Frank A Baciewicz Jr1,2*, Hakob Kocharyan3, Deborah Hackstock2, Lance Heilbrun2, Hussein D Aoun4, Fulvio Lonardo2,5 and Peter J Littrup6
1Department of Cardiothoracic Surgery, Wayne State University, USA
2Karmanos Cancer Institute, USA
3Department of Radiology, Detroit Medical Center/Wayne State University, USA
4Department of Radiology, Karmanos Cancer Institute/Wayne State University, USA
5Department of Pathology, Wayne State University, USA
6Department of Diagnostic Imaging, Ascension Medical Center, Rochester, USA
Objectives: Lobectomy for clinical stage I lung cancer has an 80% to 90% 5-year survival rate but has morbidity and mortality risks. Not all clinical stage I patients are surgical candidates and some refuse surgery. This study’s primary endpoint was to describe the histologic outcome of stage I lung cancer patients treated by percutaneous CT guided cryoablation (PCA).
Methods: Histologically confirmed, clinically staged stage I tumors underwent PCA with standard cryo probes (Endocare, Irvine, Cal). Intraprocedure CT documentation of visible ice (-0 degree Celsius) extending beyond the tumor margins (~1 cm) was performed. Resection of the ablation zone/tumor and lymph node dissection with extensive histologic review was then performed.
Results: Nine patients (7 male, 2 female), median age 65.9 years (range 52 to 78) with mean CT scan tumor diameter 1.7 cm ± 0.3 cm underwent PCA for 4 right upper lobe, 4 left upper lobe and 1 right lower lobe tumors. There were 2 grade 3 CTCAE and 3 grade 1-2 CTCAE complications. Two patients required admission after PCA. Surgical resection via thoracotomy was performed a median of 64.6 days after PCA. Two resections showed only 1 microscopic focus of tumor (≤ 1 mm). Only one showed macroscopic residual tumor (1 cm) and the remaining 6 showed no tumor. The only patient with macroscopic residual disease had pathologic stage IIIB.
Conclusion: Outpatient PCA in clinical stage I Non-Small Cell Lung Cancer (NSCLC) offers a safe, feasible treatment with complete local tumor eradiation in 6/9 patients.
Baciewicz FA Jr, Kocharyan H, Hackstock D, Heilbrun L, Aoun HD, Lonardo F, et al. Percutaneous Cryoablation for Clinical Stage I Non-Small Cell Lung Cancer: Histology, Results, and Safety. Clin Oncol. 2021;6:1801..