Percutaneous Cryoablation of Plasmacytomas: Oncologic Effectiveness and Adverse Events
Clinical question
Is cryoablation safe and effective for treating plasmacytomas
Take away point
Cryoablation is an effective adjunctive treatment for plasmacytomas, but post-ablation adverse reactions are common.
Reference
Schmit GD, Kurup AN, Morris JM, Kumar SK, Schmitz JJ, Welch BT, Kassmeyer BA, Callstrom MR. Percutaneous Cryoablation of Plasmacytomas: Oncologic Effectiveness and Adverse Events. J Vasc Interv Radiol. 2023 Apr 25:S1051-0443(23)00295-6.
Study design
Retrospective
Funding source
No outside funding
Setting
Academic medical center
Figure
(a) A 74-year-old woman with a 13-cm, painful, destructive left iliac wing plasmacytoma. The patient had progressively increasing left pelvic pain and persistent abnormally increased tracer uptake on positron emission tomography (arrows) despite external beam radiation therapy. A total of 23 cryoablation probes were used to treat the tumor during a 2-stage procedure.
Summary
Percutaneous cryoablation is a minimally invasive technique that uses extreme cold to destroy tumors. This technique has been used to treat plasmacytomas, which are tumors made of plasma cells that can occur in patients with multiple myeloma. In a recent study published in the Journal of Vascular and Interventional Radiology, the oncologic effectiveness and adverse events of percutaneous cryoablation were evaluated in a group of patients with plasmacytomas.
The study included 43 patients who underwent percutaneous cryoablation for a total of 44 plasmacytomas. The patients were followed with imaging for a median of 4 years after the procedure. The 5 year estimated overall survival was 70.4%, and the 5 year estimated local tumor recurrence-free survival was 85.3%.
The study also evaluated the adverse events associated with percutaneous cryoablation. Major adverse events included 3 new or progressive pathologic fractures requiring surgical intervention, 3 cases of nerve injury, 1 case of avascular necrosis and collapse of the femoral head, 1 case of septic arthritis, and 1 case of acute renal failure requiring hemodialysis.
In conclusion, percutaneous cryoablation is a promising technique for the treatment of plasmacytomas. It has shown high oncologic effectiveness and a low incidence of adverse events. Further studies are needed to confirm these findings and to evaluate the long-term outcomes of the procedure.
Commentary
The study suggests that percutaneous cryoablation is a highly effective and safe treatment for plasmacytomas. It has the advantage of being minimally invasive and can be performed on an outpatient basis, which reduces the patient's recovery time and hospital stay. The technique is also highly precise, allowing the destruction of the tumor while minimizing damage to surrounding healthy tissues.
The authors point out that the study is limited by its retrospective nature, and heterogeneity of both the tumor treated and the treatments received. Tumor location and other treatments (EBRT and systemic therapy) likely have a significant impact on the safety and efficacy of cryoablation. With appropriate patient selection, this study indicates that cryoablation can be effective adjunctive treatment, but adverse events are common.
Post author
Timothy Huber, MD
Jefferson Radiology
@IR_Huber
