Thoracic masses treated with percutaneous cryotherapy: initial experience with more than 200 procedures

Area of Science:

• Interventional Radiology
• Oncology
• Medical Imaging

Background:

• Percutaneous cryotherapy (PCT) is an emerging minimally invasive treatment for thoracic malignancies.
• Evaluating the initial clinical experience with computed tomography (CT)-guided PCT is crucial for understanding its efficacy and safety.
• Patient selection, particularly for those unsuitable for surgery, is a key consideration for PCT.

Purpose of the Study:

• To report the initial experience and outcomes of CT-guided percutaneous cryotherapy (PCT) for thoracic cancer masses.
• To assess the effectiveness of PCT in achieving tumor ice formation and subsequent tumor response.
• To evaluate the safety profile and procedural morbidity associated with thoracic PCT.

Main Methods:

• One hundred eighty-seven patients with thoracic cancer, ineligible for surgery, underwent CT-guided PCT.
• Tumor ice formation was visualized by CT, and its extent was compared to initial tumor size and location.
• Follow-up CT scans assessed tumor response, complications, and imaging findings at various intervals post-treatment.

Main Results:

• Mean tumor coverage by ice formation was 99% for peripheral masses ≤4 cm and 80% for central masses >4 cm (P < .001).
• Within one week, 80% of masses developed necrotic cavitation, with minimal pulmonary scarring noted by 6 months.
• The overall rate of pneumothorax was 12%, with other side effects being self-limiting; no major bleeding or bronchial damage occurred.

Conclusions:

• CT-guided PCT demonstrated low procedural morbidity, even near mediastinal structures, despite extensive freezing.
• Ongoing advancements in cryotechnology, imaging, and treatment planning are expected to improve outcomes for larger central masses.
• PCT represents a viable treatment option for thoracic cancer in non-surgical candidates, with potential for further optimization.