Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
Cardiovasc Intervent Radiol. 2022 Jan;45(1):69-79. doi: 10.1007/s00270-021-03025-7. Epub 2021 Dec 2.
Large tumors may prove unsuitable for surgical cure or other local therapies due to their size, involvement of critical structures, prior non-ablative treatment failure, or coexisting disease burden. This study was performed to assess the safety and feasibility of percutaneous cryoablation for treatment of large tumors exceeding 6 cm in size, and to highlight the key technical considerations inherent to such cases.
This single-institution retrospective study identified 77 patients (42 male, 35 female; median age 55 years) who underwent 96 cryoablation procedures for treatment of 78 tumors (mean diameter 9.8 ± 3.6 cm) from 2008 through 2020. Technical success, procedure-related complications, mortality, oncologic outcomes, and procedural logistics were evaluated. Technical success was defined as ice ball extension at least 5 mm beyond the tumor margins.
Intentional subtotal ablations were performed in 32% of cases due to tumor encroachment on vulnerable structures or as part of staged/combined therapies. Of the 68% of cases that were planned for complete ablation, the technical success rate was 100%. Major complications occurred after 19/96 (20%) procedures, with hemorrhage and acute kidney injury each occurring in 6/96 (6%). Post-procedural myositis occurred in 24/96 (25%) cases and was not considered a major complication in the absence of acute kidney injury. Local recurrence occurred in 2/23 (8.7%) of patients undergoing ablation for cure or local control at a median follow-up duration of 13 months.
Percutaneous cryoablation may be used to treat large (> 6 cm) tumors with a high degree of technical success and an acceptable safety profile.
由于肿瘤体积较大、涉及关键结构、先前非消融治疗失败或合并疾病负担，大肿瘤可能不适合手术治愈或其他局部治疗。本研究旨在评估经皮冷冻消融治疗直径超过 6cm 的大肿瘤的安全性和可行性，并强调此类病例中固有的关键技术考虑因素。
本单中心回顾性研究纳入 2008 年至 2020 年间 77 例（42 例男性，35 例女性；中位年龄 55 岁）接受 96 次冷冻消融治疗 78 个肿瘤（平均直径 9.8±3.6cm）的患者。评估技术成功率、与操作相关的并发症、死亡率、肿瘤学结果和操作流程。技术成功定义为冰球延伸至肿瘤边缘至少 5mm 以外。
由于肿瘤侵犯脆弱结构或作为分期/联合治疗的一部分，32%的病例进行了有意的次全消融。在计划完全消融的 68%的病例中，技术成功率为 100%。96 次操作中有 19 次（20%）发生了重大并发症，其中 6 次（6%）发生了出血和急性肾损伤。96 次操作中有 24 次（25%）发生了术后肌炎，但在没有急性肾损伤的情况下，不被认为是重大并发症。在中位随访 13 个月时，23 例因根治或局部控制而行消融治疗的患者中有 2 例（8.7%）发生局部复发。
经皮冷冻消融术可用于治疗大（>6cm）肿瘤，具有较高的技术成功率和可接受的安全性。
