Vascular and Interventional Radiology

Thoracic Masses Treated with Percutaneous Cryotherapy: Initial Experience with More than 200 Procedures

PURPOSE: To perform and report initial experience with percutaneous cryotherapy (PCT) of the thorax.

MATERIALS AND METHODS: A human investigation committee approved the study protocol, and all patients gave informed consent. One hundred eighty-seven patients who were not surgical candidates underwent computed tomography (CT)-guided PCT for treatment of thoracic cancer masses. CT-visualized low-attenuating ice formation after PCT was compared with initial tumor size and location. At 1 week and at 1, 3, 6, and 12 months after PCT, the various findings seen on available CT scans and any complications were noted. χ2 and Student t tests were used to identify significant differences in frequencies and mean values of imaging observations, respectively.

RESULTS: Ice formation was identified at CT as reduced attenuation values (in Hounsfield units) within soft-tissue masses, the mean sizes of which were 4.3 cm ± 0.2 (standard deviation) in peripheral locations and 6.4 cm ± 0.3 in central locations. Tumor size and location were independent predictors of tumor coverage by low-attenuating ice: Mean coverage was 99% for peripheral masses 4 cm or smaller (n = 101) and 80% for central masses larger than 4 cm (n = 58) (P < .001). An area of necrotic cavitation larger than the original mass developed in 80% (77 of 96) of masses within 1 week and was nearly resolved by 3 months in 7% (five of 76) of masses. By 6 months, minimal pulmonary scarring was noted in 56 patients and 86% of masses showed reduced or stable size. The overall rate of pneumothorax was only 12% (22 of 187 patients), and other side effects appeared to be self limited. No major bleeding or bronchial damage was noted. Two deaths in debilitated patients were temporally related, and two complications involved brachial and recurrent laryngeal nerve damage. The patient with laryngeal nerve damage regained speech within 2 months.

CONCLUSION: CT-guided PCT yielded low procedural morbidity given the extent of freezing, even near mediastinal structures. Ongoing advances in cryotechnology, imaging guidance, and treatment planning may help to avoid the degree of undertreatment of larger central masses observed in this study.

© RSNA, 2005

References

  • 1 Bahn DK, Lee F, Badalament R, Kumar A, Greski J, Chernick M. Targeted cryoablation of the prostate: 7-year outcomes in the primary treatment of prostate cancer. Urology 2002; 60(2 suppl 1):3-11. Crossref, MedlineGoogle Scholar
  • 2 Lee FT, Mahvi DM, Chosy SG, et al. Hepatic cryosurgery with intraoperative US guidance. Radiology 1997; 202:624-632. LinkGoogle Scholar
  • 3 Sanderson DR, Neel HB, Fontana RS. Bronchoscopic cryotherapy. Ann Otol Rhinol Laryngol 1981; 90:354-358. Crossref, MedlineGoogle Scholar
  • 4 Homasson JP. Bronchoscopic cryotherapy. J Bronchol 1995; 2:145-153. CrossrefGoogle Scholar
  • 5 Maiwand MO. The role of cryosurgery in palliation of tracheo-bronchial carcinoma. Eur J Cardiothorac Surg 1999; 15:764-768. Crossref, MedlineGoogle Scholar
  • 6 Mathur PN, Wolf KM, Busk MF, Briete M, Datzman M. Fiberoptic bronchoscopic cryotherapy in the management of tracheobronchial obstruction. Chest 1996; 110:718-723. Crossref, MedlineGoogle Scholar
  • 7 Deygas N, Froudarakis , Ozenne G, Vergnon JM. Cryotherapy in early superficial bronchogenic carcinoma. Chest 2001; 120:26-31. Crossref, MedlineGoogle Scholar
  • 8 Littrup PJ, Mody A, Sparschu RA, et al. Prostatic cryotherapy: ultrasonographic and pathologic correlation in the canine model. Urology 1994; 44:175-184. Crossref, MedlineGoogle Scholar
  • 9 Dupuy DE, Zagoria RJ, Akerley W, Mayo-Smith WW, Kavanagh PV, Safran H. Percutaneous radiofrequency ablation of malignancies in the lung. AJR Am J Roentgenol 2000; 174:57-59. Crossref, MedlineGoogle Scholar
  • 10 Zagoria RJ, Chen MY, Kavanagh PV, Torti FM. Radio frequency ablation of lung metastases from renal cell carcinoma. J Urol 2001; 166:1827-1828. Crossref, MedlineGoogle Scholar
  • 11 Dupuy DE, Mayo-Smith WW, Abbott GF, DiPetrillo T. Clinical applications of radio-frequency tumor ablation in the thorax. RadioGraphics 2002; 22:S259-S269. LinkGoogle Scholar
  • 12 Lee FT, Jr, Chosy SG, Littrup PJ, Warner TF, Kuhlman JE, Mahvi DM. CT-monitored percutaneous cryoablation in a pig liver model: pilot study. Radiology 1999; 211:687-692. LinkGoogle Scholar
  • 13 Liu BQ, Peto R, Chen ZM, et al. Emerging tobacco hazards in China. I. Retrospective proportional mortality study of one million deaths. BMJ 1998; 317:1411-1422. Google Scholar
  • 14 Littrup PJ, Wang H, Duan Y, Zhang Y, Feng H, Nie Z. Percutaneous cryotherapy of the thorax: clinical observations from more than 200 procedures (abstr). Radiology 2003; 229(P):438. Google Scholar
  • 15 Rodgers BM, Blake KD, Alexander JA. The effects of profound cryotherapy upon the pulmonary parenchyma. J Thorac Cardiovasc Surg 1982; 83:784-789. Crossref, MedlineGoogle Scholar
  • 16 Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR. Renal cell carcinoma: clinical experience and technical success with radio-frequency ablation of 42 tumors. Radiology 2003; 226:417-424. LinkGoogle Scholar
  • 17 Moorjani N, Zhao F, Tian Y, Liang C, Kaluba J, Maiwand MO. Effects of cryoanalgesia on post-thoracotomy pain and on the structure of intercostal nerves: a human prospective randomized trial and a histological study. Eur J Cardiothorac Surg 2001; 20:502-507. Crossref, MedlineGoogle Scholar
  • 18 Fukumoto S, Shirato H, Shimzu S, et al. Small-volume image-guided radiotherapy using hypofractionated, coplanar, and noncoplanar multiple fields for patients with inoperable stage I nonsmall cell lung carcinomas. Cancer 2002; 95:1546-1553. Crossref, MedlineGoogle Scholar
  • 19 Vergnon JM, Schmitt T, Alamartine E, Barthelemy JC, Fournel P, Emonot A. Initial combined cryotherapy and irradiation for unresectable non-small cell lung cancer: preliminary results. Chest 1992; 102:1436-1440. Crossref, MedlineGoogle Scholar
  • 20 Chen A, Galloway M, Landreneau R, et al. Intraoperative 125I brachytherapy for high-risk stage I non-small cell lung carcinoma. Int J Radiat Oncol Biol Phys 1999; 44:1057-1063. Crossref, MedlineGoogle Scholar
  • 21 Homasson JP, Pecking A, Roden S, Angebault M, Bonniot JP. Tumor fixation of bleomycin labeled with 57 cobalt before and after cryotherapy of bronchial carcinoma. Cryobiology 1992; 29:543-548. Crossref, MedlineGoogle Scholar
  • 22 Clarke DM, Baust JM, Van Buskirk RG, Baust JG. Chemo-cryo combination therapy: an adjunctive model for the treatment of prostate cancer. Cryobiology 2001; 42:274-285. Crossref, MedlineGoogle Scholar

Article History

Published in print: Apr 2005