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

Abstract

PurposeAssess safety and local tumor progression-free survival (LTPFS) of percutaneous cryoablation for pleural-based thoracic malignancies. Materials and methodsRetrospective 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. ResultsMedian 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. ConclusionPercutaneous cryoablation for pleural lesions is associated with a long duration of local control and most complications were minor and self-limited.