title: Image-guided percutaneous cryotherapy for the management of gynecologic cancer metastases.
abstract: OBJECTIVE
  To report the clinical response to image-guided percutaneous cryotherapy (IPC) for the palliative management of localized metastases in patients with gynecologic malignancies.
  
  
  METHODS
  Institutional review board approval and patient consent were obtained. Gynecologic oncology patients were identified from our institution's cryotherapy database from August 2003 to August 2007. Cryotherapy was performed with 2.4 mm diameter probes (Endocare, Irvine, CA) with ultrasound or computerized tomography (CT) guidance under conscious sedation and local anesthesia. Follow-up was conducted by imaging studies and clinical encounters, using Response Evaluation Criteria in Solid Tumors (RECIST criteria).
  
  
  RESULTS
  Twenty-eight ablation sessions were performed for 41 metastatic foci in 15 patients with gynecologic malignancies. Twelve patients had prior chemotherapy and 5 patients had prior radiation. Median follow-up was 317.5 days (range 95-1189). Median post-procedure pain score: 3/10 (range 0-5). Mean initial tumor size was 2.6 cm in maximal diameter. Median reduction in tumor diameter at 1 month was 21.4% (range 2-67.4%), at 3 months was 43.6% (range 16-80.4%), at 6 months was 54.7% (range (16.6-88.9%) and at 9 months was 58.2% (range 32-88.9%). Ten patients received concurrent chemotherapy, 8 had progression of disease at other sites and 2 had stable disease, while the cryotherapy site improved. One of 5 patients who had cryotherapy in the previously irradiated zone had recurrence. A liver capsule hematoma developed as an immediate complication in one patient and an enterocutaneous fistula developed in another.
  
  
  CONCLUSIONS
  IPC is a well-tolerated, effective tool for local control of isolated metastatic foci as a single-modality treatment and for local control of symptomatic metastases in select patients undergoing systemic therapy for the management of gynecologic malignancies.
authors.affiliation: Division of Gynecologic Oncology, Wayne State University, Karmanos Cancer Center, Detroit, MI, USA.
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Solomon
authors.forename: Adnan R
authors.initials: AR
authors.lastname: Munkarah
authors.forename: Vinaya R
authors.initials: VR
authors.lastname: Vorugu
authors.forename: Gunter
authors.initials: G
authors.lastname: Deppe
authors.forename: Barbara
authors.initials: B
authors.lastname: Adam
authors.forename: John M
authors.initials: JM
authors.lastname: Malone
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Littrup
mesh_terms: D003131:Combined Modality Therapy; D017679:Cryotherapy / Q000379:methods*; D005260:Female; D005833:Genital Neoplasms, Female / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D009362:Neoplasm Metastasis; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography