical variables, and categorical variables were expressed as number of cases
      and "(%)".

      This study has been approved by the local ethics committee. Informed consent was obtained
      from all patients.
    

Intervention name(s): Endobronchial hamartomas treatment
Intervention type(s): Procedure
Intervention description(s): General anesthesia was administered by an intravenous anesthesia technique. Patients were intubated with a rigid bronchoscope. Debulking procedures were performed by mechanical tumor resection (MTR) using the tip of the rigid bronchoscope, rigid pliers or argon plasma coagulation assisted MTR or cryorecanalization or electrocautery - snare probe. An innovation of our study was that cryotherapy was performed in the regions where the lesions originated after debulking
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Hamartoma, Cryotherapy