Percutaneous Cryoablation of Pulmonary Metastases from Colorectal Cancer
et al. (2011) Percutaneous Cryoablation of Pulmonary Metastases from Colorectal
Cancer. PLoS ONE 6(11): e27086. doi:10.1371/journal.pone.0027086
Percutaneous Cryoablation of Pulmonary Metastases from Colorectal Cancer
Yoshikane Yamauchi 0
Yotaro Izumi 0
Masafumi Kawamura 0
Seishi Nakatsuka 0
Hideki Yashiro 0
Norimasa Tsukada 0
Masanori Inoue 0
Keisuke Asakura 0
Hiroaki Nomori 0
Adam I. Marcus, Emory University, United States of America
0 1 Department of Surgery, School of Medicine, Keio University , Tokyo , Japan , 2 Department of Radiology, School of Medicine, Keio University , Tokyo , Japan , 3 Department of Surgery, School of Medicine, Teikyo University , Tokyo , Japan
Objective: To evaluate the safety and efficacy of cryoablation for metastatic lung tumors from colorectal cancer. Methods: The procedures were performed on 24 patients (36-82 years of age, with a median age of 62; 17 male patients, 7 female patients) for 55 metastatic tumors in the lung, during 30 sessions. The procedural safety, local progression free interval, and overall survival were assessed by follow-up computed tomographic scanning performed every 3-4 months. Results: The major complications were pneumothorax, 19 sessions (63%), pleural effusion, 21 sessions (70%), transient and self-limiting hemoptysis, 13 sessions (43%) and tract seeding, 1 session (3%). The 1- and 3-year local progression free intervals were 90.8% and 59%, respectively. The 3-years local progression free intervals of tumors #15 mm in diameter was 79.8% and that of tumors .15 mm was 28.6% (p = 0.001; log-rank test). The 1- and 3-year overall survival rates were 91% and 59.6%, respectively. Conclusion: The results indicated that percutaneous cryoablation is a feasible treatment option. The local progression free interval was satisfactory at least for tumors that were #15 mm in diameter.
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Pulmonary metastases are common in patients with colorectal
cancer. The 5-year probability of survival was found to be 2740%
[1,2,3,4,5,6,7] in patients who had undergone surgical resection.
In 1965, Thomford et al., reported criteria for resection of
metastatic lung tumors which have been generally accepted by the
surgical community [8]. Resectability depends on the number and
location of lesions, patients age, comorbidities and pulmonary
function tests as well as the ECOG performance status.
Nonsurgical candidates are usually managed with systemic
chemotherapy. As for chemotherapy, newer systemic
chemotherapeutic regimens for metastatic colorectal cancer have recently
shown improved response rates (3550%) and overall survival (18
20months) [9,10,11]. Still, a less invasive local therapeutic option
is desirable, that is as effective as surgery.
Many interventional radiologists regard cryoablation as an
intraoperative modality used by urologists and general surgeons
for prostate gland [12] and liver tumor ablations [13], respectively.
Although percutaneous cryoablation of the thorax has also been
reported in 2005 [14], percutaneous cryoablation is still not as
widely applied as radiofrequency ablation for lung tumors [15].
During the cryoablation, the cryoprobe uses high-pressure argon
and helium gases for freezing and thawing, respectively, on the
basis of the Joule-Thompson principle. The ice ball can be
detected by CT as ground glass opacity. The air in the lung can
interfere with the creation of the ice ball. When the cryoprobe is
inserted into normal pulmonary parenchyma, initial freezing
causes the formation of an ice ball with a diameter of only 1 cm
because the air prevents conduction of low temperatures, and
there is not enough water in the parenchyma. However, after
thawing, the massive intra-alveolar hemorrhage excludes the air
and results in the formation of a larger ice ball in the subsequent
freezing step. We therefore performed 3 freeze/thaw cycles to
freeze a volume of tissue 2.53.0 cm in diameter.
We have previously reported the preliminary results of
percutaneous cryoablation for lung tumors performed under
computed tomography (CT) guidance with local anesthesia as a
local curative treatment, which showed promising perioperative
outcomes and local disease control in a mixed group of tumors
[16]. However, the survival benefits of cryoablation remain
unclear, and the type of patients that would benefit from this
procedure is also unknown. In order to evaluate the safety and
efficacy of this procedure for pulmonary metastasis from colorectal
cancer, we have retrospectively reviewed the safety, the local
progression free interval, and the survival rates in 24 nonsurgical
candidates in this study. To our knowledge, this is the first report
of the feasibility as well as the local control potential of
cryoablation which focuses specifically on lung metastasis from
colorectal cancer, which is one of the most frequently encountered
metastatic lesions in the lung.
Ethics
This study protocol was approved by Keio University
institutional review board (approval ID: 14 (...truncated)