Safety and efficacy of percutaneous cryoablation for primary and metastatic pleural based tumors

Erica S Alexander; Elena N Petre; Michael Offin; Marjorie Zauderer; Ken Zhao; Vlasios Sotirchos; Stephen B Solomon; Etay Ziv

doi:10.1016/j.ejrad.2024.111465

Safety and efficacy of percutaneous cryoablation for primary and metastatic pleural based tumors

Eur J Radiol. 2024 Apr 10:175:111465. doi: 10.1016/j.ejrad.2024.111465. Online ahead of print.

Authors

Erica S Alexander¹, Elena N Petre², Michael Offin³, Marjorie Zauderer⁴, Ken Zhao⁵, Vlasios Sotirchos⁶, Stephen B Solomon⁷, Etay Ziv⁸

Affiliations

¹ Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA. Electronic address: alexane@mskcc.org.
² Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA. Electronic address: petree@mskcc.org.
³ Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA. Electronic address: offinm@mskcc.org.
⁴ Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA. Electronic address: zauderem@mskcc.org.
⁵ Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA. Electronic address: zhaok@mskcc.org.
⁶ Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA. Electronic address: sotirchv@mskcc.org.
⁷ Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA. Electronic address: solomons@mskcc.org.
⁸ Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA. Electronic address: zive@mskcc.org.

PMID: 38621339
DOI: 10.1016/j.ejrad.2024.111465

Abstract

Purpose: Assess safety and local tumor progression-free survival (LTPFS) of percutaneous cryoablation for pleural-based thoracic malignancies.

Materials and methods: Retrospective study of 46 patients (17 treated for palliation; 9 for oligoprogression; 20 for curative intent), with 62 pleural-based thoracic lesions, treated in 59 cryoablation sessions. Patients were treated from 9/2005-11/2021 with CryoCare CS (Varian, Irvine, CA) or IceFORCE (Boston Scientific, Marlborough, MA) systems. For tumors treated with curative intent and/or oligoprogression, LTPFS of the treated tumor(s) and overall survival (OS) were estimated using Kaplan-Meier method. Post-operative complications were reported for all sessions, including those with palliative intent; univariate analyses were used to calculate factors associated with increased complication risk.

Results: Median number of tumors treated in a single treatment session was 1 (range 1-4). Largest dimension of the treated tumor was 2.1 cm [IQR:0.9-5 cm]. Of the 59 treatments, 98.3 % were technically successful. Median LTPFS was 14.4 (95 % CI: 9.4-25.6) months. Tumor size was a significant predictor of LTPFS (HR: 1.21, 95 % CI: 1.03-1.44, p = 0.023). Median OS was 52.4 (28.1-NR) months. Complications occurred in 28/59 sessions (47.5 %); 2/59 (3.4 %) were ≥ grade D by Society of Interventional Radiology adverse event criteria (death; hypoxia requiring supplemental oxygen upon discharge). Pain and pneumothorax were the most common complications. The length of lung parenchyma traversed was a significant predictor of pneumothorax: HR 0.48 (95 %CI: 0.14-0.83), p = 0.0024.

Conclusion: Percutaneous cryoablation for pleural lesions is associated with a long duration of local control and most complications were minor and self-limited.

Keywords: Cryoablation; Pleural.