George Mikhail MD, Presenter: Nothing to Disclose

Ammar Ahmed Chaudhry MD, Abstract Co-Author: Nothing to Disclose

Jung Hwoon Edward Yoon MD, Abstract Co-Author: Nothing to Disclose

Thomas Bilfinger MD, Abstract Co-Author: Nothing to Disclose

William Henry Moore MD, Abstract Co-Author: Research Grant, EDDA Technology, Inc Medical Board, EDDA Technology, Inc Research Grant, Galil Medical Ltd Research Grant, Endo Health Solutions Inc

Compare frequency of recurrence and major complications in patients with lung nodules treated with cryoablation, radiofrequency ablation (RFA) or Stereotactic Ablative Radiotherapy (SABR).

A retrospective IRB-approved analysis of patients who underwent cryoablation, RFA or SABR for primary stage 1 lung cancer performed from January 2007 to March 2013 was performed in this study. All procedures were performed using general anesthesia and CT guidance. Follow-up imaging with CT of the chest was obtained at 1, 3, 6, 12, 24, 36, 48 and 60 months post-procedure to evaluate the ablated lung nodule. Nodule surface area, density (in Hounsfield units) and size of cavitations were recorded. Degree of nodule enhancement was also recorded.

80 patients underwent SABR out of which 6 had disease recurrence as evidenced by metastatic disease within first six months,1 within 6 to 12 months, 3 within 12 to 24 months, 1 after 24 months. 49 patients underwent cryoablation out of which 2 had disease recurrence as evidenced by metastatic disease in the first 6 months, 1 between 6 to 12 months, 1 between 12 to 24 months and 1 after 24 months. 9 patients underwent RFA out of which 1 patient had disease recurrence which reccurred between 12 to 24 months. There were no recurrences in the 0-6 month period, 6-12 month period, or greater than 24 months period. In terms of major complications, 67/80 patients in the SABR group went on to develop radiation fibrosis in the ablation zone. None of the patients required hospitalization post SABR. 1/9 patients developed respiratory distress post RFA, requiring greater than 48 hour hospitalization. 1/49 patients develop large pulmonary hemorrhage requiring ICU admission.  

Our study shows that patients who underwent cryoablation had a lower frequency of metastatic disease recurrence (10.2%) as compared to RFA (11.1%), and SABR (13.75%).

This study shows metastatic disease recurrence rates of cryoablation are lower than those of SABR, providing compelling evidence to use cryoablation as primary non-surgical intervention to treat lung nodules due to its lower metastatic progression rate.

Mikhail, G, Chaudhry, A, Yoon, J, Bilfinger, T, Moore, W, Lung Nodule Treatment with Cryoablation versus Radiofrequency Ablation versus Stereotactic Ablative Radiotherapy: A Survival Study.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14017229.html