title: Percutaneous Cryoablation for the Treatment of Recurrent Malignant Pleural Mesothelioma: Safety, Early-Term Efficacy, and Predictors of Local Recurrence.
abstract: OBJECTIVE
  To determine safety and early-term efficacy of CT-guided cryoablation for treatment of recurrent mesothelioma and assess risk factors for local recurrence.
  
  
  METHODS
  During the period 2008-2012, 24 patients underwent 110 cryoablations for recurrent mesothelioma tumors in 89 sessions. Median patient age was 69 years (range, 48-82 y). Median tumor size was 30 mm (range, 9-113 mm). Complications were graded using Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4.0). Recurrence was diagnosed on CT or positron emission tomography/CT by increasing size, nodular enhancement, or hypermetabolic activity and analyzed using the Kaplan-Meier method. Cox proportional hazards model was used to determine covariates associated with local tumor recurrence.
  
  
  RESULTS
  Median duration of follow-up was 14.5 months. Complications occurred in 8 of 110 cryoablations (7.3%). All but 1 complication were graded CTCAE v4.0 1 or 2. No procedure-related deaths occurred. Freedom from local recurrence was observed in 100% of cases at 30 days, 92.5% at 6 months, 90.8% at 1 year, 87.3% at 2 years, and 73.7% at 3 years. Tumor recurrence was diagnosed 4.5-24.5 months after cryoablation (mean 5.7 months). Risk of tumor recurrence was associated with a smaller ablative margin from the edge of tumor to iceball ablation margin (multivariate hazard ratio 0.68, CI 0.48-0.95, P = .024).
  
  
  CONCLUSIONS
  CT-guided cryoablation is safe for local control of recurrent mesothelioma, with a low rate of complications and promising early-term efficacy. A smaller ablative margin may predispose to tumor recurrence.
authors.affiliation: Division of Thoracic Radiology, University of California, Los Angeles, Los Angeles, California. Electronic address: fabtin@mednet.ucla.edu.
authors.forename: Fereidoun
authors.initials: F
authors.lastname: Abtin
authors.affiliation: Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, California.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Quirk
authors.affiliation: Division of Thoracic Radiology, University of California, Los Angeles, Los Angeles, California.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Suh
authors.affiliation: Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, California.
authors.forename: William
authors.initials: W
authors.lastname: Hsu
authors.affiliation: Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, California.
authors.forename: Simon X
authors.initials: SX
authors.lastname: Han
authors.affiliation: Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, California.
authors.forename: Grace-Hyun J
authors.initials: GJ
authors.lastname: Kim
authors.affiliation: Division of Thoracic Radiology, University of California, Los Angeles, Los Angeles, California.
authors.forename: Scott
authors.initials: S
authors.lastname: Genshaft
authors.affiliation: Mallinckrodt Institut of Radiology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Jesse K
authors.initials: JK
authors.lastname: Sandberg
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Olga
authors.initials: O
authors.lastname: Olevsky
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, California.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Cameron
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003452:Cryosurgery / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D000072662:Margins of Excision; D008654:Mesothelioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D010997:Pleural Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000072078:Positron Emission Tomography Computed Tomography; D011183:Postoperative Complications / Q000209:etiology; D016016:Proportional Hazards Models; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden