Percutaneous Cryoablation of Non-small Cell Lung Cancer in Patients with Recurrence After Stereotactic Body Radiation Therapy

Abstract

Purpose: Evaluate safety and efficacy of lung cancer cryoablation in patients with stereotactic body radiation therapy (SBRT) recurrence. Materials and Methods: Between 9/2018 and 11/2023, all patients with non-small cell lung cancer (NSCLC) treated with lung cryoablation after SBRT recurrence were retrospectively identified. Histories of smoking, COPD, post-procedural pneumothorax, adverse events requiring immediate post-procedural hospitalization, and initiation/worsening of home oxygen requirements 3–6 months later were obtained. Technical success was defined as ability to envelope the targeted tumor with an ice-ball without premature cessation of the cryoablation protocol. Outcome measures included local control, local progression-free survival, and overall survival at 6 months, 1 year, 2 years, and 3 years. Results: 29 patients with NSCLC recurrence after SBRT underwent percutaneous cryoablation with 35 treatment sessions. Mean lesion size and standard deviation was 2.8 ± 1.5 cm (Range, 1.0–7.4 cm). Pneumothorax and hospitalization rates were 44.4% (16/36) and 36.1% (14/36). The mean number of ablation probes was 2.5 ± 1.5 (Range, 1–6). Twenty-six patients had COPD (92.9%), of which 3.8% (1/26) had new or worsened home oxygen requirements. All (36/36) cryoablations achieved technical success. Local control, local progression-free survival, and overall survival were 100%/92.9%/92.9% at 6 months, 76.2%/70.8%/92.9% at 1 year, 64.9%/60.3%/62.3% at 2 years, and 31.5%/22.6%/35.4% at 3 years. Conclusion: Percutaneous cryoablation of non-small cell lung cancer may be a safe and effective treatment alternative for recurrence after SBRT without worsening pulmonary function. Graphic Abstract: (Figure presented.)