Percutaneous Computed Tomography-guided Cryotherapy of Thoracic Masses in Nonsurgical Candidates: Experience in 19 Patients

Abstract

Percutaneous cryotherapy has become a minimally invasive treatment option for unresectable lung malignancies. We report the experience and outcomes with percutaneous computed tomography (CT)-guided cryotherapy of primary lung malignancies, as well as recurrence and metastases, in patients ineligible for surgery. Methods: The procedure was performed after administration of local anesthesia on 23 tumors in 19 patients (10 male and 9 female patients; mean age, 58.7 years). None of the patients were surgical candidates and underwent CT-guided percutaneous cryotherapy for treatment of the malignant mass in the lung. Visualization of low-attenuation ice ball formation was performed using CT scanning after each cycle of freezing and thawing therapy. Subsequent CT scans were scheduled at 3-month intervals post-procedure to assess tumor control. Results: No lethal complication, major bleeding or bronchial damage was observed in any of the 23-cryotherapy sessions performed. Three patients developed pneumothorax and one patient required chest tube insertion. Thirteen tumors (56.5%) regressed, including two complete responses, five tumors (21.7%) were stationary and the remaining five tumors (21.7%) were found to be progressing at the 3-month follow-ups. No recurrence was found in the 11 regressed tumors for 6 months, and there was also no recunence in the two tumors that completely responded up to 12 months later with a satisfactory procedure. Conclusion: Percutaneous cryotherapy for primary lung cancer, recurrence and metastatic lung tumors is feasible and safe for local control.

Keywords

• computed tomography
• cryotherapy
• pulmonary nodules