Successful Lung Cryoablation for a Bulky Lung Carcinoma

Abstract

A 49-year-old man was referred for ablation of a 6.3-cm lung tumor (Fig 1). Prior history included Hodgkin disease (1992), tobacco use, right upper lobectomy for lung adenocarcinoma (2013), and chemotherapy for a contralateral recurrence (2015), with a complete response. A recurrence occurred in 2017; he was contraindicated for additional surgery and radiotherapy because of prior radiation and compromised pulmonary function: forced expiratory volume in 1 second (FEV1) = 68% and maximal oxygen uptake (VO2max) = 41%. Lung cryoablation was planned. Using computed tomographic guidance, 7 cryoprobes (IceRoad-Cx, Galil Medical, Yokne'am Illit, Israel) (Figs 2, 3) were successfully placed and activated for 3 freeze-thaw cycles. A 24-hour intensive care unit recovery and chest tube were required due to a pneumothorax and lung consolidation. He was discharged 12 days later. Positron emission tomography-computed tomography after 2 years of follow-up showed a complete metabolic response and the shrinkage of the ablation scar (Fig 4). Figure 2Computed tomography volume rendering reformation demonstrated the 7 cryoprobes coursing through the chest wall into the mass. View Large Image Figure Viewer Download Hi-res image Figure 3Multiplanar reconstruction orthogonal to the long axis of the probes shows their distribution within the tumor in order to create an encompassing ice ball with safety margins. View Large Image Figure Viewer Download Hi-res image Figure 4Axial computed tomography with positron emission tomography fusion obtained 2 years after treatment shows the absence of metabolic activity and the shrinkage of the ablation scar. View Large Image Figure Viewer Download Hi-res image