Abstract No. 319 - Role of percutaneous cryoablation in management of recurrent mesothelioma following lung sparing pleurectomy and decortications

Abstract

Purpose Local recurrence rate is high for patients with malignant pleural mesothelioma (MPM) undergone lung surgery. To assess the morbidity and efficacy of outpatient CT-guided percutaneous Cryoablation (PCT) in the control of localized recurrence in this group. Materials and Methods Following IRB approval, retrospective review of our thoracic surgery databases for patients who have one or more PCT treatments for localized recurrence of malignant pleural mesothelioma following lung sparing surgery were performed. Various analysis addressing technical aspects of PCT and survival were obtained. Results By December 2011, 24 patients were identified whom underwent treatment of a total of 107 lesions. Mean patient age was 63.5 years. 13/24 (54.2%) male and 11/21 (45.8%) female. Histologies were epithelioid predominant 17/24 (70.8%), mixed 3/24 (12.5%), and sarcomatoid in 1/24 (4.2%). 22/24 patients (91.7%) had detailed follow-up. Median disease-free interval following surgery was 24.5 months. 19/24 patients (79.2%) underwent multiple PCT with a mean of 4.25 (range 1-25; median=3) lesions/patient. Lesions measured a mean of 32.5 mm (range 9-113; median=30) by 18.0 mm (range 6-60; median 17) in diameter. Each lesion treated with a median of 2 probes (range 1-4) and median of 3 freeze-thaw cycles (range 2-4). Mean max freeze time was 9.68 min (range 7-10; median=10) with a mean total freeze time of 24.2 min/lesion (range 18-40; median=22). The mean max thaw time between freeze cycles was 6.7 min (range 2-10; median=8). The edge of ice ball beyond tumor was mean 6.58 mm (range 0-12.6; median=6.3). All patients were treated as outpatients without hospital admission, and low procedural morbidity (6/107 =5.6%). 102/107 cryoablated lesions (95.3%) were completely controlled following a single PCT as measured by serial PET scans. Following the 1st PCT median survival was 11.4 months. Overall median survival with this strategy was 36.1 months. Conclusion Percutaneous cryoablation (PCT) of localized malignant pleural mesothelioma recurrences following surgery can be performed safely as an outpatient procedure with minimal morbidity (5.6%), a very high efficacy rate (95.3%), and an improved overall survival (36.1 mos).