Percutaneous Image-guided Cryoablation Research Articles

Percutaneous cryoablation of breast cancer metastases: Analysis of long-term single center experience, efficacy and outcomes.

e13105 Background: Percutaneous image-guided cryoablation is a minimally invasive loco-regional treatment modality with wide availability and advantages of minimal sedation, short recovery, and ability to continue concurrent systemic therapy. However, there is a paucity of data about its long-term effects in the treatment of metastatic breast cancer despite evidence suggesting a potential survival advantage with loco-regional therapy for oligo-metastatic disease. Methods: We conducted retrospective analysis of patients who underwent CT-guided percutaneous cryoablation for metastatic breast cancer and had at least 1 follow up post cryoablation. Patient data including demographics, cancer treatment history and outcomes were extracted by chart review after IRB approval. Descriptive analyses of overall survival (OS), progression-free survival (PFS), and time to next-line treatment (TTNL) was performed. Results: The study encompassed 37 metastatic breast cancer patients who underwent cryotherapy between 2004-2021. These ablation procedures targeted various metastatic sites, which included the liver, lung, renal, lymph nodes, subcutaneous nodules, and bone. Their median age at the time of cryoablation was 58 years (range: 34-90). Among them, 46% had triple-negative breast cancer (TNBC), 41% were HR+/HER2-, and 8% were HER2+. Prior to first cryoablation procedure, 59% of patients had received more than one line of systemic therapy, and 73% were actively undergoing systemic treatment. The median size of the metastatic lesions treated with cryoablation was 1.8 cm (range: 0.4-6.5 cm). The most frequent site for cryotherapy was the liver (38%), followed by lymph nodes (30%). For the entire cohort, median PFS, TTNL, and OS were 7.1, 14, and 65.7 months, respectively. Subgroup analysis revealed mPFS of 3.1, 7.4 and 14.2 months for TNBC, Her2+ and HR+/Her2- cohorts respectively. Subgroup analysis for OS was not reported due to the small number of events and premature follow up time. Among the 27 patients who experienced disease progression, the majority (74%) had distant progression, with 22% occurring within the same organ but outside the ablation zone. Local recurrence within the ablation zone was rare, observed in only 4% of cases. Conclusions: Percutaneous image-guided cryoablation of metastatic breast cancer lesions demonstrated durable local response, prolonged PFS, TTNL and OS. Future studies investigating cryoablation as part of a multidisciplinary treatment approach for patients with metastatic breast cancer are worthwhile to confirm disease control rate and improvement in survival.

Abstract 2468: Phase II study of cryoablation and post-progression immune checkpoint inhibition in metastatic melanoma

Abstract Introduction: Efforts to overcome resistance to immune checkpoint inhibition (ICI) are paramount, and novel combination strategies are in development. Image-guided percutaneous cryoablation is an established minimally invasive oncologic treatment that has demonstrated immune modulatory effects. We hypothesized that cryoablation may prime the tumor microenvironment (TME) through direct modulation of the tumor, thereby generating an anti-tumor response in ICI refractory tumors. Methods: In this non-randomized phase II single-center study, subjects with unresectable melanoma progressing on ICI underwent cryoablation of an enlarging metastasis, and ICI was continued for a minimum of two additional cycles. The primary endpoint was safety and feasibility, with objective response rate (ORR) and disease control rate (DCR) in non-ablated lesions a key secondary endpoint. To better understand the inflammatory state of TME as well as factors determining response to cryoablation, we performed immunohistochemistry (PD-L1, CD8+ TIL) as well as single-cell RNA-sequencing (ScRNAseq) on evaluable pre- and post-cryoablation biopsies obtained from metastatic sites of 15 patients. Results: From May 2018 through July 2020, 17 patients were treated. This regimen was feasible with all patients ongoing cryoablation with no unexpected safety signal. The ORR and DCR was 23.5% (95% CI 6.81-49.9) and 41.2% (95% CI 18.44-67.08), respectively, with four patients experiencing PR and three patients SD. Durable control, defined as tumor control ≥6 months, was achieved in 35%. Median progression-free survival (PFS) was 59 days (95% CI 42, 179) with a 6-month PFS rate of 23.5% (95% CI 7.3%, 44.9%). Median overall survival (OS) was 387 days (95% CI 106, 608) with a 1-year OS rate of 53% (95% CI (27.6%, 73%). Correlative analysis demonstrated pre-ablation tumors were uniformly associated with a “cold” TME, as all samples were PD-L1 negative and the majority had low levels of CD8+ TIL, defined as ˂5% of tumor cells associated with CD8+ TILs. ScRNAseq revealed no clear trends of cell type composition to predict best response to cryoablation, however an increase in B/plasma cells was seen in patients with disease control, suggesting these cells may play a role in mounting a durable anti-tumor response after cryoablation. Conclusion: The anti-tumor efficacy of combining cryoablation and post-progression ICI was superior to what would be expected with the use of post-progression ICI alone with an acceptable safety profile. Our data support further study of this novel, synergistic therapeutic approach. Citation Format: Meghan J. Mooradian, Florian J. Fintelmann, Thomas J. LaSalle, Judit Simon, Alexander Graur, Alona Muzikansky, Mari Mino-Kenudson, Sophia Shalhout, Howard L. Kaufman, Russell W. Jenkins, Donald Lawrence, Aleigha Lawless, Tatyana Sharova, Raul N. Uppot, Jacy Fang, Emily M. Blaum, Anna L. Gonye, Irena Gushterova, Genevieve M. Boland, Nir Hacohen, Moshe Sade-Feldman, Ryan J. Sullivan. Phase II study of cryoablation and post-progression immune checkpoint inhibition in metastatic melanoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2468.

Percutaneous Image-Guided Cryoablation of Endophytic Renal Cell Carcinoma

PurposeEndophytic renal cancer treatment is a challenge. Due to difficulties in endophytic tumor visualization during surgical extirpation, image-guided percutaneous cryoablation (PCA) is an attractive alternative. The minimally invasive nature of PCA makes it favorable for comorbid patients as well as patients in which surgery is contraindicated. Oncological outcomes and complications after PCA of endophytic biopsy-proven renal cell carcinoma (RCC) were reviewed in this study.Materials and MethodsPatients were included after a multidisciplinary team conference from January 2015 to November 2021. Inclusion criteria were endophytic biopsy-proven T1 RCC treated with PCA with one year of follow-up. Complications were reported according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system and the Clavien-Dindo classification (CDC) system. Major complications were defined as a grade ≥ 3 according to the CDC.ResultsFifty-six patients were included with a total of 56 endophytic tumors treated during 61 PCA sessions. The median RENAL nephrometry score was 9 (IQR 2), and the mean tumor size was 25.7 mm (SD ± 8.9 mm). Mean hospitalization time was 0.39 (SD ± 1.1) days. At a mean follow-up of 996 days (SD ± 559), 86% of tumors were recurrence free after one PCA. No patients progressed to metastatic disease. According to the CIRSE classification, 10.7% (n = 6) had grade 3 complications, and 5.4% (n = 3) had CDC major complications.ConclusionThis study demonstrates that PCA of endophytic biopsy-proven T1 RCC is safe with few major complications and excellent local tumor control rates at almost three-year mean follow-up.Level of Evidence 3Retrospective cohort study.Graphic

Renal Function After CT-Guided Cryoablation of Small Renal Tumours in Patients with Solitary Kidney: An Analysis of European Multinational Prospective EuRECA Registry

PurposeTreatment of renal cell carcinoma (RCC) in patients with solitary kidneys remains challenging. The purpose of this multicentre cohort study was to explore how renal function is affected by percutaneous image-guided cryoablation in patients with solitary kidneys.Material and MethodsData from the European Registry for Renal Cryoablation database were extracted on patients with RCC in solitary kidneys treated with image-guided, percutaneous cryoablation. Patients were excluded if they had multiple tumours, had received previous treatment of the tumour, or were treated with more than one cryoablation procedure. Pre- and post-treatment eGFR (within 3 months of the procedure) were compared.ResultsOf 222 patients with solitary kidneys entered into the database, a total of 70 patients met inclusion criteria. The mean baseline eGFR was 55.8 ± 16.8 mL/min/1.73 m2, and the mean 3-month post-operative eGFR was 49.6 ± 16.5 mL/min/1.73 m2. Mean eGFR reduction was − 6.2 mL/min/1.73 m2 corresponding to 11.1% (p = 0.01). No patients changed chronic kidney disease group to severe or end-stage chronic kidney disease (stage IV or V). No patients required post-procedure dialysis.ConclusionImage-guided renal cryoablation appears to be safe and effective for renal function preservation in patients with RCC in a solitary kidney. Following cryoablation, all patients had preservation of renal function without the need for dialysis or progression in chronic kidney disease stage despite the statistically significant reduction in eGFR.Level of Evidence 3Observational study.Graphical

Percutaneous Image Guided Cryoablation of Adrenal Metastases From Renal Cell Carcinoma: A Single Institution Review

ObjectivesTo assess the safety, technical success, disease progression, and survival associated with percutaneous image-guided cryoablation of renal cell carcinoma metastasis (mRCC) in the adrenal gland. MethodsRetrospective, single-institution review of adult patients undergoing percutaneous cryoablation for adrenal mRCC between the years of 2007-2021. Technical parameters, technical success, safety, and survival were analyzed according to standard criteria. Results46 patients (39 male; mean age 66±8.8 years) with 57 tumors ablated over 51 sessions with a median hospital length of stay of 1 day (range 0-3 days). 44 (96%) had primary of clear cell histology. Aim of ablation was curative intent in 39 of 57 tumors (72%) with local tumor control in the remainder. There were 2 (4%) technical failures and technique efficacy was achieved in 52 out of the remaining 55 (95%). There were no CTCAE immediate complications and 4 of 51 (8%) delayed complications. 25 of 57 (44%) had disease progression anywhere, away from ablation site. 1-,3-, and 5-year recurrence free survival rates were 100, 89, and 89% and overall survival was 98, 85, and 71%. 51 of 57 (89%) underwent pre-procedural alpha blockade with hypertensive crisis in 27 of 56 (54%) available records, of which there were no adverse outcomes. ConclusionsPercutaneous cryoablation of mRCC to the adrenal glands is safe with robust local control, leading to advocacy for its ongoing use in this patient population. Multi-disciplinary management is recommended for successful treatment.

MP47-18 OUTCOMES OF PERCUTANEOUS RENAL CRYOABLATION IN A LARGE COHORT OVER 15 YEARS

You have accessJournal of UrologyCME1 Apr 2023MP47-18 OUTCOMES OF PERCUTANEOUS RENAL CRYOABLATION IN A LARGE COHORT OVER 15 YEARS Zachary A. Valley, Evan Allarie, Steven Lu, Richard Cormack, Michael Welsh, Bryan J. Donnelly, and Kamaljot S. Kaler Zachary A. ValleyZachary A. Valley More articles by this author , Evan AllarieEvan Allarie More articles by this author , Steven LuSteven Lu More articles by this author , Richard CormackRichard Cormack More articles by this author , Michael WelshMichael Welsh More articles by this author , Bryan J. DonnellyBryan J. Donnelly More articles by this author , and Kamaljot S. KalerKamaljot S. Kaler More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Historically, the standard of care for renal cell carcinoma (RCC) has been partial nephrectomy (PN) or radical nephrectomy (RN). Image-guided percutaneous cryoablation (PCA) of renal masses has emerged as a nephron-sparing, minimally invasive alternative. In this study, we aim to assess outcomes of percutaneous renal cryoablation at a single centre over 15 years. METHODS: Patients who underwent PCA of renal masses from 2006 to 2022 were included with no exclusions. All patients had cross-sectional imaging prior to the procedure and most underwent biopsy at the time of procedure. Cryoprobe placement and ice-ball formation was monitored via computed tomography (CT) imaging during the procedure. Data were collected via electronic medical record review, as well as pre-, intra-, and post-procedure imaging review. Data included demographics, tumor characteristics, pathology, local recurrence and metastatic disease rates, complications, pre- and post-procedure renal function and blood counts, co-morbidities, and mortality rate of patients in follow-up. RESULTS: This study included 598 patients in the analysis with a median age of 65.1 years and median follow-up of 39 months (Table 1). The average size of tumor was 2.7 cm. Overall local recurrence rate was 4.8% including surgically resected and hereditary RCC. Average nephrometry score was 6.1. Median time to local recurrence was 2.0 years. Five percent of patients made up 52% of the recurrences. Overall survival rate was 82.3% at time of analysis. Cancer-specific survival overall was 97.3%. Average length of time to discharge was 28.2 hours. The Clavien-Dindo 3+ complication rate was 2.3%. Overall metastatic rate was 1.8% and 0.7% in patients with no recurrence. CONCLUSIONS: PCA outcomes in this large cohort with no exclusions and long-term follow-up revealed an overall low recurrence rate, low complication rate, and an acceptable metastatic rate. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e651 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary A. Valley More articles by this author Evan Allarie More articles by this author Steven Lu More articles by this author Richard Cormack More articles by this author Michael Welsh More articles by this author Bryan J. Donnelly More articles by this author Kamaljot S. Kaler More articles by this author Expand All Advertisement PDF downloadLoading ...

Resolution of Pain after Percutaneous Image-Guided Cryoablation of Extraperitoneal Endometriosis

PurposeTo retrospectively evaluate the relief of pain after percutaneous image-guided cryoablation of symptomatic extraperitoneal endometriosis (EE). Material and MethodsFrom 2017 to 2022, cryoablation of EE was performed at a single institution on a total of 47 lesions in 42 consecutive patients (median age, 37 years; interquartile range [IQR], 33–39.5 years). Patient and procedural characteristics were reviewed retrospectively. Tolerance and outcomes in terms of pain and patient satisfaction were evaluated. ResultsThe median follow-up duration was 13.5 months (IQR, 1.1–37.7 months) after cryoablation. The median pain-free survival rate was 93.8% (95% confidence interval [CI], 77.3–98.4) at 6 months and 82.7% (95% CI, 58.8–93.5) after 12 months. Pain decreased from a median of 8/10 (IQR, 7–9) on the visual analog scale to 0/10 (IQR, 0–1) at the last follow-up (P < .0001). The median Patient Global Impression of Change score recorded at the last follow-up was 1/7 (IQR, 1–2). The efficacy rate of cryoablation to avoid secondary surgery was 92.8% (39/42) per patient and 93.6% (44/47) per nodule treated. Four patients (9.5%, 4/42) experienced an adverse event in the days following the procedure, and 1 patient (2%) experienced a severe adverse event. ConclusionsPercutaneous cryoablation is safe and effective in significantly reducing pain and obtaining local control of EE.

Image-guided percutaneous lung cryoablation for the treatment of lung tumors

Image-guided percutaneous lung cryoablation for the treatment of lung tumors

Percutaneous Image-Guided Cryoablation of Metastatic Colorectal Adenocarcinoma to the Abdominal Wall

AbstractAbdominal wall metastases are rarely seen in primary colorectal cancer; the majority of cases are attributed to seeding from previous procedures. We report a case of percutaneous cryoablation of metastatic colorectal cancer to the abdominal wall with no evidence of recurrence 1 year later.

8439 Differences in Outcomes between Percutaneous Image-Guided Cryoablation Versus Surgical Excision for Abdominal Wall Endometriosis

<h3>Study Objective</h3> To compare the outcomes of percutaneous image-guided cryoablation versus surgery for abdominal wall endometriosis (AWE) <h3>Design</h3> Retrospective cohort study of all patients treated for AWE from 01/2000 to 02/2022. <h3>Setting</h3> Academic tertiary health system. <h3>Patients or Participants</h3> Women who underwent cryoablation (n=25) or surgical excision (n=50) for treatment of AWE. <h3>Interventions</h3> Percutaneous image-guided cryoablation versus surgical excision. <h3>Measurements and Main Results</h3> There was no significant difference between patients undergoing cryoablation versus surgery in terms of age (37±4.6 vs 35.9±6.1, p=0.37), parity (2 [2,3] vs 2 [1,3], p=0.53), presence of pelvic endometriosis (68% vs 68%, p=0.99), number of prior surgeries (2 [2,4] vs 2 [2,3], p=0.79) and cesarean deliveries (2 [1,2] vs 1 [1,2], p=0.73). Mean BMI was significantly higher in the cryoablation group (34.6±8.6 vs 28.7±6.8, p=0.005). Most patients in both cryoablation and surgery groups had no prior intervention for AWE (60% vs 78%), however 36% of cryoablation and 22% of surgical patients underwent prior surgical excision of AWE. The most common location was prior CS scar (cryoablation 80% vs surgery 86%). Lesion number and size (cm) was similar for both cryoablation and surgical groups (1 [1,1] vs 1 [1,1], p=0.059, and 2.7 [1.8,4.0] vs 2.6 [1.7,5.0], p=0.97). Median length of hospital stay was similar between groups (cryoablation 1 [0,1] vs surgery 0 [0,2], p=0.42). Complications included wound infection (cryoablation 4%, surgery 6%), hematoma (cryoablation 8%, surgery 4%), edema (cryoablation 12%, surgery 0%). Recurrence after treatment was similar between cryoablation (24%) and surgery (18%) groups (p=0.76). There was significant decrease of pain in both groups, however this decrease was not significantly different between groups p-value 0.83. <h3>Conclusion</h3> Percutaneous image-guided cryoablation seems equivalent to surgical excision for the treatment of AWE in terms of pain reduction and recurrence risk with low risk of complications. It is a potential option to consider for women wanting to avoid surgery or who are not surgical candidates.

Percutaneous image-guided cryoablation with temporary balloon occlusion of the renal artery for the treatment of central renal tumors

PurposeThe purpose of this study was to report the technical feasibility and outcomes of percutaneous image-guided cryoablation with temporary balloon occlusion of the renal artery for the treatment of central renal tumors. Materials and methodsAll consecutive patients with central renal tumors treated with cryoablation and temporary renal artery occlusion from January 2017 to October 2021 were retrospectively included. Patient demographics, tumor's characteristics, procedural data, technical success, primary and secondary clinical efficacy, complications (according to Cardiovascular and Interventional Radiology Society of Europe [CIRSE] classification) and follow-up were investigated. ResultsA total of 14 patients (8 men, 6 women; mean age 72.4 years ± 21.4 [SD] years; age range: 42–93 years) with 14 central renal tumors (median size, 32 mm; IQR: 23.5, 39.5 mm; range: 13–50 mm) were treated with percutaneous image-guided cryoablation and temporary balloon occlusion of the renal artery. Technical success was 13/14 (93%), with 1/14 (7%) failure of vascular access. A median of 4 cryoprobes (IQR: 3, 4.75) were inserted and protective hydrodissection was performed in 11/14 (79%) patients. Median time to perform cryoprobes insertion, hydrodissection and vascular access was 26.5 min (IQR: 18, 35 min), 10 min (IQR: 10, 17 min) and 30 min (IQR: 20, 45 min) respectively. Median duration of the whole intervention was 150 min (IQR: 129, 180 min; range: 100–270 min). Median hospital stay was 2.5 days (IQR: 2, 4 days; range: 2–14 days). Major complications occurred in 3/14 (21%) patients. Primary efficacy rate was 93% (13/14 patients). Median oncological follow-up was 25 months (IQR: 11, 33 months; range: 6–39 months). One patient experienced renal tumor recurrence at 14-months of follow-up, which was successfully treated with repeat cryoablation. ConclusionPercutaneous image-guided cryoablation of renal tumors with temporary balloon occlusion of the renal artery is technically feasible, with a high technical success rate and paths the way for percutaneous treatment of central renal tumors.

Abstract No. 49 Percutaneous image-guided cryoablation of the intercostobrachial nerve for management of post-mastectomy pain syndrome

Breast cancer is the most common invasive cancer to affect women worldwide. Post-mastectomy pain syndrome (PMPS) is reported to affect 30-80% of patients who undergo mastectomy or lumpectomy. PMPS is described as persistent pain that affects the anterior thorax, axilla, and/or medial upper arm–for which no established efficacious treatment exists. The purpose of this study was to evaluate the feasibility, safety, and early efficacy of percutaneous CT-guided cryoablation of the intercostobrachial nerve for management of PMSP.

JIM Reading List.

JIM Reading List.

Safety and Efficacy of Percutaneous Cryoablation of Extraspinal Thyroid Cancer Bone Metastases with Curative Intent: Single-Center Experience with a Median Follow-up of More than 5 Years

PurposeTo determine the oncologic outcomes and safety profile of image-guided percutaneous cryoablation (PCA) for extraspinal thyroid cancer bone metastases with curative intent. Materials and MethodsBetween January 2010 and January 2020, 16 consecutive patients (8 men, 8 women; mean age, 61 years ± 19; range, 30–84 years) with 18 bone metastases (median bone tumor size, 19 mm; interquartile range [IQR], 12–29 mm; range, 7–58 mm) underwent PCA of oligometastatic extraspinal bone metastases. Thirteen (81%) patients were radioiodine therapy resistant. Two patients underwent 2 bone tumor ablations in a single session. Procedural data, oncologic outcomes, follow-up (with magnetic resonance imaging and positron emission tomography–computed tomography), and adverse events were retrospectively investigated. Local tumor progression-free survival, disease-free survival, and overall survival were estimated using the Kaplan-Meier method. ResultsA median of 2 cryoprobes (IQR, 1.25–3 cryoprobes; range, 1–7 cryoprobes) were used, with 2 freezing cycles; the median length of freezing was 20 minutes (IQR, 17–20 minutes; range, 10–20 minutes). The technical success was 100% (18/18), and the primary technical efficacy was 94.4% (17/18). The median follow-up was 68 months (IQR, 38–93 months). During follow-up, 3 of 17 (17.6%) tumors demonstrated local progression at 7, 13, and 27 months. Consequently, the 1-, 2-, 3-, 4-, and 5-year local tumor progression-free survivals were 93.3%, 84.6%, 76.9%, 75%, and 72.7%, respectively. Two of 16 (12.5%) patients died during follow-up at 43 and 88 months. The major adverse event rate was 5.5% (1/18) with 1 postablative acromion fracture. ConclusionsPCA for extraspinal thyroid cancer bone metastases demonstrated high local tumor control rates with a safe profile at long-term follow-up.

Punctural Percutaneous Image-Guided Cryoablation for Pain Relief in Bone Metastases

Percutaneous image-guided cryoablation (PICA) in relieve pain from metastatic bone disease was performed in 24 patients. The cryoprobes were navigated and the ice sphere was monitored using computed tomography. Each patient, depending on the volume of the lesion, underwent from one to four ablations. Pain assessment was performed using a numerical rank scale. A decrease in the pain index after PICA was from 4.1±0.8 points to 1.3±0.5 points. The duration of analgesic affect correlated with local control of the tumor. A later postoperative complication was noted in one case in the form of a bone fracture in the ablation zone. Further study of the effectiveness of this technology is necessary by analyzing larger samples and comparing them with the results of treatment with other methods of local exposure.

Percutaneous image-guided cryoablation of spinal metastases: over 10-year experience in two academic centers.

To report on safety and clinical effectiveness of cryoablation for the treatment of spinal metastases (SM) in patients needing pain palliation or local tumor control (LTC). All consecutive patients with SM who underwent cryoablation from May 2008 to September 2020 in two academic centers were retrospectively identified and included in the present analysis. Patient characteristics, goal of treatment (curative/palliative), SM characteristics, procedural details, and clinical outcomes (pain relief; local tumor control [LTC]) were analyzed. There were 74 patients (35 women; median age 61years) accounting for 105 SM. Additional cementoplasty was used for 76 SM (76/105; 72.4%). There were 9 complications (out of 105 SM [8.5%]; 2 major and 7 minor) in 8 patients. Among the 64 (64/74; 86.5%) patients with painful SM, the mean Numerical Pain Rating Scale dropped from 6.8 ± 2.2 (range, 0-10) at the baseline to 4.1 ± 2.4 (range, 0-9; p < 0.0001) at 24h, 2.5 ± 2.6 (range, 0-9; p < 0.0001) at 1month, and 2.4 ± 2.5 (range, 0-9; p < 0.0001) at the last available follow-up (mean 14.7 ± 19.6months; median 6). Thirty-four patients (34/64; 53.1%) were completely pain-free at the last follow-up. At mean 25.9 ± 21.2months (median 16.5) of follow-up, LTC was achieved in 23/28 (82.1%) SM in 21 patients undergoing cryoablation with curative intent. Cryoablation of SM, often performed in combination with vertebral augmentation, is safe, achieves fast and sustained pain relief, and provides high rates of LTC at mean 2-year follow-up. •Cryoablation of spinal metastases is safe. •Cryoablation of spinal metastases allows rapid and sustained pain relief. •The mean2-year rate of local tumor control after cryoablation of spinal metastases is 82.1%.

Percutaneous Image-Guided Cryoablation of Post-Surgical Renal Cancer Recurrences in the Renal Fossa: A Single-Center Retrospective Analysis

Percutaneous Image-Guided Cryoablation of Post-Surgical Renal Cancer Recurrences in the Renal Fossa: A Single-Center Retrospective Analysis

Feasibility and safety of percutaneous image-guided cryoablation of abdominal wall endometriosis.

To evaluate the feasibility and safety of percutaneous image-guided cryoablation of abdominal wall endometriosis (AWE). A retrospective review of percutaneous cryoablation (CT or MR) of AWE was performed from January 2018 to December 2020. Eighteen patients were identified from an internal percutaneous ablation database. Technical success, complications, and outcomes were analyzed according to standard nomenclature. Patients comprised 18 females (mean age 36.9years) who underwent 18 cryoablation procedures to treat 23 AWE deposits. Three of the 18 cases were performed under MR guidance, while the remaining 15 employed CT guidance. Technical success was achieved in all 18 cases (100%). Fifteen of 18 patients (83%) had biopsy proven AWE deposits prior to treatment. Hydrodisplacement was used to displace adjacent bowel, bladder, or neurovascular structures in 13/18 cases (72%). The mean number of probes used per case was 3. Sixteen of 23 (70%) of AWE deposits had imaging follow-up (median 85days). Of the 16 lesions with imaging follow-up, 15 (94%) demonstrated no residual enhancement or T1 hyperintensity at the treatment site and 1 lesion (6%) demonstrated residual/progressive disease. At clinical follow-up, 13 of 14 (93%) patients reported improvement in AWE-related symptoms. Eleven patients had clinically documented pain scores before and after ablation and all demonstrated substantial symptomatic improvement. No society of interventional radiology (SIR) major complications were observed. Percutaneous cryoablation of AWE is feasible with a favorable safety profile. Further longitudinal studies are needed to document durable response over time.

Active Versus Passive Thaw After Percutaneous Cryoablation of Pulmonary Tumors: Effect on Incidence, Grade, and Onset of Hemoptysis.

BACKGROUND. Hemoptysis is common after percutaneous image-guided cryoablation of pulmonary tumors. OBJECTIVE. The purpose of our study was to evaluate the effect of a final active thaw on the incidence, grade, and onset of hemoptysis after percutaneous cryoablation of pulmonary tumors. METHODS. This retrospective cohort study included 60 consecutive CT-guided cryoablation sessions targeting 95 pulmonary tumors in 47 patients from March 2017 to September 2020. The final thaw of a triple-freeze protocol was active (electrical, helium-free) in 27 of 60 sessions (45%, active group) and passive in 33 of 60 sessions (55%, passive group). The incidence, onset, and management of hemoptysis were recorded using prospectively collected data. Hemoptysis, pneumothorax, and hemothorax within 30 days after ablation were graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The volume of immediate posttreatment changes on CT was quantified using semiautomated segmentation. Outcomes were compared between groups using generalized estimating equation models. A parsimonious multivariable model for hemoptysis incidence was developed using purposeful selection of predefined covariates followed by bootstrap resampling. Local tumor control was compared between groups using the Kaplan-Meier method and log-rank testing. RESULTS. Hemoptysis occurred after 26 of 60 (43%) sessions and was self-limited (CTCAE grade 1) in 22 of 26 (85%) sessions. The incidence of hemoptysis was lower in the active group than in the passive group (19% vs 64%, respectively; p = .002). The odds of hemoptysis adjusted for immediate posttreatment changes were 92% lower in the active group (odds ratio [OR], 0.08 [95% CI, 0.02-0.37]; p = .004). The odds of hemoptysis greater than grade 1 were 79% lower in the active group (OR, 0.21 [95% CI, 0.07-0.64]; p = .006). In the active group, the onset of hemoptysis was significantly delayed (OR, 0.75 [95% CI, 0.61-0.91]; p = .005). Pneumothorax (p = .60), hemothorax (p = .84), and local tumor control (p = .77) did not differ between groups. CONCLUSION. Active thaw after the final freeze reduces the incidence and grade of hemoptysis and delays the onset of hemoptysis after percutaneous cryoablation of pulmonary tumors without adversely affecting other procedural complications and local tumor control. CLINICAL IMPACT. Active thaw after the final freeze improves the safety profile of triple-freeze cryoablation of pulmonary tumors by reducing the incidence and grade of hemoptysis and by delaying the onset of hemoptysis beyond the immediate recovery period.

Freezing Nodal Disease: Local Control Following Percutaneous Image-Guided Cryoablation of Locoregional and Distant Lymph Node Oligometastases: A 10-Year, Single-Center Experience

PurposeTo retrospectively assess the technical feasibility, safety, and oncologic outcomes of percutaneous image-guided cryoablation (PCA) of locoregional and distant lymph node metastases (LNMs). MethodsAll consecutive patients undergoing PCA of LNMs between February 2009 and December 2019 were identified using a retrospective database search. Every patient was followed up at 1, 3, 6, and 12 months after treatment using contrast-enhanced magnetic resonance imaging and at approximately 3–6-month intervals using computed tomography or positron emission tomography–computed tomography. The Kaplan-Meier method was used to calculate local tumor progression-free survival, disease-free survival, and overall survival. Locoregional and distant groups were compared using the Fisher test. Technical success, technique efficacy, complications, and oncologic outcomes were analyzed. ResultsFifty-six metachronous oligometastatic LNMs (median size, 15 mm [interquartile range, 13–15 mm; range, 9–36 mm]) were treated in 37 sessions in 29 patients and defined as locoregional (26/37 sessions) or distant (11/37 sessions). Seventeen patients had undergone prior surgery or radiotherapy. Six patients underwent 8 retreatments for locoregional progression. An additional visceral oligometastasis was treated in 4 of the 11 distant LNM PCA sessions. The technical success and primary technique efficacy rates were 100%. The complication rate was 5.4% (2 transient nerve palsies). At a median follow-up of 23 months, there were 2 instances of local tumor progression (5.6%); the 1-, 2-, and 3-year local tumor progression-free survival was 100%, 94.3%, and 94.3%, respectively. Thirteen (45%) patients demonstrated no disease progression. The 1-, 2-, and 3-year overall survival was 96.2%, 90.5%, and 70%, respectively. The patients were free from systemic oncologic therapy following 20 (54%) sessions, with a mean treatment break of 19.1 months. ConclusionsThe PCA of lymph node oligometastases is feasible and safe, and offers promising local tumor control at midterm follow-up.