The Increasing Role of CT-Guided Cryoablation for the Treatment of Liver Cancer: A Single-Center Report

SIMPLE SUMMARY: Image-guided percutaneous ablation of primary and metastatic liver tumors has been gaining importance in patients who are not suitable for hepatic resection or liver transplantation. The aim of our retrospective study was to assess the effectiveness of CT-guided cryoablation in 49 patients with hepatocellular carcinoma or liver metastases. Our results highlighted that cryoablation is an effective and safe method for the treatment of liver cancers that are not amenable to surgical resection. Furthermore, cryoablation has important advantages when compared to other ablation techniques such as radiofrequency or microwave ablation; therefore, this method should be included in the armamentarium of treatment options in centers dedicated to the multidisciplinary treatment of liver cancer. ABSTRACT: Purpose: Cryoablation (CrA) is a minimally invasive treatment that can be used in primary and metastatic liver cancer. The purpose of this study was to assess the effectiveness of CrA in patients with hepatocellular carcinoma (HCC) and liver metastases. Methods: We retrospectively evaluated the patients who had CrA for HCC or liver metastases between 2015 and 2020. Technical success, complete ablation, CrA-related complications, local tumor progression, local recurrences, and distant metastases were evaluated in the study population. In patients with HCC, the median survival was also estimated. Results: Sixty-four liver tumors in 49 patients were treated with CrA (50 metastases and 14 HCC). The mean tumor diameter was 2.15 cm. The mean follow-up was 19.8 months. Technical success was achieved in the whole study population. Complete tumor ablation was observed after one month in 92% of lesions treated with CrA (79% and 96% in the HCC Group and metastases Group, respectively, p < 0.001). Local tumor progression occurred in 12.5 of lesions, with no difference between the study groups (p = 0.105). Sixteen patients (33%) developed local recurrence (45% and 29% in the HCC Group and metastases Group, respectively, p = 0.477). Seven patients (14%) developed distant metastases in the follow-up period. Ten patients (20.8%) underwent redo CrA for local recurrence or incomplete tumor ablation. Minor complications were observed in 14% of patients. In patients with HCC, the median survival was 22 months. Conclusions: CrA can be safely used for treatment of HCC and liver metastases not amenable of surgical resection. Further studies are necessary to better define the role of CrA in the multidisciplinary treatment of liver malignancies.