New technologies of percutaneous cryoablation of tumors under the control of flat-detector computed tomography: Immediate and long-term results of treatment of 256 patients

Background. Previously, we developed and described two technologies for angiographically-assisted percutaneous argon-helium cryoablation (PCA) of metastatic liver tumors and kidney cancer using flat-detector computed tomography (FD–CT) for visualization, navigation, monitoring, and assessment of the immediate treatment response. Furthermore, we have used FD–CT imaging and FD–CT navigation to perform PCA of metastatic lung and bone tumors, as well as cryoneurolysis. However, we have not yet presented either immediate or long-term results of using these new technologies.

Aim. To study the immediate and long-term results of using the technology of angiographically-assisted FD–CT-guided PCA of hypovascular liver metastases, kidney tumors and FD–CT-guided PCA of lung metastases. Materials and methods. Between February 2017 and February 2021, 345 sessions of argon-helium PCA were performed in 256 patients: in 216 cases due to liver metastases, in 14 due to kidney tumors, in 7 due to lung metastases, in 19 due to pain syndrome.

Results. The technical success of angiographically-assisted FD–CT-controlled PCA was 98.7 % for liver metastases, 92.9 % for kidney tumors, 100 % for lung metastases. The technical success and clinical effectiveness of interventions aimed at treating pain syndrome were 100 %. All complications were grade I–III per the CIRSE (Cardiovascular and Interventional Radiological Society of Europe) classification and were successfully eliminated either directly during the cryoablation procedure or in the early postoperative period. After angiographically-assisted FD–CT-controlled PCA of liver metastases, median overall survival was 37.0 months, 1-, 2-, 3- and 5-year survival rates were, respectively, 93.0, 69.1, 51.7 and 27.9 %; after the procedures for kidney tumors the values were 73.5 months and 100, 100, 100 and 100 %; after the procedures for lung metastases, 26.0 months and 85.7, 71.4, 28.6 and 28.6 %, respectively.

Conclusion. The developed technologies of argon-helium PCA under FD–CT control are safe and effective for curative treatment of malignant tumors of the liver, kidneys and lungs, as well as for palliative treatment of bone metastases and cryoneurolysis. To confirm the obtained results and further develop angiographically-assisted FD–CT-guided PCA technologies with their possible inclusion in the standards of medical care, it is necessary to conduct additional large prospective multicenter studies.

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