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. 2017 Dec;209(6):1381-1389.
doi: 10.2214/AJR.16.17582. Epub 2017 Sep 27.

Percutaneous Image-Guided Cryoablation of Hepatic Tumors: Single-Center Experience With Intermediate to Long-Term Outcomes

Daniel I Glazer  1 , Servet Tatli  2 , Paul B Shyn  1 , Mark G Vangel  3 , Kemal Tuncali  1 , Stuart G Silverman  1
Affiliations

Percutaneous Image-Guided Cryoablation of Hepatic Tumors: Single-Center Experience With Intermediate to Long-Term Outcomes

Daniel I Glazer et al. AJR Am J Roentgenol. 2017 Dec.

Abstract

Objective: The purpose of this article is to report our intermediate to long-term outcomes with image-guided percutaneous hepatic tumor cryoablation and to evaluate its technical success, technique efficacy, local tumor progression, and adverse event rate.

Materials and methods: Between 1998 and 2014, 299 hepatic tumors (243 metastases and 56 primary tumors; mean diameter, 2.5 cm; median diameter, 2.2 cm; range, 0.3-7.8 cm) in 186 patients (95 women; mean age, 60.9 years; range, 29-88 years) underwent cryoablation during 236 procedures using CT (n = 126), MRI (n = 100), or PET/CT (n = 10) guidance. Technical success, technique efficacy at 3 months, local tumor progression (mean follow-up, 2.5 years; range, 2 months to 14.6 years), and adverse event rates were calculated.

Results: The technical success rate was 94.6% (279/295). The technique efficacy rate was 89.5% (231/258) and was greater for tumors smaller than 4 cm (93.4%; 213/228) than for larger tumors (60.0%; 18/30) (p < 0.0001). Local tumor progression occurred in 23.3% (60/258) of tumors and was significantly more common after the treatment of tumors 4 cm or larger (63.3%; 19/30) compared with smaller tumors (18.0%; 41/228) (p < 0.0001). Adverse events followed 33.8% (80/236) of procedures and were grade 3-5 in 10.6% (25/236) of cases. Grade 3 or greater adverse events more commonly followed the treatment of larger tumors (19.5%; 8/41) compared with smaller tumors (8.7%; 17/195) (p = 0.04).

Conclusion: Image-guided percutaneous cryoablation of hepatic tumors is efficacious; however, tumors smaller than 4 cm are more likely to be treated successfully and without an adverse event.

Keywords: cryoablation; hepatocellular carcinoma; liver; metastases.

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Figures

Fig. 1
Fig. 1
Flowchart of inclusion and exclusion criteria for determining technical success, technique efficacy, and local tumor progression of patients undergoing percutaneous image-guided cryoablation of hepatic tumors.
Fig. 2
Fig. 2. 55-year-old man with renal cell carcinoma metastatic to liver treated with percutaneous MRI-guided cryoablation
A, Preablation contrast-enhanced CT shows 2.1-cm peripheral metastasis (arrow) in segment VIII. B, Intraprocedural T1-weighted unenhanced MR image shows ice ball as signal void (arrowheads). C, Twenty-four-hour contrast-enhanced MR image shows ablation zone (arrowheads) surrounding nonenhancing tumor (curved arrow) with minimal enhancement of adjacent hepatic parenchyma. D, Four-year follow-up subtraction image from contrast-enhanced MR image shows involution of ablation zone (arrow) and absence of residual or recurrent tumor.
Fig. 3
Fig. 3. 75-year-old man with colon cancer metastatic to liver treated with percutaneous CT-guided cryoablation
A, Preablation contrast-enhanced MR image shows 1.2-cm metastasis (arrow) at liver dome medially, area often difficult to separate from diaphragm and heart using artificial ascites. B, Intraprocedural unenhanced CT image shows hypoattenuating ice ball (arrowheads) directly adjacent to right atrium (curved arrow). C, Twenty-four-hour contrast-enhanced MR image shows nonenhancing ablation zone (arrowheads). D, Four-year follow-up contrast-enhanced MR image shows involution of ablation zone (arrow) and absence of residual or recurrent tumor.
Fig. 4
Fig. 4
Graphs of progression-free survival for all tumors (top) and according to tumor size (bottom). Dashed lines represent 95% CIs.
See this image and copyright information in PMC

Comment in

  • Lollipops.
    Walser EM. Walser EM. AJR Am J Roentgenol. 2018 Apr;210(4):W182. doi: 10.2214/AJR.17.18959. AJR Am J Roentgenol. 2018. PMID: 29565202 No abstract available.

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References

    1. American Cancer Society. Cancer facts & figures 2015. Atlanta, GA: American Cancer Society; 2015.
    1. Danet IM, Semelka RC, Leonardou P, et al. Spectrum of MRI appearances of untreated metastases of the liver. AJR. 2003;181:809–817. - PubMed
    1. Hwang M, Jayakrishnan TT, Green DE, et al. Systematic review of outcomes of patients undergoing resection for colorectal liver metastases in the setting of extra hepatic disease. Eur J Cancer. 2014;50:1747–1757. - PubMed
    1. Bala MM, Riemsma RP, Wolff R, Kleijnen J. Cryotherapy for liver metastases. Cochrane Database Syst Rev. 2013;6:CD009058. - PubMed
    1. Shin DS, Ingraham CR, Dighe MK, et al. Surgical resection of a malignant liver lesion: what the surgeon wants the radiologist to know. AJR. 2014;203:W21–W33. [web] - PubMed

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