A study published by Yuan et al in the Journal of Vascular and Interventional Radiology found using percutaneous image-guided needle-based thermal ablation—the precise application of extreme heat or cold to a tumor using sophisticated imaging in a single outpatient session—is a safe and effective adjunctive therapy for the local control of metastatic gynecologic cancers throughout the lungs, liver, soft tissues, and bones in patients with advanced localized cancers unresponsive to systemic therapy.
Background
Metastatic gynecologic cancers—including ovarian, endometrial or uterine, and cervical cancers—are often aggressive and have low survival rates. Patients diagnosed with these cancers often undergo extensive and multiple surgeries as part of standard treatment. However, surgery can be invasive and is not always feasible for patients with advanced cancers with localized nonresponsive tumors or patients who are not traditional candidates for surgical or radiation therapies.
One alternative option being studied is thermal ablation, which is an image-guided, minimally invasive, needle-based approach that delivers highly accurate and precise localized treatment only to cancer cells while minimizing the effects to surrounding tissue. Thermal ablation was pioneered for liver, lung, and kidney cancers, but it is currently being studied in other malignancies, including prostate and gynecologic cancers.
Other benefits of thermal ablation are that it is an outpatient procedure, done with minimal sedation with lower risk and lower cost, in combination with systemic therapies, compared to traditional surgery or radiation.
Study Findings
In the new study, a multidisciplinary team aimed to demonstrate the high safety and efficacy of percutaneous thermal ablation in targeting localized metastatic gynecologic malignancies. The study group included 42 women ranging from age 25 to 78 with metastatic gynecologic tumors (119 metastatic tumors) treated with radiofrequency (47 tumors), microwave (47 tumors), or cryogenic (30 tumors) ablation from over 2,800 ablations performed from January 2001 to January 2019.
Nearly 96% of the patients in the study achieved a complete tumor response over a median follow-up period of 10 months. Overall survival was 37.5 months and progression-free survival rate was 16.5 months. Fewer than 5% of patients experienced any major side effects.
This is the first and largest study to show that image-guided needle-based thermal ablation is a safe and effective approach for patients with localized metastatic gynecologic cancers throughout the body, especially for those who cannot undergo additional surgery because of a declining health status or in areas previously radiated.
Disclosure: The research was supported by funding from the UCLA Radiology Integrated Diagnostics Program. For full disclosures of the study authors, visit jvir.org.
