Outcomes Following Percutaneous Microwave and Cryoablation of Lung Metastases from Adenoid Cystic Carcinoma of the Head and Neck: A Bi-Institutional Retrospective Cohort Study

Konstantin S Leppelmann; Vincent M Levesque; Alexander C Bunck; Alexis M Cahalane; Michael Lanuti; Stuart G Silverman; Paul B Shyn; Florian J Fintelmann

doi:10.1245/s10434-021-09714-4

Outcomes Following Percutaneous Microwave and Cryoablation of Lung Metastases from Adenoid Cystic Carcinoma of the Head and Neck: A Bi-Institutional Retrospective Cohort Study

Ann Surg Oncol. 2021 Oct;28(11):5829-5839. doi: 10.1245/s10434-021-09714-4. Epub 2021 Feb 23.

Authors

Konstantin S Leppelmann^{1

2}, Vincent M Levesque³, Alexander C Bunck², Alexis M Cahalane^{1

4}, Michael Lanuti^{5

4}, Stuart G Silverman^{3

4}, Paul B Shyn^#^{3

4}, Florian J Fintelmann^#^{6

7}

Affiliations

¹ Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
² Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
³ Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
⁴ Harvard Medical School, Boston, MA, USA.
⁵ Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
⁶ Department of Radiology, Massachusetts General Hospital, Boston, MA, USA. fintelmann@mgh.harvard.edu.
⁷ Harvard Medical School, Boston, MA, USA. fintelmann@mgh.harvard.edu.

^# Contributed equally.

PMID: 33620616
DOI: 10.1245/s10434-021-09714-4

Abstract

Obective: The aim of this study was to report outcomes following percutaneous microwave and cryoablation of lung metastases from adenoid cystic carcinoma (ACC) of the head and neck.

Material and methods: This bi-institutional retrospective cohort study included 10 patients (6 females, median age 59 years [range 28-81]) who underwent 32 percutaneous ablation sessions (21 cryoablation, 11 microwave) of 60 lung metastases (median 3.5 tumors per patient [range 1-16]) from 2007 to 2019. Median tumor diameter was 16 mm [range 7-40], significantly larger for cryoablation (22 mm, p = 0.002). A median of two tumors were treated per session [range 1-7]. Technical success, local control, complications, and overall survival were assessed.

Results: Primary technical success was achieved for 55/60 tumors (91.7%). Median follow-up was 40.6 months (clinical) and 32.5 months (imaging, per tumor). Local control at 1, 2, and 3 years was 94.7%, 80.8%, and 76.4%, respectively, and did not differ between ablation modalities. Five of fifteen recurrent tumors underwent repeat ablation, and secondary technical success was achieved in four (80%). Assisted local tumor control at 1, 2, and 3 years was 96.2%, 89.8%, and 84.9%, respectively. Complications occurred following 24/32 sessions (75.0%) and 57.2% Common Terminology Criteria for Adverse Events (CTCAE) lower than grade 3. Of 13 pneumothoraces, 7 required chest tube placements. Hemoptysis occurred after 7/21 cryoablation sessions, and bronchopleural fistula developed more frequently with microwave (p = 0.037). Median length of hospital stay was 1 day [range 0-10], and median overall survival was 81.5 months (IQR 40.4-93.1).

Conclusion: Percutaneous computed tomography-guided microwave and cryoablation can treat lung metastases from ACC of the head and neck. Complications are common but manageable, with full recovery expected.

Keywords: Adenoid cystic carcinoma; Computed tomography guidance; Cryoablation; Lung metastasis; Microwave ablation; Percutaneous ablation.

MeSH terms

Adult
Aged
Aged, 80 and over
Carcinoma, Adenoid Cystic* / surgery
Cryosurgery*
Female
Humans
Kidney Neoplasms* / surgery
Lung Neoplasms* / surgery
Microwaves / therapeutic use
Middle Aged
Neoplasm Recurrence, Local / surgery
Retrospective Studies
Treatment Outcome