Percutaneous Image-Guided Microwave and Cryoablation for Lung Sarcoma

(A) Pre-procedure axial image from contrast-enhanced CT scan of chest demonstrates a 1 cm solid right upper lobe nodule adjacent to right mainstem bronchus (arrow). (B) Intra-procedural coronal reformatted image shows two cryoablation probes within nodule. (C) 1-month follow-up sagittal chest CT image shows expected post-ablation changes encompassing treated nodule (arrow). (D) 1-year follow-up sagittal chest CT image shows expected involution of treatment zone into flat bandlike scar without residual tumor

Percutaneous Cryoablation of Central Right Upper Lobe Chondrosarcoma Metastasis in 56-Year-Old Woman. (A) Pre-procedure axial image from contrast-enhanced CT scan of chest demonstrates a 1 cm solid right upper lobe nodule adjacent to right mainstem bronchus (arrow). (B) Intra-procedural coronal reformatted image shows two cryoablation probes within nodule. (C) 1-month follow-up sagittal chest CT image shows expected post-ablation changes encompassing treated nodule (arrow). (D) 1-year follow-up sagittal chest CT image shows expected involution of treatment zone into flat bandlike scar without residual tumor (arrow).

October 11, 2021 — According to ARRS’ American Journal of Roentgenology (AJR), percutaneous image-guided microwave and cryoablation allow for repeat minimally invasive treatment of sarcoma lung metastases with manageable, predominantly mild complications.

“High primary technical success, local control, and overall survival support microwave and cryoablation for treating sarcoma lung metastases,” concluded 2019 ARRS Scholar Florian J. Fintelmann of Massachusetts General Hospital and Harvard Medical School. Noting that ablation modality and tumor location did not affect local progression (p>.05), “treatment failure was low, especially for small tumors,” Fintelmann continued.

Fintelmann and colleagues’ retrospective cohort study included 27 patients (16 women, 11 men; median age, 64 years; Eastern Cooperative Oncology Group performance score, 0–2) who underwent 39 percutaneous CT-guided ablation sessions (21 microwave, 18 cryoablation; 1–4 sessions per patient) to treat 65 sarcoma lung metastases (median 1 tumor per patient, range 1–12; median tumor diameter 11 mm, range 5–33 mm; 25% non-peripheral) from 2009 to 2021.

Estimated 2-year local control rate for microwave versus cryoablation was 95% and 98% for tumors ≤1 cm, and 62% and 79% for tumors >1 cm. Additionally, tumor size ≤1 cm was associated with decreased cumulative incidence of local progression (p=.048).

Reiterating the suitability of both percutaneous microwave and cryoablation for treating tumors ≤1 cm, whether peripheral or non-peripheral, “complications, if they occur, are not life-threatening,” the authors of this AJR article added.

For more information: www.arrs.org