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

Sunday, March 5, 2023

4:21 PM – 4:30 PM

Location: Phoenix Convention Center, 221AB

Presenting Author(s)

EA

Erica S. Alexander, MD (she/her/hers)

Assistant Attending
Memorial Sloan Kettering Cancer Center

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

NP

Nadia N. Petre, MD

Senior Research Scientist
Memorial Sloan Kettering Cancer Center
MO

Michael Offin, MD

Assistant Attending
Memorial Sloan Kettering Cancer Center
MZ

Marjorie Zauderer, MD

Associate Attending
Memorial Sloan Kettering Cancer Center
KZ

Ken Zhao, MD

Assistant Attending
Memorial Sloan Kettering Cancer Center
Vlasios S. Sotirchos, MD

Assistant Attending
Memorial Sloan Kettering Cancer Center
EZ

Etay Ziv, MD PhD

Associate Attending
Memorial Sloan Kettering Cancer Center
SS

Stephen B. Solomon, MD

Section Chief
Memorial Sloan Kettering Cancer Center

Disclosure(s):

Erica S. Alexander, MD: No financial relationships to disclose

Ken Zhao, MD: No financial relationships to disclose

Vlasios S. Sotirchos, MD: No financial relationships to disclose

Etay Ziv, MD PhD: Ethicon J&J: Research Grant Recipient (Ongoing); Novartis Pharmaceuticals Corporation: Research Grant Recipient (Ongoing)

Stephen B. Solomon, MD: Aperture Medical: Board Membership (Ongoing), Consultant (Ongoing), Ownership Interest (Ongoing); Elesta: Research Grant Recipient (Ongoing); GE Healthcare: Consultant (Ongoing), Research Grant Recipient (Ongoing); Johnson & Johnson: Consultant (Ongoing), Ownership Interest (Ongoing); Microbot: Consultant (Ongoing); XAct Robotics: Consultant (Ongoing)

Purpose:

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.

Results:

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.

Conclusion:

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.