4.3 Article

Percutaneous Cryoablation of Large Tumors: Safety, Feasibility, and Technical Considerations

Journal

CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY
Volume 45, Issue 1, Pages 69-79

Publisher

SPRINGER
DOI: 10.1007/s00270-021-03025-7

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This study assessed the safety and feasibility of percutaneous cryoablation for large tumors exceeding 6 cm in size, showing a high degree of technical success and acceptable safety profile in most cases.
Introduction Large tumors may prove unsuitable for surgical cure or other local therapies due to their size, involvement of critical structures, prior non-ablative treatment failure, or coexisting disease burden. This study was performed to assess the safety and feasibility of per-cutaneous cryoablation for treatment of large tumors exceeding 6 cm in size, and to highlight the key technical considerations inherent to such cases. Materials and Methods This single-institution retrospective study identified 77 patients (42 male, 35 female; median age 55 years) who underwent 96 cryoablation procedures for treatment of 78 tumors (mean diameter 9.8 +/- 3.6 cm) from 2008 through 2020. Technical success, procedure-related complications, mortality, oncologic outcomes, and procedural logistics were evaluated. Technical success was defined as ice ball extension at least 5 mm beyond the tumor margins. Results Intentional subtotal ablations were performed in 32% of cases due to tumor encroachment on vulnerable structures or as part of staged/combined therapies. Of the 68% of cases that were planned for complete ablation, the technical success rate was 100%. Major complications occurred after 19/96 (20%) procedures, with hemorrhage and acute kidney injury each occurring in 6/96 (6%). Post-procedural myositis occurred in 24/96 (25%) cases and was not considered a major complication in the absence of acute kidney injury. Local recurrence occurred in 2/23 (8.7%) of patients undergoing ablation for cure or local control at a median follow-up duration of 13 months. Conclusion Percutaneous cryoablation may be used to treat large (> 6 cm) tumors with a high degree of technical success and an acceptable safety profile.

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