Hussein D. Aoun MD, Presenter: Nothing to Disclose

Peter John Littrup MD, Abstract Co-Author: Founder, CryoMedix, LLC Research Grant, Galil Medical Ltd Research Grant, Endo Health Solutions Inc Officer, Delphinus Medical Technologies, Inc

Barbara A. Adam MSN, Abstract Co-Author: Nothing to Disclose

Mohamed M. Jaber MD, Abstract Co-Author: Nothing to Disclose

Brian Faustino Baigorri MD, Abstract Co-Author: Nothing to Disclose

Matthew Prus BS, Abstract Co-Author: Nothing to Disclose

Evan N. Fletcher MS, BA, Abstract Co-Author: Nothing to Disclose

Mark J. Krycia BS, Abstract Co-Author: Nothing to Disclose

To assess the technical feasibility, efficacy and complication rates of CT guided percutaneous cryoablation of adrenal masses.

27 Ct fluoroscopic-guided percutaneous cryoablations were performed on 28 metastatic tumors, in 22 patients, noting tumor size and type, abutting vessels >3mm, recurrences, complications, need for hydrodissection of surrounding vital structures and anesthesia-managed hypertension monitoring by arterial catheter. Complications followed the grading system of the National Institutes of Health, Common Terminology of Complications and Adverse Events (CTCAE). Local tumor recurrence and involution was monitored over time with 1, 3, 6, 12 month and annual scans thereafter.

All patients required only conscious sedation. Average tumor and ablation size was 4.0 cm and 5.7 cm respectively. Of the 28 tumors, tumor origin was non-small cell lung (11), renal (11), sarcoma (3) ovarian cancer (1), colorectal (1) and small cell lung (1). Multiple tumors were ablated in 2 of total 24 procedures. Local recurrence rate was 17.9% (5/28) for an average followup time of 1.6 yrs. Other than 1 patient with leiomyosarcoma of the inferior vena cava having 2 re-treatments for local recurrence vasculature did not appear to effect recurrence rate. The major complication (> grade 3) rate was 3.7% (1/27), with 0 major complications attributable to the procedure. One death was due to a pulmonary embolism unrelated to the ablation procedure. Transient severe hypertension (>260/120) was noted in 3 cases which was rapidly managed by labetalol and nitroglycerin drips with no sequales.

CT guided percutaneous cryoablation is a safe, effective and low morbidity alternative for patients with adrenal tumors. Transient hypertension is related only to residual viable adrenal tissue but can be safely managed.

Oligometastatic disease is becoming more common with improved systemic treatments. Adrenal cryoablation contributes to improved local control for many tumor types, with greater probe density required near major vasculature.

Aoun, H, Littrup, P, Adam, B, Jaber, M, Baigorri, B, Prus, M, Fletcher, E, Krycia, M, Percutaneous Adrenal Cryoablation: A Safe, Well Visualized and Effective Treatment.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14019728.html