title: MRI-guided percutaneous cryotherapy for soft-tissue and bone metastases: initial experience.
abstract: OBJECTIVE
  We sought to determine the safety and feasibility of percutaneous MRI-guided cryotherapy in the care of patients with refractory or painful metastatic lesions of soft tissue and bone adjacent to critical structures.
  
  
  METHODS
  Twenty-seven biopsy-proven metastatic lesions of soft tissue (n = 17) and bone (n = 10) in 22 patients (15 men, seven women; age range, 24-85 years) were managed with MRI-guided percutaneous cryotherapy. The mean lesion diameter was 5.2 cm. Each lesion was adjacent to or encasing one or more critical structures, including bowel, bladder, and major blood vessels. A 0.5-T open interventional MRI system was used for cryoprobe placement and ice-ball monitoring. Complications were assessed for all treatments. CT or MRI was used to determine local control of 21 tumors. Pain palliation was assessed clinically in 19 cases. The mean follow-up period was 19.5 weeks.
  
  
  RESULTS
  Twenty-two (81%) of 27 tumors were managed without injury to adjacent critical structures. Two patients had transient lower extremity numbness, and two had both urinary retention and transient lower extremity paresthesia. One patient had chronic serous vaginal discharge, and one sustained a femoral neck fracture at the ablation site 6 weeks after treatment. Thirteen (62%) of the 21 tumors for which follow-up information was available either remained the same size as before treatment or regressed. Eight tumors progressed (mean local progression-free interval, 5.6 months; range, 3-18 months). Pain was palliated in 17 of 19 patients; six of the 17 experienced complete relief, and 11 had partial relief.
  
  
  CONCLUSIONS
  MRI-guided percutaneous cryotherapy for metastatic lesions of soft tissue and bone adjacent to critical structures is safe and can provide local tumor control and pain relief in most patients.
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA. ktuncali@partners.org
authors.forename: Kemal
authors.initials: K
authors.lastname: Tuncali
authors.forename: Paul R
authors.initials: PR
authors.lastname: Morrison
authors.forename: Carl S
authors.initials: CS
authors.lastname: Winalski
authors.forename: John A
authors.initials: JA
authors.lastname: Carrino
authors.forename: Sridhar
authors.initials: S
authors.lastname: Shankar
authors.forename: John E
authors.initials: JE
authors.lastname: Ready
authors.forename: Eric
authors.initials: E
authors.lastname: vanSonnenberg
authors.forename: Stuart G
authors.initials: SG
authors.lastname: Silverman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D017679:Cryotherapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012983:Soft Tissue Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome