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Mooradian MJ, Fintelmann FJ, LaSalle TJ, Simon J, Graur A, Muzikansky A, Mino-Kenudson M, Shalhout S, Kaufman HL, Jenkins RW, Lawrence D, Lawless A, Sharova T, Uppot RN, Fang J, Blaum EM, Gonye ALK, Gushterova I, Boland GM, Azzoli C, Hacohen N, Sade-Feldman M, Sullivan RJ. Cryoablation and post-progression immune checkpoint inhibition in metastatic melanoma: a phase II trial. Nat Commun 2024; 15:7357. [PMID: 39191779 PMCID: PMC11349953 DOI: 10.1038/s41467-024-51722-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 08/16/2024] [Indexed: 08/29/2024] Open
Abstract
Image-guided percutaneous cryoablation is an established minimally invasive oncologic treatment. We hypothesized that cryoablation may modify the immune microenvironment through direct modulation of the tumor, thereby generating an anti-tumor response in tumors refractory to immune checkpoint inhibition (ICI). In this non-randomized phase II single-center study (NCT03290677), subjects with unresectable melanoma progressing on ICI underwent cryoablation of an enlarging metastasis, and ICI was continued for a minimum of two additional cycles. The primary endpoints were safety, feasibility and tumor response in non-ablated lesions. From May 2018 through July 2020, 17 patients were treated on study. The study met its primary endpoints with the combination strategy found to be safe and feasible with an objective response rate of 23.5% and disease control rate of 41% (4 partial response, 3 stable disease). Our data support further study of this synergistic therapeutic approach.
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Affiliation(s)
- Meghan J Mooradian
- Division of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Florian J Fintelmann
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas J LaSalle
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Broad Institute of the Massachusetts Institute of Technology, Boston, MA, USA
- Program in Health Sciences and Technology, Harvard Medical School & Massachusetts Institute of Technology, Boston, MA, USA
| | - Judit Simon
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Alexander Graur
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Alona Muzikansky
- Biostatics Department, Massachusetts General Hospital, Boston, MA, USA
| | - Mari Mino-Kenudson
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Sophia Shalhout
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Mass Eye and Ear, Boston, MA, USA
| | - Howard L Kaufman
- Division of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Russell W Jenkins
- Division of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Donald Lawrence
- Division of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Aleigha Lawless
- Division of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Tatyana Sharova
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Raul N Uppot
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jacy Fang
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Broad Institute of the Massachusetts Institute of Technology, Boston, MA, USA
| | - Emily M Blaum
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Broad Institute of the Massachusetts Institute of Technology, Boston, MA, USA
| | - Anna L K Gonye
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Broad Institute of the Massachusetts Institute of Technology, Boston, MA, USA
| | - Irena Gushterova
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Broad Institute of the Massachusetts Institute of Technology, Boston, MA, USA
| | - Genevieve M Boland
- Harvard Medical School, Boston, MA, USA
- Broad Institute of the Massachusetts Institute of Technology, Boston, MA, USA
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Azzoli
- Division of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
- Division of Hematology/Oncology, Lifespan Cancer Institute, Brown University, Providence, RI, USA
| | - Nir Hacohen
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Broad Institute of the Massachusetts Institute of Technology, Boston, MA, USA
| | - Moshe Sade-Feldman
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Broad Institute of the Massachusetts Institute of Technology, Boston, MA, USA
| | - Ryan J Sullivan
- Division of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Narayanan G, Mahendra AM, Gentile NT, Schiro BJ, Gandhi RT, Peña CS, Dijkstra M. Safety and Effectiveness of Irreversible Electroporation in Lymph Node Metastases. Cardiovasc Intervent Radiol 2024; 47:1066-1073. [PMID: 38943032 PMCID: PMC11303484 DOI: 10.1007/s00270-024-03795-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/19/2024] [Indexed: 06/30/2024]
Abstract
PURPOSE Demonstrating the safety and efficacy of percutaneous irreversible electroporation (IRE) for the treatment of lymph node metastases. MATERIALS AND METHODS An IRB-approved, single-center retrospective review was performed on patients with lymph node metastases gastrointestinal, and genitourinary primary cancers. Primary objective safety was evaluated by assessing complications graded according to the Clavien-Dindo Classification, and efficacy was determined by tumor response on follow-up imaging and local progression-free survival (LPFS). Secondary outcome measures were technical success (complete ablation with an adequate ablative margin > 5 mm), length of hospital stay and distant progression-free survival (DPFS). RESULTS Nineteen patients underwent percutaneous IRE between June 2018 and February 2023 for lymph node metastases, close to critical structures, such as vasculature, bowel, or nerves. The technical success was achieved in all cases. Complications occurred in four patients (21.1%), including two self-limiting grade 1 hematomas, a grade 1 abdominal pain, and grade 2 nerve pain treated with medication. Seventeen patients were hospitalized overnight, one patient stayed two nights and another patient stayed fourteen nights. Median follow-up was 25.5 months. Median time to local progression was 24.1 months (95% CI: 0-52.8) with 1-, 2-, and 5-year LPFS of 57.9%, 57.9% and 20.7%, respectively. Median time to distant progression was 4.3 months (95% CI: 0.3-8.3) with 1-, 2-, and 5-year DPFS of 31.6%, 13.2% and 13.2%, respectively. CONCLUSION IRE is a safe and effective minimally-invasive treatment for lymph node metastases in locations, where temperature dependent ablation may be contraindicated. Care should be taken when employing IRE near nerves.
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Affiliation(s)
- Govindarajan Narayanan
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Ashwin M Mahendra
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Nicole T Gentile
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Brian J Schiro
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Ripal T Gandhi
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Constantino S Peña
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Madelon Dijkstra
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA.
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Cancer Center Amsterdam, Amsterdam, The Netherlands.
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Moussa M, Alswang JM, Degerstedt SG, Honhart J, Abiola GO, Ramalingam V, Ahmed M. Utility of Intraoperative Neuromonitoring to Protect against Adjacent Nerve Injury in Musculoskeletal and Lymph Nodal Cryoablation. J Vasc Interv Radiol 2024:S1051-0443(24)00442-1. [PMID: 38964631 DOI: 10.1016/j.jvir.2024.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 05/30/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024] Open
Abstract
PURPOSE To demonstrate the utility of intraoperative neuromonitoring (IONM) as an effective method of passive thermoprotection against cryogenic injury to neural structures during musculoskeletal and lymph node cryoablation. MATERIAL AND METHODS Twenty-nine patients (16 men; mean age among men, 68.6 years [range, 45-90 years]; mean age among women, 62.6 years [range, 28-88 years]) underwent 33 cryoablations of musculoskeletal and lymph node lesions. Transcranial electrical motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs) of target nerves were recorded throughout the ablations. Significant change was defined as waveform amplitude reduction greater than 30% (MEP) and 50% (SSEP). The primary outcomes of this study were immediate postprocedural neurologic deficits and frequency of significant MEP and SSEP amplitude reductions. RESULTS Significant amplitude reductions were detected in 54.5% (18/33) of MEP tracings and 0% (0/33) of SSEP tracings. Following each occurrence of significant amplitude reductions, freeze cycles were promptly terminated. Intraprocedurally, 13 patients had full recovery of amplitudes to baseline, 11 of whom had additional freeze cycles completed. In 5 of 33 (15.2%) cryoablations, there were immediate postprocedural neurologic deficits (moderate adverse events). Unrecovered MEPs conferred a relative risk for neurologic sequela of 23.2 (95% CI, 3.22-167.21; P < .001) versus those with recovered MEPs. All 5 patients had complete neurologic recovery by 12 months. CONCLUSIONS IONM (with MEP but not SSEP) is a reliable and safe method of passive thermoprotection of neurologic structures during cryoablation. It provides early detection of changes in nerve conduction, which when addressed quickly, may result in complete restoration of MEP signals within the procedure and minimize risk of cryogenic neural injury.
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Affiliation(s)
- Marwan Moussa
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts.
| | | | - Spencer G Degerstedt
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - John Honhart
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Godwin O Abiola
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Vijay Ramalingam
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Muneeb Ahmed
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
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Mushtaq A, Mynderse L, Thompson S, Adamo D, Lomas D, Favazza C, Lu A, Kwon E, Woodrum D. Magnetic Resonance Imaging-Guided Cryoablation of Prostate Cancer Lymph Node Metastasis. J Vasc Interv Radiol 2024:S1051-0443(24)00409-3. [PMID: 38914160 DOI: 10.1016/j.jvir.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 06/05/2024] [Accepted: 06/14/2024] [Indexed: 06/26/2024] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of magnetic resonance (MR) imaging-guided cryoablation of prostate cancer metastatic lymph nodes (LNs). MATERIALS AND METHODS Fifty-two patients with prostate cancer who underwent MR imaging-guided LN ablation from September 2013 to June 2022 were retrospectively reviewed. Of these, 6 patients were excluded because adequate ablation margins (3-5 mm) could not be achieved secondary to adjacent structures. The remaining 46 patients (mean age, 70 years [SD ± 7]) underwent 55 MR imaging-guided cryoablation procedures of metastatic LNs (25 in the pelvic sidewall, 20 within the pelvic region, and 10 in the abdomen) with procedural intent of complete ablation. Locoregional tumor control (ie, technical success in the target LN) was evaluated on initial follow-up positron emission tomography (PET) scans at a mean of 4 months (SD ± 2). Preablation and postablation prostate-specific antigen (PSA) levels were recorded. Imaging follow-up continued until a median of 27.5 months (range: 3-108 months). RESULTS Ninety-five percent (52/55) of treated LNs demonstrated no considerable activity on PET scans at initial follow-up at 4 months (SD ± 2). PSA decreased to an undetectable level of <0.1 ng/mL after cryoablation in 14 of 46 (30.4%) patients with corresponding lack of activity in 13 of 46 (28.2%) patients on continued PET imaging follow-up. Only 6 of 55 (10.9%) patients had transient adverse events, which all resolved with no long-term sequalae. CONCLUSIONS MR imaging-guided percutaneous cryoablation of metastatic LNs is a safe and technically effective technique for treating metastatic prostate cancer in LNs.
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Affiliation(s)
- Aliza Mushtaq
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia.
| | - Lance Mynderse
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Scott Thompson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Daniel Adamo
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Derek Lomas
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | - Aiming Lu
- Department of Medical Physics, Mayo Clinic, Rochester, Minnesota
| | - Eugene Kwon
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - David Woodrum
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Parvinian A, Thompson SM, Schmitz JJ, Welch BT, Hibbert R, Adamo DA, Kurup AN. Update on Percutaneous Ablation for Sarcoma. Curr Oncol Rep 2024; 26:601-613. [PMID: 38647995 DOI: 10.1007/s11912-024-01532-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW To provide an update on the current state of percutaneous thermal ablation in the treatment of sarcoma. RECENT FINDINGS Data continue to accrue in support of ablation for local control and palliation of specific sarcoma subtypes such as extra-abdominal desmoid fibromatosis and for broader indications such as the treatment of oligometastatic disease. The synergistic possibilities of various combination therapies such as cryoablation and immunotherapy represent intriguing areas of active investigation. Histotripsy is an emerging non-invasive, non-thermal ablative modality that may further expand the therapeutic arsenal for sarcoma treatment. Percutaneous thermal ablation is a valuable tool in the multidisciplinary management of sarcoma, offering a minimally invasive adjunct to surgery and radiation therapy. Although there remains a paucity of high-level evidence specific to sarcomas, ablation techniques are demonstrably safe and effective for achieving local tumor control and providing pain relief in select patients and are of particular benefit in those with metastatic disease or requiring palliative care.
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Affiliation(s)
- Ahmad Parvinian
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Scott M Thompson
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Brian T Welch
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Rebecca Hibbert
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - A Nicholas Kurup
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
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van der Reijd DJ, Baetens TR, Gomez Munoz F, Aarts BM, Lahaye MJ, Graafland NM, Lok CAR, Aalbers AGJ, Kok NFM, Beets-Tan RGH, Maas M, Klompenhouwer EG. Percutaneous cryoablation: a novel treatment option in non-visceral metastases of the abdominal cavity after prior surgery. Abdom Radiol (NY) 2022; 47:3345-3352. [PMID: 35779093 PMCID: PMC9388473 DOI: 10.1007/s00261-022-03598-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To assess the primary safety and oncological outcome of percutaneous cryoablation in patients with non-visceral metastases of the abdominal cavity after prior surgery. METHODS All patients with non-visceral metastases after prior abdominal surgery, treated with percutaneous cryoablation, and at least one year of follow-up were retrospectively identified. Technical success was achieved if the ice-ball had a minimum margin of 10 mm in three dimensions on the per-procedural CT images. Complications were recorded using the Society of Interventional Radiology (SIR) classification system. Time until disease progression was monitored with follow-up CT and/or MRI. Local control was defined as absence of recurrence at the site of ablation. RESULTS Eleven patients underwent cryoablation for 14 non-visceral metastases (mean diameter 20 ± 9 mm). Primary tumor origin was renal cell (n = 4), colorectal (n = 3), granulosa cell (n = 2), endometrium (n = 1) and appendix (n = 1) carcinoma. Treated metastases were localized retroperitoneal (n = 8), intraperitoneal (n = 2), or in the abdominal wall (n = 4). Technical success was achieved in all procedures. After a median follow-up of 27 months (12-38 months), all patients were alive. Local control was observed in 10/14 non-visceral metastases, and the earliest local progression was detected after ten months. No major adverse events occurred. One patient suffered a minor asymptomatic adverse event. CONCLUSION This proof-of-concept study suggests that cryoablation can be a minimal invasive treatment option in a selected group of patients with non-visceral metastases in the abdominal cavity after prior surgery.
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Affiliation(s)
- D. J. van der Reijd
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands ,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - T. R. Baetens
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - F. Gomez Munoz
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands ,Department of Interventional Radiology, Hospital Clinic Universitari, Barcelona, Spain
| | - B. M. Aarts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M. J. Lahaye
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N. M. Graafland
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C. A. R. Lok
- Department of Gynecology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A. G. J. Aalbers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N. F. M. Kok
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R. G. H. Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands ,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands ,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - M. Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E. G. Klompenhouwer
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Editor's Notebook: July 2021. AJR Am J Roentgenol 2021; 217:1-2. [PMID: 34180711 DOI: 10.2214/ajr.21.25967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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