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Local tumor control and survival after image-guided thermal ablation of adrenal gland metastases
JVIR
’
Scientific Session
3:09 PM
Monday
Abstract No. 187
Percutaneous image-guided ablation of musculoskeletal non–small cell lung cancer metastases: pain palliation, local tumor control, and remission of oligometastatic disease A. Wallace1, T. Madaelil1, M. Austin1, E. Wiesner1, J. Jennings1; Mallinckrodt Institute of Radiology, St. Louis, MO
3:18 PM
Abstract No. 188
Local tumor control and survival after imageguided thermal ablation of adrenal gland metastases N. Frenk1, F. Fintelmann1, D. Daye1, P. Shyn2, R. Arellano1, S. Silverman2, R. Uppot1; 1Massachusetts General Hospital, Boston, MA; 2Brigham and Women’s Hospital, Boston, MA
S83
Purpose: To evaluate local control and survival after ablation of metastases to the adrenal gland. Materials: With IRB approval, consecutive ablations performed for adrenal metastases at two academic medical centers between July 2002 and June 2016, were analyzed. Tumors greater than 5 cm, ablations performed with palliative intent (debulking for symptom control) and patients without follow-up were excluded. 48 procedures were performed on 43 tumors (mean diameter 2.7 cm; range 0.7-4.9) in 35 patients (M:F ¼ 23:12; mean age 66 years, range 41-80). Primary malignancies were renal cell cancer (n ¼ 17), non–small cell lung cancer (n ¼ 9) and others (n ¼ 9). 51% of patients had a non-resected primary tumor plus adrenal and extraadrenal metastases; adrenal glands were the only site of disease in 40%; primary tumor and adrenal gland metastasis were present in 9%. Treatment modalities included cryoablation (58%), radiofrequency (25%) and microwave (17%). Mean follow-up was 38 months (range, 2-128). Clinical data and imaging were reviewed and compared to published surgical results. Results: Primary and secondary technical efficacy was 88% and 94%, respectively. Excluding two technical failures, there was local progression in 24% of tumors. Cumulative local tumor progression rate was 18%, 26% and 37% at 1, 3 and 5 years, respectively. Assisted tumor control was achieved in 79% of tumors. In patients with solitary adrenal metastasis, median disease-free survival was 8 months. Median survival for all patients was 30 months (80%, 44% and 34% at 1, 3 and 5 years, respectively). Non-small cell lung cancer was associated with worse survival (p ¼ 0.036). Complications were mostly related to intraprocedural catecholamine surge. No procedure-related deaths occurred. Conclusions: Percutaneous ablation of adrenal metastases can achieve local control of adrenal metastases but more than one procedure may be required. Non-small cell lung cancer is associated with worse survival. Overall survival compares favorably with published surgical results of adrenalectomy.
3:27 PM
Abstract No. 189
Value of adrenergic blockade in preventing hypertensive crisis during ablation of adrenal masses F. Linch1, J. Ruiz2, K. Ahrar2, A. Tam2, S. Sabir2; 1 University of Texas Health Science Center McGovern Medical School, Houston, TX; 2MD Anderson Cancer Center, Houston, TX Purpose: To investigate the association between pre-procedure adrenergic blockade before image-guided percutaneous adrenal mass ablation and hypertensive crisis (HC). Materials: A retrospective review of percutaneous adrenal mass ablations performed between 2005 and 2016 was undertaken. 29 patients (24 men, 5 women; mean age, 65 y (38–83 y)) underwent 32 ablation sessions. Pre-procedure adrenergic blockade was initiated for 6 (19%) sessions. Of these, irreversible ɑ-blockade was used in 4 (13%) sessions, and ɑ- and β-blockade was used in 2 (6%) sessions. Routine hypertensive management with adrenergic blockade was present in 8 (25%) sessions. Ablated areas included adrenal metastases from renal cell carcinoma (n ¼ 12), melanoma (n ¼ 7), hepatocellular carcinoma (n ¼ 3), adrenocortical carcinoma (n ¼ 3), non–small cell lung cancer (n ¼ 2), other tumors (n ¼ 3), and hyperplastic adrenal tissue (n ¼ 5). Tumors
MONDAY: Scientific Sessions
Purpose: To evaluate the safety and effectiveness of ablation of non–small cell lung cancer musculoskeletal metastases in terms of achieving pain palliation, local tumor control, and disease remission in patients with oligometastatic disease. Materials: Retrospective review of 76 non–small cell lung cancer musculoskeletal metastases in 44 patients treated with percutaneous image-guided ablation was performed. The mean age of the cohort was 63.6 ± 9.5 years and included 43% (33/ 76) men. Tumors were lytic (75%, 57/76), blastic 5.3% (4/76), mixed (17%, 13/76), or normal bone quality (2.6%, 2/76). Tumors were located in the spine (63%, 48/76) or pelvis (37%, 28/76). The median tumor volume was 39.1 mL (range, 0.8–900.0 mL). Indications for treatment included both pain palliation and local tumor control (68%, 52/76) or pain palliation only (32%, 24/76). In 14 patients (32%, 14/44) with oligometastatic disease (defined as ≤ 5 metastases), the goal of therapy was disease remission. Tumors were treated with radiofrequency ablation (63%, 48/76), cryoablation (36%, 27/76), or microwave ablation (1.3%, 1/76). Combination radiation and ablation therapy was used to treat 17% of tumors (13/76) and ablation was performed after failed radiation therapy in 12% of cases (9/76). Cementoplasty was performed after 70% (53/76) of ablations either to stabilize (79%, 42/53) or prevent (21%, 11/53) pathologic fracture. Results: Of the patients treated for pain palliation, median preand post-procedure pain scores were 8.0 and 3.0 respectively (P o 0.001). Radiographic local tumor control rates were 95% (35/ 37) at 3 months, 85% (23/27) at 6 months, and 84% (16/19) at 12 months after treatment. A disease-free interval of at least 3 months was achieved in 64% (11/14) of patients with oligometastatic disease, in whom the median disease-free interval was 6.3 months (range, 30.8–35.2 months). The procedural complication rate was 1.3% (1/76), which included one case of radicular pain after radiofrequency ablation of a spinal metastasis that resolved with corticosteroid injections. Conclusions: Ablation is a safe and effective therapy for pain palliation and local control of non–small cell lung cancer musculoskeletal metastases.
’
’
Scientific Session
3:09 PM
Monday
Abstract No. 187
Percutaneous image-guided ablation of musculoskeletal non–small cell lung cancer metastases: pain palliation, local tumor control, and remission of oligometastatic disease A. Wallace1, T. Madaelil1, M. Austin1, E. Wiesner1, J. Jennings1; Mallinckrodt Institute of Radiology, St. Louis, MO
3:18 PM
Abstract No. 188
Local tumor control and survival after imageguided thermal ablation of adrenal gland metastases N. Frenk1, F. Fintelmann1, D. Daye1, P. Shyn2, R. Arellano1, S. Silverman2, R. Uppot1; 1Massachusetts General Hospital, Boston, MA; 2Brigham and Women’s Hospital, Boston, MA
S83
Purpose: To evaluate local control and survival after ablation of metastases to the adrenal gland. Materials: With IRB approval, consecutive ablations performed for adrenal metastases at two academic medical centers between July 2002 and June 2016, were analyzed. Tumors greater than 5 cm, ablations performed with palliative intent (debulking for symptom control) and patients without follow-up were excluded. 48 procedures were performed on 43 tumors (mean diameter 2.7 cm; range 0.7-4.9) in 35 patients (M:F ¼ 23:12; mean age 66 years, range 41-80). Primary malignancies were renal cell cancer (n ¼ 17), non–small cell lung cancer (n ¼ 9) and others (n ¼ 9). 51% of patients had a non-resected primary tumor plus adrenal and extraadrenal metastases; adrenal glands were the only site of disease in 40%; primary tumor and adrenal gland metastasis were present in 9%. Treatment modalities included cryoablation (58%), radiofrequency (25%) and microwave (17%). Mean follow-up was 38 months (range, 2-128). Clinical data and imaging were reviewed and compared to published surgical results. Results: Primary and secondary technical efficacy was 88% and 94%, respectively. Excluding two technical failures, there was local progression in 24% of tumors. Cumulative local tumor progression rate was 18%, 26% and 37% at 1, 3 and 5 years, respectively. Assisted tumor control was achieved in 79% of tumors. In patients with solitary adrenal metastasis, median disease-free survival was 8 months. Median survival for all patients was 30 months (80%, 44% and 34% at 1, 3 and 5 years, respectively). Non-small cell lung cancer was associated with worse survival (p ¼ 0.036). Complications were mostly related to intraprocedural catecholamine surge. No procedure-related deaths occurred. Conclusions: Percutaneous ablation of adrenal metastases can achieve local control of adrenal metastases but more than one procedure may be required. Non-small cell lung cancer is associated with worse survival. Overall survival compares favorably with published surgical results of adrenalectomy.
3:27 PM
Abstract No. 189
Value of adrenergic blockade in preventing hypertensive crisis during ablation of adrenal masses F. Linch1, J. Ruiz2, K. Ahrar2, A. Tam2, S. Sabir2; 1 University of Texas Health Science Center McGovern Medical School, Houston, TX; 2MD Anderson Cancer Center, Houston, TX Purpose: To investigate the association between pre-procedure adrenergic blockade before image-guided percutaneous adrenal mass ablation and hypertensive crisis (HC). Materials: A retrospective review of percutaneous adrenal mass ablations performed between 2005 and 2016 was undertaken. 29 patients (24 men, 5 women; mean age, 65 y (38–83 y)) underwent 32 ablation sessions. Pre-procedure adrenergic blockade was initiated for 6 (19%) sessions. Of these, irreversible ɑ-blockade was used in 4 (13%) sessions, and ɑ- and β-blockade was used in 2 (6%) sessions. Routine hypertensive management with adrenergic blockade was present in 8 (25%) sessions. Ablated areas included adrenal metastases from renal cell carcinoma (n ¼ 12), melanoma (n ¼ 7), hepatocellular carcinoma (n ¼ 3), adrenocortical carcinoma (n ¼ 3), non–small cell lung cancer (n ¼ 2), other tumors (n ¼ 3), and hyperplastic adrenal tissue (n ¼ 5). Tumors
MONDAY: Scientific Sessions
Purpose: To evaluate the safety and effectiveness of ablation of non–small cell lung cancer musculoskeletal metastases in terms of achieving pain palliation, local tumor control, and disease remission in patients with oligometastatic disease. Materials: Retrospective review of 76 non–small cell lung cancer musculoskeletal metastases in 44 patients treated with percutaneous image-guided ablation was performed. The mean age of the cohort was 63.6 ± 9.5 years and included 43% (33/ 76) men. Tumors were lytic (75%, 57/76), blastic 5.3% (4/76), mixed (17%, 13/76), or normal bone quality (2.6%, 2/76). Tumors were located in the spine (63%, 48/76) or pelvis (37%, 28/76). The median tumor volume was 39.1 mL (range, 0.8–900.0 mL). Indications for treatment included both pain palliation and local tumor control (68%, 52/76) or pain palliation only (32%, 24/76). In 14 patients (32%, 14/44) with oligometastatic disease (defined as ≤ 5 metastases), the goal of therapy was disease remission. Tumors were treated with radiofrequency ablation (63%, 48/76), cryoablation (36%, 27/76), or microwave ablation (1.3%, 1/76). Combination radiation and ablation therapy was used to treat 17% of tumors (13/76) and ablation was performed after failed radiation therapy in 12% of cases (9/76). Cementoplasty was performed after 70% (53/76) of ablations either to stabilize (79%, 42/53) or prevent (21%, 11/53) pathologic fracture. Results: Of the patients treated for pain palliation, median preand post-procedure pain scores were 8.0 and 3.0 respectively (P o 0.001). Radiographic local tumor control rates were 95% (35/ 37) at 3 months, 85% (23/27) at 6 months, and 84% (16/19) at 12 months after treatment. A disease-free interval of at least 3 months was achieved in 64% (11/14) of patients with oligometastatic disease, in whom the median disease-free interval was 6.3 months (range, 30.8–35.2 months). The procedural complication rate was 1.3% (1/76), which included one case of radicular pain after radiofrequency ablation of a spinal metastasis that resolved with corticosteroid injections. Conclusions: Ablation is a safe and effective therapy for pain palliation and local control of non–small cell lung cancer musculoskeletal metastases.
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