Percutaneous imaging-guided cryoablation for lung cancer

Abstract

Percutaneous cryoablation under imaging guidance has been proved to be a safe and effective method for ablation and debulking of tumors, providing radical cure or palliation, as the case may be, for patients with different stages of disease. The local control rate is high with cryoablation, and the complications are usually controllable, making it a reasonable choice in lung cancer treatment. In this paper the technique and mechanism of action of cryoablation are summarized, and studies performed on the application of percutaneous cryoablation in various stages of lung cancer are reviewed. Its emerging application in the treatment of pure ground-glass nodules (GGNs) is also introduced.

Keywords: Cryoablation; ground-glass nodule (GGN); lung neoplasms.

Figure 1

Schematic representation of the double- and triple-freeze protocols. Black and blue arrows in the iceballs and cryolesions represent the cryoprobe. Cryolesions are zones of destruction observed by the naked eye, and cryozones are the actual zones of destruction seen on pathological examination [this figure was adopted with authors’ permission from Niu et al. (10)].

Figure 2

A 72-year-old female patient with left lung cancer in stage IIb (T2aN0M0), which in later biopsy was confirmed as adenocarcinoma with epidermal growth factor receptor (EGFR)-sensitive mutation. Due to insufficient cardiopulmonary reserve and her reluctance to receive chemotherapy, the patient was treated with cryoablation of the primary tumor, followed by EGFR-tyrosine kinase inhibitor (TKI). (A) CT scan before cryoablation; the white arrow indicates the primary tumor; (B) CT scan during cryoablation, the white arrow is pointing at the tumor and the red arrow at the 3 cryoprobes; (C) CT scan 1.5 years post cryoablation; the white arrow is pointing at the traces of the ablated tumor.