title: Percutaneous cryoablation of metastatic lesions from non-small-cell lung carcinoma: initial survival, local control, and cost observations.
abstract: OBJECTIVE
  To assess feasibility, complications, local tumor recurrences, overall survival (OS), and estimates of cost effectiveness for multisite cryoablation (MCA) of oligometastatic non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  A total of 49 computed tomography- and/or ultrasound-guided percutaneous MCA procedures were performed on 60 tumors in 31 patients (19 women and 12 men) with oligometastatic NSCLC. Average patient age was 65 years. Tumor location was grouped according to common metastatic sites. Median OS was determined by Kaplan-Meier method and defined life-years gained (LYGs). Estimates of MCA costs per LYG were compared with established values for systemic therapies.
  
  
  RESULTS
  Total numbers of tumors and cryoablation procedures for each anatomic site were as follows: lung, 20 and 18; liver, nine and seven; superficial, 12 and 11; adrenal, seven and seven; paraaortic/isolated, two and two; and bone, 10 and seven. A mean of 1.6 procedures per patient were performed, with a median clinical follow-up of 11 months. Major complication and local recurrence rates were 8% (four of 49) and 8% (five of 60), respectively. Median OS for MCA was 1.33 years, with an estimated 1-year survival rate of approximately 53%. MCA appeared cost-effective even when added to the cost of best supportive care or systemic regimens, with an adjunctive cost-effectiveness ratio of $49,008-$87,074.
  
  
  CONCLUSIONS
  MCA was associated with very low morbidity and local tumor recurrence rates for all anatomic sites, and possibly increased OS. Even as an adjunct to systemic therapies, MCA appeared cost-effective for palliation of oligometastatic NSCLC.
authors.affiliation: Department of Radiology, Wayne State University, Karmanos Cancer Institute, Detroit, MI 48201, USA.
authors.forename: Hyun J
authors.initials: HJ
authors.lastname: Bang
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Littrup
authors.forename: Brandt P
authors.initials: BP
authors.lastname: Currier
authors.forename: Dylan J
authors.initials: DJ
authors.lastname: Goodrich
authors.forename: Hussein D
authors.initials: HD
authors.lastname: Aoun
authors.forename: Lydia C
authors.initials: LC
authors.lastname: Klein
authors.forename: Jarret C
authors.initials: JC
authors.lastname: Kuo
authors.forename: Lance K
authors.initials: LK
authors.lastname: Heilbrun
authors.forename: Shirish
authors.initials: S
authors.lastname: Gadgeel
authors.forename: Allen C
authors.initials: AC
authors.lastname: Goodman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics* / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003452:Cryosurgery / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000191:economics* / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D008824:Michigan; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010166:Palliative Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D015641:Radiography, Interventional / Q000191:economics / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000191:economics; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000191:economics