Faculty Bibliography

PURPOSE/OBJECTIVE:To evaluate ablation zone sizes in patients undergoing pulmonary tumor cryoablation with 14-gauge cryoablation probes. MATERIALS AND METHODS/METHODS:Single-center retrospective analysis of all consecutive patients who underwent cryoablation of pulmonary tumors with one or more 14-gauge probes (August 2017-June 2020) was performed. Intraprocedural and 1-2 month post-procedural chest CTs were evaluated to characterize pulmonary lesions, ice balls, and ablation zones. Single-probe 14-gauge ablation zone volumes were compared to manufacturer reference isotherms, and to single- and two-probe ablation zones from a prior investigation of 17-gauge probes. Overall and local recurrence-free survival were calculated to 3 years. RESULTS:) (all p<0.001). Three-year overall and local recurrence-free survival were 69% (95% CI: 53-89%) and 87% (95% CI: 74-100%), respectively. CONCLUSIONS:14-gauge probes generate larger ablation volumes than 17-gauge probes. Manufacturer-reported isotherms are significantly larger than actual cryoablation zones. Cryoablation can attain low rates of local recurrence.

Purpose: To describe our experience with lung cryoablation and factors impacting procedural outcomes. Materials: We performed a retrospective review of all percutaneous lung cryoablation patients done at a single institution between August 2017 and May 2019. Procedures were performed using computed tomographic guidance and triple freeze-thaw protocol. Complications and intraprocedural imaging features of the ice balls were recorded. Tumor progression was determined via World Health Organization guidelines. Overall survival was calculated using Kaplan-Meier analysis.
Result(s): A total of 39 patients (mean age, 75.1 years; range 40-94 years), 61.5% (25/39) of whom were female, underwent a total of 45 procedures. The mean follow-up time was 398.4 days (range, 34-746). The mean pre-ablation size of the lung cancer was 19.0 x 13.4 mm. 48.9% (22/45) of tumors were ground glass or part solid. An average of 1.3 probes (range, 1-3) were used for each case (1.4 probe per cm of tumor). 5 cases were performed with a round 2.1 cm diameter ice device, while 40 were performed with an ovoid 2.1 cm diameter device. The immediate post ablation zone measured an average of 28.0 x 21.2 mm (range, 9.4-62.5 mm). At 1-month follow-up, the ablation zone measured 29.3 x 19.3 mm (range, 14.3-47.0 mm). Pneumothorax was the most common complication seen in 46.7% (21/45) of cases. Chest tube placement was required in 33.3% (15/45) of cases. Local recurrence was seen in 6.7% (3/45) of lesions during the follow-up period. There were no 30-day mortalities; however, there were 6 deaths recorded (15.3%) during the study period. 83.3% (5/6) of the deaths were patients with solid tumors. Mean tumor size in these patients was 21.8 x 17.3 mm (range, 15.0-33.0 mm). Mean overall survival probability by Kaplan-Meier was 88.8% (SE: 0.05) at 1 year and 73.2% (SE: 1.4) at 2 years.
Conclusion(s): Lung cryoablation remains a safe and effective therapy option for patients with early stage malignant lung tumors, including both ground glass and part solid tumors. Current cryoablation technologies provide adequate ablation zones for tumors up to 2.0 cm.
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RATIONALE: Mycobacterium avium complex pulmonary disease (MAC-PD) is associated with substantial morbidity, and standard daily multidrug therapy is difficult to tolerate. Objectives: To characterize response to a three-times-weekly (TIW) regimen of clarithromycin, ethambutol, and rifampin. METHODS: A 1-yr prospective noncomparative trial of TIW treatment was conducted during 2000-2003 in 17 U.S. cities. Participants were 91 HIV-negative adults, diagnosed with moderate to severe MAC-PD, who originally participated in a trial of an inhaled IFN-gamma treatment. Improvement in sputum culture, high-resolution computed tomography (HRCT), and symptoms were assessed. RESULTS: Treatment response rates (and median response times) were 44% (2 mo or longer) for culture, 60% (5.5-11.5 mo) for HRCT, and 53% (8.5 mo) for symptoms. Having noncavitary, compared with cavitary, disease increased culture response by 4.0 times (95% confidence interval [CI], 1.7-9.2) and HRCT response by 4.9 times (95% CI, 1.9-13.0). Culture response was 1.5 times (95% CI, 1.1-2.2) higher for older subjects and 2.2 times (95% CI, 1.0-4.7) higher for previously untreated subjects. Being smear-negative increased culture response by 2.3 times (95% CI, 1.1-5.2) but decreased HRCT response by 4.4 times (95% CI, 1.7-11.5). Increasing ethambutol use by 5 mo increased culture response by 1.5 times (95% CI, 1.0-2.1) but decreased symptom response. Not having chronic obstructive pulmonary disease, bronchiectasis, or poor lung function increased symptom response by 1.9 to 3.9 times. CONCLUSIONS: TIW therapy was less effective for MAC-PD patients with cavitary disease and a history of chronic obstructive pulmonary disease, bronchiectasis, or previous treatment for MAC-PD. Further research is needed to study the long-term outcomes of TIW treatment