Percutaneous Cryoablation: Safety and Efficacy for Pain Palliation of Metastases to Pleura and Chest Wall |
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| Institution: | 1. Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114;2. Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114;3. Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114;4. Department of Radiation Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114;5. Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany;1. Department of Radiology, Second Xiangya Hospital, Central South University, No 139 Middle Renmin Road, Changsha, Hunan, 410011, People’s Republic of China;2. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;3. Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;4. Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;5. Yale School of Medicine, New Haven, Connecticut;1. Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei 11217, Taiwan;2. Faculty of Medicine, School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong St., Taipei 11221, Taiwan;3. School of Medicine, National Yang-Ming University, Taipei, Taiwan;4. Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan;5. Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan;6. Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan;7. Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan;8. Department of Biomedical Imaging and Radiological Sciences, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan;1. Department of Radiology, Instituto de Radiologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil;2. Department of Endocrinology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil;3. Endocrinology Unit, Instituto do Câncer do Estado de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, s/n? - Rua 1 – Cerqueira César, 05403-900, São Paulo, SP, Brazil;4. Department of Oncology, Instituto do Câncer do Estado de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, s/n? - Rua 1 – Cerqueira César, 05403-900, São Paulo, SP, Brazil;5. Instituto do Câncer do Estado de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, s/n? - Rua 1 – Cerqueira César, 05403-900, São Paulo, SP, Brazil;6. Interventional Radiology Unit, Rede de Hospitais São Camilo de São Paulo, São Paulo, SP, Brazil;7. Neurophysiology Unit, Rede de Hospitais São Camilo de São Paulo, São Paulo, SP, Brazil;1. Department of Radiologic Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA;2. Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, CA;3. Department of Radiology, Thoracic and Interventional Section, David Geffen School of Medicine, University of California, Los Angeles, CA;4. Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA;5. Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA;6. Department of Radiology, Section of Interventional Radiology, David Geffen School of Medicine, University of California, Los Angeles, CA;7. Division of Thoracic Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA;8. Department of Radiology, Royal Victoria Hospital, Ontario, Canada;9. Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA;10. Department of Radiology, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville, SC;11. Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA;12. Society of Interventional Radiology, Fairfax, VA;13. Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX;1. Department of General Thoracic Surgery, Kashiwa Kousei General Hospital, 617 Shikoda, Kashiwa City, 277-8551, Chiba, Japan;2. Department of Radiology, Kameda Medical Center, Chiba, Japan;3. Department of Emergency and Trauma Center, Kameda Medical Center, Chiba, Japan;4. Department of Medical Engineering, Kameda Medical Center, Chiba, Japan;1. Departments of Interventional Oncology Guangzhou, China;2. Interventional Radiology, Guangzhou, China;3. Medical Imaging, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China;4. Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China;5. Fuda Institute of Cryosurgery for Cancer, Guangzhou, China |
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| Abstract: | PurposeTo assess safety and efficacy of percutaneous cryoablation for pain palliation of metastases to pleura and chest wall.Materials and MethodsThis retrospective single-center cohort study included 22 patients (27% female, mean age 63 y ± 11.4) who underwent 25 cryoablation procedures for pain palliation of 39 symptomatic metastases measuring 5.1 cm ± 1.9 (range, 2.0–8.0 cm) in pleura and chest wall between June 2012 and December 2017. Pain intensity was assessed using a numerical scale (0–10 points). Statistical tests t test, χ2, and Wilcoxon signed rank were performed.ResultsPatients were followed for a median of 4.1 months (interquartile range IQR], 2.3–10.1; range, 0.1–36.7 mo) before death or loss to follow-up. Following cryoablation, pain intensity decreased significantly by a median of 4.5 points (IQR, 2.8–6; range, 0–10 points; P = .0002 points, Wilcoxon signed rank). Pain relief of at least 3 points was documented following 18 of 20 procedures. Pain relief occurred within a median of 1 day following cryoablation (IQR, 1–2; range, 1–4 d) and lasted for a median of 5 weeks (IQR, 3–17; range, 1–34 wk). Systemic opioid requirements decreased in 11 of 22 patients (50%) by an average of 56% ± 34. Difference in morphine milligram equivalents was not significant (P = .73, Wilcoxon signed rank). No procedure-related complications occurred despite previous radiation of 7 tumors. Of 25 procedures, 22 (88%) were performed on an outpatient basis.ConclusionsPercutaneous cryoablation for metastases to pleura and chest wall can safely provide significant pain relief within days following a single session. |
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