Can Image-Guided Ablation Achieve Local Control of Adrenal Metastases?

Local control of adrenal gland metastases that measure < 5 cm can be accomplished through the use of image-guided ablation, according to a study published in the Journal of Vascular and Interventional Radiology.

Less invasive treatments for adrenal metastases are needed because patient comorbidities often mean that adrenalectomy is not possible. However, among other limitations, previous studies have focused on tumors that measured 5 cm, a size at which percutaneous ablation typically has inferior results.

In this study, researchers examined data from image-guided ablations of adrenal metastases that were < 5 cm. The procedures occurred between  July 2002 and June 2016 at 2 academic medical centers and included 51 procedures performed on 46 tumors in 38 patients. The patients had renal cell carcinoma, non–small cell lung cancer, and other primary malignancies. The tumors had a mean diameter 2.8 cm ± 1.1, with a range of 0.7–4.9 cm.

In 59% of patients, cryoablation was used, while radiofrequency ablation was used in 24% of procedures and microwave ablation in 18%. Patients were followed for a mean of 37 months.

Results revealed a 96% technical success rate. Primary efficacy rate was 72%, and secondary efficacy was 25%, the researchers reported.

Local tumor progression-free survival at 1, 3, and 5 years was 82%, 69%, and 55%. There was an 82% rate of overall survival at 1 year, and a 44% and 34% rate at 3 and 5 years, respectively. The median rate of disease-free survival in 16 patients with isolated adrenal metastatis was 8 months, and there was no evidence of disease at follow-up in 4 patients.

“In conclusion, percutaneous ablation can achieve local control in adrenal metastases < 5 cm. As local control and survival rates compare favorably with published results of surgery and radiation, a comparative, prospective randomized study is warranted,” the study’s authors wrote.

Reference

Frenk NE1, Daye D2, Tuncali K3, et al. Local Control and Survival after Image-Guided Percutaneous Ablation of Adrenal Metastases. J Vasc Interv Radiol. 2017 Sep 16. pii: S1051-0443(17)30706-6. doi: 10.1016/j.jvir.2017.07.026. [Epub ahead of print].