CT-guided thin needles percutaneous cryoablation (PCA) in patients with primary and secondary lung tumors: A preliminary experience

• Published in: European journal of radiology 2013-05, Vol.82 (5), p.e246-e253
• Main Authors: Pusceddu, Claudio, Sotgia, Barbara, Fele, Rosa Maria, Melis, Luca
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cryosurgery - instrumentation; Cryosurgery - methods; Female; Humans; Image guided tumor ablation; Interventional radiology; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - secondary; Lung Neoplasms - surgery; Male; Middle Aged; Needles; Percutaneous cryotherapy; Pilot Projects; Radiofrequency ablation; Radiology; Reproducibility of Results; Sensitivity and Specificity; Surgery, Computer-Assisted - methods; Thoracic masses; Tomography, X-Ray Computed - instrumentation; Tomography, X-Ray Computed - methods; Treatment Outcome
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2012.12.010

Abstract Purpose To report the data of our initial experience with CT-guided thin cryoprobes for percutaneous cryoablation (PCA) in patients with primary and secondary pulmonary tumors. Material and methods CT-guided thin needles PCA was performed on 34 lung masses (11 NSCLC = 32%; 23 secondary lung malignancies = 68%) in 32 consecutive patients (24 men and 8 women; mean age 67 ± 10 years) not suitable for surgical resection. Lung masses were treated using two types of cryoprobes: IceRod and IceSeed able to obtain different size of iceball. The number of probes used ranged from 1 to 5 depending on the size of the tumor. After insertion of the cryoprobes into the lesion, the PCA were performed with two 2 (91%) or 3 (9%) cycles each of 12 min of freezing followed by a 4 min active thawing phase and a 4 min passive thawing phase for each one for all treatments. Results All cryoablation sessions were successfully completed. All primary and metastatic lung tumors were ablated. No procedure-related deaths occurred. Morbidity consisted of 21% (7 of 34) pneumothorax and 3% (1 of 34) cases asymptomatic small pulmonary hemorrhage, respectively, all of CTCAE grade 1 (Common Terminology Criteria for Adverse Events). Low density of entire lesion, central necrosis and solid mass appearance were identify in 21 (62%), 7 (21%) and 6 (17%) of cryoablated tumors, respectively. No lymphadenopathy developed in the region of treated lesions. Technical success (complete lack of enhancement) was achieved in 82%, 97% and 91% of treated lesions at 1-, 3- and 6-months CT follow-up scan, respectively ( p < .000). Comparing the tumor longest diameter between the baseline and at 6 month CT images, technical success was revealed in 92% cases ( p < .000). Conclusion Our preliminary experience suggests that PCA is a feasible treatment option. Well-designed clinical trials with a larger patient population are necessary to further investigate the long-term results and prognostic factors.