Peter John Littrup MD, Presenter: Consultant, Endocare, Inc Research support, Endocare, Inc

Hussein D. Aoun MD, Abstract Co-Author: Nothing to Disclose

Deepa Ann Cyriac MD, Abstract Co-Author: Nothing to Disclose

Barb Adam BA, Abstract Co-Author: Nothing to Disclose

Vinaya Reddy MD, Abstract Co-Author: Nothing to Disclose

Radhika Sarnaik MA, Abstract Co-Author: Nothing to Disclose

Cryotherapy has been associated with high morbidity in open surgical series while radiofrequency (RF) ablation has ~ 40% recurrence rates near vasculature. We assessed complications and outcomes of our percutaneous hepatic cryotherapy series, up to and beyond 12 months.

One hundred thirty-two CT fluoroscopic-guided, percutaneous cryotherapy was performed on 185 liver tumors (142 metastatic carcinomas and 43 primary hepatomas) in 86 patients, noting tumor size and abutting vessels>3mm. Esophageal dilatator balloons or local saline injection acted as insulation barriers for adjacent bowel (N=28). Patients received CT or MRI at ~1, 3, 6, 12, 18, 24 months and yearly thereafter. All complications were graded according to Common Toxicity Criteria for Adverse Events Version 3.0 (CTCAE) of the National Cancer Institute.

All patients required only conscious sedation. The ablated tumors and ice balls had mean diameters of 3.2 cm and 5.3 cm, respectively. Major grade >3 and self-limited minor complications occurred following 11 (6%) and 29 (16%) procedures, respectively. After an average follow-up of ~18 months, the total local recurrence of 11% (21/185) was comprised of 14% (17/80) peri-vascular and only 4% (4/105) non-vascular rate (p<0.025). No difference in local recurrence was noted for masses >3cm (15% = 11/75) vs. <3cm (9% = 10/110) but larger masses were more prone to distant failures.

Percutaneous CT-guided hepatic cryotherapy offers a well visualized, low morbidity alternative despite complex patients. Tumor size remains independent, while abutting vasculature increases recurrence rates, yet remains much lower than all reported RF results.

Presentation Preference: Paper Only Category: Liver Mets  

Littrup, P, Aoun, H, Cyriac, D, Adam, B, Reddy, V, Sarnaik, R, Recurrence Following Percutaneous Cryotherapy of Liver Tumors: Relation to Tumor Size and Vessel Proximity.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/7122507.html