1. Percutaneous Cryoablation of Metastatic Ovarian Cancer for Local Tumor Control: Improved Patient Survival and Estimated Cost-Effectiveness
Brandt P. Currier B.S.1, Hyun J. Bang M.D.2, Peter J. Littrup M.D.1, May M. Kassem M.D.1, Barbara A. Adam NP2
1Karmanos Cancer Center, Detroit, MI, 2Wayne State University, Detroit, MI

2. Introduction: Cancer Statistics – Metastatic Epithelial Ovarian Cancer (mEOC)
8th most common cancer in women and the 2nd most common type of gynecological cancer
Estimated 15,000 deaths and 22,000 newly diagnosed cases in 2010 in USA
75% have advanced stage ovarian cancer at initial diagnosis
Poor response to conventional therapeutic strategies
Chemotherapy / Radiation therapy / Targeted Drugs

3. Introduction: Cancer Statistics – Metastatic Epithelial Ovarian Cancer (mEOC)
Standard treatment involves surgical removal of visible disease, followed by chemotherapy
80% of patients eventually relapse following primary surgical intervention, effective secondary treatment options are necessary
Secondary cytoreductive efforts only able to remove all gross residual disease in up to 50% of patients
Need more stats

4. Introduction: Secondary Cytoreduction
Graphical representation depicting the difference in survival for patients with/without residual disease following secondary cytoreduction (11-13). Residual disease remained in 57% of patients in these studies

5. Methods and Materials: Patient Groups
Location
Liver
Lung
Soft Tissue
Total
Retroperitoneal
Superficial
Intraperitoneal
Bone
Subtotal
# of Patients 6 2 7 4 1
15*
21*
# of Procedures 8 17
31**
41**
# of Tumors 10 9 19 36 48
*Six patients each had procedures/tumors in two locations.
**One procedure was performed in two soft tissue locations.

6. Results:
3-year-old with ovarian carcinoma presents here with a 3.6 x 3.6 x 3.2 cm bi-lobed mass lying just anterior to the third portion of the duodenum and just inferior to the pancreatic head (top left). Up to 300cc of saline was injected to displace the mass from the duodenum. Two cryoprobes were placed to cover the superior aspect of the lesions (top middle) and a third was placed to cover the anterior/inferior extent (top right). Following two, 7-minute freeze cycles, ice formation covered all margins of the tumor, measuring 5.2 x 4.5 x 5.1 cm (bottom middle). No progression of ice into adjacent bowel or pancreatic head was suspected. The patient tolerated the procedure well and was discharged with stable vital signs. Follow-up imaging nearly two years post ablation shows much of the targeted area was completely ablated (bottom right), however the mesenteric node has increased laterally but was successfully targeted with further ablation (Figure 11).

7. Results:
55-year-old with metastatic ovarian cancer status post multiple courses of surgical debulking and chemotherapy. She has also undergone percutaneous cryotherapy five times. The 3.0 x 1.8 x 1.8 cm mass lying adjacent to a surgical clip, just inferior to the third portion of the duodenum is again noted (image 1) just lateral to a previous ablation site (Figure 7). Two 18-gauge Trocar needles were placed between this tumor mass and adjacent loops of small bowel. Up to 560 cc of contrast containing saline was injected during the procedure to provide protection from the adjacent ice. Two 2.4 mm cryotherapy probes bracketed the mass (image 2). Following an approximate 8 minute freeze-thaw-freeze cycle, overall ice measured 4.0 x 3.0 x 3.0 cm (image 3). This did not appear to extend into any adjacent loops of bowel and appeared to cover all visualized portions of the tumor. Follow-up imaging 19 months post ablation (image 4) shows significant resorption, free of local recurrence.

8. Results: Survival
Median survival 56.9 months
5-year survival = ~30%

9. Study Conclusion
Cryoablation appears to be a safe option for patients with residual disease following surgical efforts with apparent increased overall survival.
Significant findings:
Low Complications: 3 major complications (7%)
Low Recurrences: 1 local recurrence (2%)
Improved Survival: 5-year survival of ~30%
Median Survival from diagnosis of metastatic disease = 56.9 months

10. Thank You MSIR I hope to continue researching ablation techniques
Quality of life
Immunologic Effects
Role in Primary Cancers