PURPOSE: Cryoablation has been successfully used to treat lung tumors. However, the safety and effectiveness of treating tumors adjacent to critical structures has not been fully established. We describe our experience with computed tomography (CT)-guided percutaneous cryoablation of central lung tumors and the role of ice ball monitoring. MATERIALS AND METHODS: Eight patients with 11 malignant central lung tumors (nine metastatic, two primary; mean, 2.6 cm; range, 1.0-4.5 cm) located adjacent to mediastinal or hilar structures were treated using CT-guided cryoablation in 10 procedures. Technical success and effectiveness rates were calculated, complications were tabulated and intraprocedural imaging features of ice balls were described. RESULTS: All procedures were technically successful; imaging after 24 hours demonstrated no residual tumor. Five tumors recurred, three of which were re-ablated successfully. A hypodense ice ball with well-defined margin was visible during the first (n=6, 55%) or second (n=11, 100%) freeze, encompassing the entire tumor in all patients, and abutting (n=7) or minimally involving (n=4) adjacent mediastinal and hilar structures. Pneumothorax developed following six procedures (60%); percutaneous treatment was applied in three of them. All patients developed pleural effusions, with one patient requiring percutaneous drainage. Transient hemoptysis occurred after six procedures (60%), but all cases improved within a week. No injury occurred to mediastinal or hilar structures. CONCLUSION: CT-guided percutaneous cryoablation can be used to treat central lung tumors successfully. Although complications were common, they were self-limited, treatable, and not related to tumor location. Ice ball monitoring helped maximize the amount of tumor treated, while avoiding critical mediastinal and hilar structures.
PURPOSE: Cryoablation has been successfully used to treat lung tumors. However, the safety and effectiveness of treating tumors adjacent to critical structures has not been fully established. We describe our experience with computed tomography (CT)-guided percutaneous cryoablation of central lung tumors and the role of ice ball monitoring. MATERIALS AND METHODS: Eight patients with 11 malignant central lung tumors (nine metastatic, two primary; mean, 2.6 cm; range, 1.0-4.5 cm) located adjacent to mediastinal or hilar structures were treated using CT-guided cryoablation in 10 procedures. Technical success and effectiveness rates were calculated, complications were tabulated and intraprocedural imaging features of ice balls were described. RESULTS: All procedures were technically successful; imaging after 24 hours demonstrated no residual tumor. Five tumors recurred, three of which were re-ablated successfully. A hypodense ice ball with well-defined margin was visible during the first (n=6, 55%) or second (n=11, 100%) freeze, encompassing the entire tumor in all patients, and abutting (n=7) or minimally involving (n=4) adjacent mediastinal and hilar structures. Pneumothorax developed following six procedures (60%); percutaneous treatment was applied in three of them. All patients developed pleural effusions, with one patient requiring percutaneous drainage. Transient hemoptysis occurred after six procedures (60%), but all cases improved within a week. No injury occurred to mediastinal or hilar structures. CONCLUSION: CT-guided percutaneous cryoablation can be used to treat central lung tumors successfully. Although complications were common, they were self-limited, treatable, and not related to tumor location. Ice ball monitoring helped maximize the amount of tumor treated, while avoiding critical mediastinal and hilar structures.
Authors: Mohamad E Allaf; Ioannis M Varkarakis; Sam B Bhayani; Takeshi Inagaki; Louis R Kavoussi; Stephen B Solomon Journal: Radiology Date: 2005-08-26 Impact factor: 11.105
Authors: Hiran C Fernando; Alberto De Hoyos; Rodney J Landreneau; Sebastian Gilbert; William E Gooding; Percival O Buenaventura; Neil A Christie; Chandra Belani; James D Luketich Journal: J Thorac Cardiovasc Surg Date: 2005-03 Impact factor: 5.209
Authors: Dok Hyun Yoon; Ju Hyun Shim; Wook Jin Lee; Pyo Nyun Kim; Ji Hoon Shin; Kang Mo Kim Journal: Korean J Radiol Date: 2009-06-25 Impact factor: 3.500
Authors: Caroline J Simon; Damian E Dupuy; Thomas A DiPetrillo; Howard P Safran; C Alexander Grieco; Thomas Ng; William W Mayo-Smith Journal: Radiology Date: 2007-04 Impact factor: 11.105
Authors: Roberto Luigi Cazzato; Julien Garnon; Nitin Ramamurthy; Guillaume Koch; Georgia Tsoumakidou; Jean Caudrelier; Francesco Arrigoni; Luigi Zugaro; Antonio Barile; Carlo Masciocchi; Afshin Gangi Journal: Med Oncol Date: 2016-11-11 Impact factor: 3.064
Authors: Paul B Shyn; Florian J Fintelmann; Konstantin S Leppelmann; Vincent M Levesque; Alexander C Bunck; Alexis M Cahalane; Michael Lanuti; Stuart G Silverman Journal: Ann Surg Oncol Date: 2021-02-23 Impact factor: 5.344