Autrusseau PA, Cazzato RL, Koch G, Ramamurthy N, Auloge P, De Marini P, Lipsker D, Gangi A, Garnon J. Freezing Nodal Disease: Local Control Following Percutaneous Image-Guided Cryoablation of Locoregional and Distant Lymph Node Oligometastases: A 10-Year, Single-Center Experience.
J Vasc Interv Radiol 2021;
32:1435-1444. [PMID:
34271190 DOI:
10.1016/j.jvir.2021.07.002]
[Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/23/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE
To retrospectively assess the technical feasibility, safety, and oncologic outcomes of percutaneous image-guided cryoablation (PCA) of locoregional and distant lymph node metastases (LNMs).
METHODS
All consecutive patients undergoing PCA of LNMs between February 2009 and December 2019 were identified using a retrospective database search. Every patient was followed up at 1, 3, 6, and 12 months after treatment using contrast-enhanced magnetic resonance imaging and at approximately 3-6-month intervals using computed tomography or positron emission tomography-computed tomography. The Kaplan-Meier method was used to calculate local tumor progression-free survival, disease-free survival, and overall survival. Locoregional and distant groups were compared using the Fisher test. Technical success, technique efficacy, complications, and oncologic outcomes were analyzed.
RESULTS
Fifty-six metachronous oligometastatic LNMs (median size, 15 mm [interquartile range, 13-15 mm; range, 9-36 mm]) were treated in 37 sessions in 29 patients and defined as locoregional (26/37 sessions) or distant (11/37 sessions). Seventeen patients had undergone prior surgery or radiotherapy. Six patients underwent 8 retreatments for locoregional progression. An additional visceral oligometastasis was treated in 4 of the 11 distant LNM PCA sessions. The technical success and primary technique efficacy rates were 100%. The complication rate was 5.4% (2 transient nerve palsies). At a median follow-up of 23 months, there were 2 instances of local tumor progression (5.6%); the 1-, 2-, and 3-year local tumor progression-free survival was 100%, 94.3%, and 94.3%, respectively. Thirteen (45%) patients demonstrated no disease progression. The 1-, 2-, and 3-year overall survival was 96.2%, 90.5%, and 70%, respectively. The patients were free from systemic oncologic therapy following 20 (54%) sessions, with a mean treatment break of 19.1 months.
CONCLUSIONS
The PCA of lymph node oligometastases is feasible and safe, and offers promising local tumor control at midterm follow-up.
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