Outcomes Following Percutaneous Microwave and Cryoablation of Lung Metastases from Adenoid Cystic Carcinoma of the Head and Neck: A Bi-Institutional Retrospective Cohort Study

• Published in: Annals of surgical oncology Vol. 28; no. 11; pp. 5829 - 5839
• Main Authors: Leppelmann, Konstantin S., Levesque, Vincent M., Bunck, Alexander C., Cahalane, Alexis M., Lanuti, Michael, Silverman, Stuart G., Shyn, Paul B., Fintelmann, Florian J.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.10.2021; Springer Nature B.V
• Subjects: Ablation; Adenoid; Adult; Adverse events; Aged; Aged, 80 and over; Carcinoma, Adenoid Cystic - surgery; Cohort analysis; Computed tomography; Cryosurgery; Female; Head and neck carcinoma; Head and Neck Oncology; Hemoptysis; Humans; Kidney Neoplasms - surgery; Lung cancer; Lung Neoplasms - surgery; Medicine; Medicine & Public Health; Metastases; Metastasis; Microwaves - therapeutic use; Middle Aged; Neoplasm Recurrence, Local - surgery; Oncology; Patients; Retrospective Studies; Success; Surgery; Surgical Oncology; Survival; Treatment Outcome; Tumors; Microwave ablation; Percutaneous ablation; Cryoablation; Computed tomography guidance; Lung metastasis; Adenoid cystic carcinoma
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-021-09714-4

Obective The aim of this study was to report outcomes following percutaneous microwave and cryoablation of lung metastases from adenoid cystic carcinoma (ACC) of the head and neck. Material and Methods This bi-institutional retrospective cohort study included 10 patients (6 females, median age 59 years [range 28–81]) who underwent 32 percutaneous ablation sessions (21 cryoablation, 11 microwave) of 60 lung metastases (median 3.5 tumors per patient [range 1–16]) from 2007 to 2019. Median tumor diameter was 16 mm [range 7–40], significantly larger for cryoablation (22 mm, p  = 0.002). A median of two tumors were treated per session [range 1–7]. Technical success, local control, complications, and overall survival were assessed. Results Primary technical success was achieved for 55/60 tumors (91.7%). Median follow-up was 40.6 months (clinical) and 32.5 months (imaging, per tumor). Local control at 1, 2, and 3 years was 94.7%, 80.8%, and 76.4%, respectively, and did not differ between ablation modalities. Five of fifteen recurrent tumors underwent repeat ablation, and secondary technical success was achieved in four (80%). Assisted local tumor control at 1, 2, and 3 years was 96.2%, 89.8%, and 84.9%, respectively. Complications occurred following 24/32 sessions (75.0%) and 63.2% Common Terminology Criteria for Adverse Events (CTCAE) lower than grade 3. Of 13 pneumothoraces, 7 required chest tube placements. Hemoptysis occurred after 7/21 cryoablation sessions, and bronchopleural fistula developed more frequently with microwave ( p  = 0.037). Median length of hospital stay was 1 day [range 0–10], and median overall survival was 81.5 months (IQR 40.4–93.1). Conclusion Percutaneous computed tomography-guided microwave and cryoablation can treat lung metastases from ACC of the head and neck. Complications are common but manageable, with full recovery expected.