Percutaneous cryoablation of lung tumors

Transcription

1 Percutaneous cryoablation of lung tumors Poster No.: C-0811 Congress: ECR 2013 Type: Authors: Keywords: DOI: Scientific Exhibit C. Pusceddu 1, L. Melis 1, G. B. Meloni 2 ; 1 Cagliari/IT, 2 Sassari/IT Lung, Computer applications, Respiratory system, CT, Percutaneous, Ablation procedures, Neoplasia /ecr2013/C-0811 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 9

2 Purpose Cryoablation is an highly innovative technology, already experimented successfully in the treatment of malignant kidney and prostate tumors. The aim of our study was to report our initial experience with CT-guided percutaneous cryoablation (PCA) in patients with primary and secondary lung tumours. Methods and Materials In this series thirty-two consecutive patients (24 man and 8 woman) with 34 inoperable lung tumours (12 primary and 22 metastases), mean size 2,7 cm (1-8 cm) underwent CT-guided PCA sessions. The following parameters were evaluated: the number of procedures completed; the number of ablated masses; the rate of overall morbidity and mortality (based on Common Terminology Criteria for Adverse Events; CTCAE); the results of follow-up CT images We have used cryoablation of lung tumors with patient who are not candidate for surgery (for comorbidities such as poor cardiopulmonary reserves). who do not respond to chemo or radiotherapy who have responded to definitive radiation and chemotherapy but have a persistent solitary peripheral focus cancer who show a recurrent isolated cancer even after lung resection and finally patients who refuse surgery Thecnical Aspects Page 2 of 9

3 During the first phase of freezing the iceball is clearly visible into the tumoral tissue such as a well-defined of hypodensity area (fig 1) During the second phase of freezing around the iceball there are phenomena such as blood congestion and oedema that help a best evidence of the iceball (fig 2) In some cases we have positioned one o more cannulae to facilitate the introduction of the cryoprobes into the tumor (fig 3). Images for this section: Fig. 1: During the fisrt phase of freezing the ice ball is visible into the tumor such as well defined hypodense area (arrows) Page 3 of 9

4 Fig. 2: Best evidence of the iceball during the second phase of freezing due to blood congestion and oedema. Page 4 of 9

5 Fig. 3: In this patient we have introduced the cannulas to facilitate the positioning of the cryoprobes into the tumor. Page 5 of 9

6 Results All the procedures were well tolerated. No intra-procedural deaths occurred. No major complications were observed. Morbidity consisted of 21% pneumothorax and 3% cases asymptomatic small pulmonary hemorrhage respectively, all of CTCAE grade 1. On 6-months CT follow-up scans, complete lack of enhancement was achieved in 91% of treated lesions (p<.000) and technical success tumour maximum size was revealed in 92% cases (p<.000) (fig 4). Low density of entire lesion, central necrosis and mass solid appearance were observed in 62%, 21% and 17% of cryoablated tumours. Images for this section: Page 6 of 9

7 Fig. 4: CT images show a big CRC metastasis before of the cryoablation treatment and 2 yr after cryoablation treatment Page 7 of 9

8 Conclusion Our preliminary experience confirms that PCA is a feasible and safe technique for the treatment of primary and secondary lung tumours. Our preliminary data also suggests that thin cryoprobe PCA reduces the rate of morbidity and mortality among the patient population. Future well-designed clinical trials with a larger patient populations are necessary to further investigate the long-term results and prognostic factors. References 1. Padhani AR, Ollivier L. The RECIST (Response Evaluation Criteria in Solid Tumors) criteria: implication for diagnostic radiologists. Br J Radiol 2001; 74: Goldberg SN, Grassi C, Cardella J, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 2005; 16: Saliken JC, McKinnon JG, Gray R. CT for monitoring cryotherapy. AJR 1996; 166: Hinshaw JL, Littrup PJ, Durick N et al. Optimizing the Protocol for Pulmonary Cryoablation: A Comparison of a Dual and Triple-Freeze Protocol. Cardiovasc Interv Radiol 2010; 33: Baust JG, Gage AA, Klossner BA et al. Issues critical to the successful application of cryosurgical ablation of the prostate. Technol Cancer Res Treat 2007; 6: Gillams AR. Image guided tumor ablation. Cancer Imaging 2005; 5: Sandison GA, Loye MP, Rewcastle JC, et al. X-ray CT monitoring of iceball growth and thermal distribution during cryosurgery. Phys Med Biol 1998; 43: Wang H, Littrup PJ, Duan Y, Zhang Y, Feng H, Nie Z. Thoracic masses treated with percutaneous cryotherapy: initial experience with more than 200 procedures. Radiology 2005; 235: Gage AA, Baust JM, Baust JG. Experimental cryosurgery investigations in vivo. Cryobiology 2009; 59: Kawamura M, Izumi Y, Tsukada N, et al. Percutaneous cryoablation of small pulmonary malignant tumors under computed tomographic guidance with local anesthesia for nonsurgical candidates. J Thorac Cardiovasc Surg 2006; 131: Page 8 of 9

9 Personal Information Dr Claudio Pusceddu Interventional Radiology Director Department of Radio-Oncology Oncological Hospital Cagliari Regional Reference Center Tel Page 9 of 9