Erica S. Alexander, MD (she/her/hers)
Memorial Sloan Kettering Cancer Center
Disclosure(s): No financial relationships to disclose
To assess safety and local recurrence-free survival of percutaneous cryoablation for treatment of primary and metastatic pleural lesions in the thorax.
Materials and Methods:
Retrospective study of 46 patients (25 women, 21 men), with 62 pleural-based thoracic lesions, treated in 58 CT-guided cryoablation sessions. Diagnoses included: primary pleural (n = 4), lung carcinoma (n = 12), and metastatic disease (n = 30). Median age at first treatment was 66 years (range, 14-88 yrs). Patients were treated from 9/2005 to 6/2021 with CryoCare CS (Varian, Irvine, CA) or IceFORCE (Boston Scientific, Marlborough, MA) systems.
Time to progression of index tumor(s) and overall survival were estimated using Kaplan–Meier method. Post-operative complications were recorded, and univariate analyses were used to calculate factors associated with complication risk.
The median number of tumors treated in a single treatment session was 1 (range 1-4). The largest dimension of the index tumor was 2.9 ± 1.5 cm (median ± SD) (range, 0.4-7.9 cm). Of the 58 treatments, 98.3% were technically successful.
Median local tumor progression-free survival was 14.43 months (95%CI: 9.4-38 mos). Local tumor control was achieved in 27/62 patients (43.5%); median length of follow-up was 18.23 months (IQR:3.8-42.7). Tumor size was a significant predictor of tumor progression-free survival (HR:1.31, 95%CI: 1.09-1.57, p=0.01). Median overall survival from time of treatment was 49.53 months.
Complications occurred in 28/58 sessions (48.3%). SIR Grade D-F complications occurred in 2/58 sessions (3.4%); one death occurred 4 days post ablation due to pulmonary distress and hypoxia and one patient required supplemental oxygen upon discharge. Remaining complications were self-limited. Pain and pneumothorax were the most common complications. Pneumothorax requiring chest tube occurred in 11/58 sessions (19.0%). Shorter length of lung parenchyma traversed was associated with significantly higher risk of pneumothorax: HR 0.48 (95%CI: 0.14-0.83), p=0.0024.
Percutaneous cryoablation is a safe and effective treatment for pleural lesions. Treatments were associated with good local control and most complications were minor and self-limited.