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

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.

Current Technique and Application of Percutaneous Cryotherapy

“…Although current series mainly including liver metastases of colorectal tumors are available, there are no prospective randomized studies. Two current series including 742 liver tumors yielded acceptable results regarding safety in tumors < 4 cm with grade ≥ 3 complications in 5.8 -8.7 % of interventions but a significant increase in the complication rate in larger lesions [30,31]. There are significant differences with respect to results, i. e., Littrup et al showed a local progression rate similar to that of other methods of 11.1 % after 1.8 years in metastases of colorectal tumors [30] while the progression rate reported by Glazer et al after 2.5 years was 25.4 % [31].…”

“…Two current series including 742 liver tumors yielded acceptable results regarding safety in tumors < 4 cm with grade ≥ 3 complications in 5.8 -8.7 % of interventions but a significant increase in the complication rate in larger lesions [30,31]. There are significant differences with respect to results, i. e., Littrup et al showed a local progression rate similar to that of other methods of 11.1 % after 1.8 years in metastases of colorectal tumors [30] while the progression rate reported by Glazer et al after 2.5 years was 25.4 % [31]. In a separate study including 59 patients with 151 liver metastases of colorectal carcinomas, Littrup's group reports an average survival rate of 23.6 months after cryotherapy [32].…”

“…Numerous series provide initial information regarding the local effectiveness of this therapy also in liver metastases of other tumor entities [30,31]. Recommendations regarding cryoablation of liver metastases have not yet been able to be derived from the limited data.…”

Critical review of multidisciplinary non-surgical local interventional ablation techniques in primary or secondary liver malignancies

“…Based on the intraprocedural monitoring of ice ball formation minimizing the chance of harming adjacent critical structures, the limited ice ball extension beyond the liver into the diaphragm or body wall with less pain and injury than RFA [47], cryoablation could be preferred to RFA or MWA to treat hepatic masses close to critical structures, such as the diaphragm, chest wall, heart, lung, gallbladder, and biliary tree [48,49], with better results for lesions less than 4 cm in size [50] (Figure 2).…”

Ablation of Intrahepatic Cholangiocarcinoma

“…One single-center study reviewed cryoablation of 299 primary and metastatic hepatic tumors; however, only 6 were cholangiocarcinoma. 44 Similarly, another study of cryoablation of hepatic tumors included 39 tumors of which only 3 were IHC. 45 Both studies concluded that cryoablation is an effective treatment option for both primary and metastatic liver tumors, but no survival data were reported for IHC.…”