Cryoablation as an adjunctive therapy in a multimodality treatment program for malignant pleural mesothelioma.

Abstract

e17531 Background: Therapy for malignant pleural mesothelioma (MPM) fails to control local/regional disease in most patients and uncontrolled local disease remains a major cause of mortality. Effective novel therapies for multifocal local disease are desperately needed. We hypothesized that cryoablation may help fill this need since it can be used in the pleura/chest wall without the severe pain associated with RF and microwave ablation and without the need for general anesthesia. Methods: We retrospectively reviewed a prospective database and identified patients with localized MPM who had undergone cryoablation. Outpatient CT-guided procedures using single or multiple cryo-probes (up to 4) depending on lesion size were used to deliver two 10 minute cryoablation cycles with an 8 minute thaw period between. We analzyed patient characteristics, morbidity, and response rates. Results: 30 total lesions in 15 MPM patients were treated. 12 patients had prior surgery and were pathologically staged as stage I (2=16.7%), III (8=66.6%) and IV (2=16.7%). N2 disease was present in 6/12 (50%). Lesions in the surgical group were treated at a median of 564 days following surgery (range 201-2,774). Moribidy was limited to one case of skin erythema with a superficial chest wall lesion and one case of significant pain with a paraspinous lesion. Responses were seen in 20 (67%) lesions, stable disease in 5 (16.5%) and progression occurred in only 5 (16.5%). This compares favorably to results from our database with other tumors. Median survival of patients following surgery was 866 days (range 365-2,938) and following cryoablation was 160 days (range 75-444). 6 patients are still alive (50%) and 3 patients had no followup survival information available. Conclusions: Cryoablation can provide excellent palliation for local/regional recurrence following surgery or even primary disease in patients with malignant pleural mesothelioma and should be strongly considered in patients who have limited localized disease and no other viable treatment options. Successful employement of cryoablation potentially may lead to longer survivals in MPM due to improved local disease control. No significant financial relationships to disclose.