Percutaneous Cryoablation for the Treatment of Recurrent Malignant Pleural Mesothelioma: Safety, Early-Term Efficacy, and Predictors of Local Recurrence

J Vasc Interv Radiol. 2017 Feb;28(2):213-221. doi: 10.1016/j.jvir.2016.09.027. Epub 2016 Dec 12.

Abstract

Purpose: To determine safety and early-term efficacy of CT-guided cryoablation for treatment of recurrent mesothelioma and assess risk factors for local recurrence.

Materials and methods: During the period 2008-2012, 24 patients underwent 110 cryoablations for recurrent mesothelioma tumors in 89 sessions. Median patient age was 69 years (range, 48-82 y). Median tumor size was 30 mm (range, 9-113 mm). Complications were graded using Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4.0). Recurrence was diagnosed on CT or positron emission tomography/CT by increasing size, nodular enhancement, or hypermetabolic activity and analyzed using the Kaplan-Meier method. Cox proportional hazards model was used to determine covariates associated with local tumor recurrence.

Results: Median duration of follow-up was 14.5 months. Complications occurred in 8 of 110 cryoablations (7.3%). All but 1 complication were graded CTCAE v4.0 1 or 2. No procedure-related deaths occurred. Freedom from local recurrence was observed in 100% of cases at 30 days, 92.5% at 6 months, 90.8% at 1 year, 87.3% at 2 years, and 73.7% at 3 years. Tumor recurrence was diagnosed 4.5-24.5 months after cryoablation (mean 5.7 months). Risk of tumor recurrence was associated with a smaller ablative margin from the edge of tumor to iceball ablation margin (multivariate hazard ratio 0.68, CI 0.48-0.95, P = .024).

Conclusions: CT-guided cryoablation is safe for local control of recurrent mesothelioma, with a low rate of complications and promising early-term efficacy. A smaller ablative margin may predispose to tumor recurrence.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cryosurgery / adverse effects
  • Cryosurgery / methods*
  • Disease-Free Survival
  • Feasibility Studies
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Lung Neoplasms / diagnostic imaging
  • Lung Neoplasms / pathology
  • Lung Neoplasms / surgery*
  • Male
  • Margins of Excision
  • Mesothelioma / diagnostic imaging
  • Mesothelioma / pathology
  • Mesothelioma / surgery*
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Recurrence, Local*
  • Neoplasm, Residual
  • Pleural Neoplasms / diagnostic imaging
  • Pleural Neoplasms / pathology
  • Pleural Neoplasms / surgery*
  • Positron Emission Tomography Computed Tomography
  • Postoperative Complications / etiology
  • Proportional Hazards Models
  • Radiography, Interventional / methods
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Tumor Burden

Supplementary concepts

  • Mesothelioma, Malignant