Percutaneous Cryoablation for the Treatment of Medically Inoperable Stage I Non-Small Cell Lung Cancer

Abstract

BackgroundTo evaluate the midterm results of percutaneous cryoablation for medically inoperable stage I non-small cell lung cancer.Methodology/Principal FindingsBetween January 2004 and June 2010, 160 patients underwent computer tomography guided percutaneous cryoablation for lung tumors at our institution. Of these patients, histologically proven stage I lung cancer patients with more than one year of follow-up, were retrospectively reviewed. All of these patients were considered to be medically inoperable with Charlson comorbidity index of 3 or greater. Follow-up was based primarily on computed tomography. There were 22 patients with 34 tumors who underwent 25 sessions of cryoablation treatment. Complications were pneumothoraces in 7 treatments (28%, chest tube required in one treatment), and pleural effusions in 8 treatments (31%). The observation period ranged from 12–68 months, average 29±19 months, median 23 months. Local tumor progression was observed in one tumor (3%). Mean local tumor progression-free interval was 69±2 months. One patient died of lung cancer progression at 68 months. Two patients died of acute exacerbations of idiopathic pulmonary fibrosis which were not considered to be directly associated with cryoablation, at 12 and 18 months, respectively. The overall 2- and 3-year survivals were 88% and 88%, respectively. Mean overall survival was 62±4 months. Median overall survival was 68 months. The disease-free 2- and 3-year survivals were 78% and 67%, respectively. Mean disease-free survival was 46±6 months. Pulmonary function tests were done in 16 patients (18 treatments) before and after cryoablation. Percentage of predicted vital capacity, and percentage of predicted forced expiratory volume in 1 second, did not differ significantly before and after cryoablation (93±23 versus 90±21, and 70±11 versus 70±12, respectively).Conclusions/SignificanceAlthough further accumulation of data is necessary regarding efficacy, cryoablation may be a feasible option in medically inoperable stage I lung cancer patients.

CT-guided percutaneous cryoablation of central lung tumors

“…Prior reports have focused on the feasibility, safety, and local control rate of CT-guided cryoablation of lung tumors in general; however, these reports provided no detailed information regarding tumor location and did not discuss the issues relevant to the treatment of central tumors (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). Wang et al (19) placed straight cryoablation applicators into tumors tandem to a guidance needle outside the CT gantry, as their CT gantry could not accommodate the entire length of straight cryoablation applicators.…”

“…Heat-based ablation methods may not be safe in the treatment of central lung tumors because of a possibility of bronchial disruption or perforation, which may result in bronchopleural fistula formation (19). Although cryoablation has been used to treat lung malignancies (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31), there are limited data on the safety and effectiveness of percutaneous cryoablation of central lung tumors. In this study, we describe our experience with CT-guided percutaneous cryoablation of central lung tumors and the role of ice ball monitoring.…”

Recent Advances in Bronchoscopic Treatment of Peripheral Lung Cancers

“…The complication rate was significant, however, as 28% of patients developed pneumothorax, 31% developed pleural effusions, and 24% had hemoptysis. 57 There were no procedure-related deaths. Moreover, cryotherapy in combination of brachytherapy and percutaneous implantation of controlled-release drugs M A N U S C R I P T…”

Non-extended cryoablation could be a new strategy in lung cancer management: An experiment on green fluorescent protein-labeled Lewis lung cancer-bearing mice

“…Referring to the lung cancer management, some researchers claimed that percutaneous cryoablation could only be one option for the inoperable early stage lung cancer [14,43]. Following the surgical excision spirits, most practitioners pursue radical ablation.…”