Additional Minimally-Invasive Options for Sarcoma - Cryoablation and RFA

Another quick update for those of you with metastatic sarcoma.

Our daughter is 2 years out from laser surgery on on the right, and 1 year out from laser surgery on the left. Some small nodules have appeared in the intervening times - this is a difficult aspect of determining the timing of metastasectomy and probably why so many people have to have repeated lung surgeries. Because metastasectomies seem to slow the progress of disease there is always a difficulty determining when to operate - you want to operate to slow the disease, but you don't want to operate too early because new mets appear and then you have to operate again. A second surgery is always more difficult than the first - because of scarring from the previous surgery that may make the procedure longer (need to release the adhesions) and also the greater difficulty feeling for the mets. Usually the mets will have to be larger for a second surgery, but if you wait too long, the mets may also become inoperable.

We are currently considering cryoablation at least on one side. There was a small nodule missed on our daughter's surgery on the left, and that nodule has been slowly increasing over the past year. The main danger of these tumors is if they press on a major airway. Also it adds to the overall tumor burden which may make it more difficult for patients to respond to medications. One of the world's experts is Dr. Peter Littrup: http://www.karmanos.org/app.asp?id=1117

The best candidates for cryoablation are those with fewer rather than many lung mets. It is best for the mets to be smaller than 3 cm for a complete ablation, although potentially if something regrows, it can be ablated again. We were told the reason multiple tumors aren't done is that when the lung recovers from the ablation, revascularization in the area could make the other tumors grow more quickly. It seems that it makes more sense that metastatsectomy comes first to reduce the numbers of multiple tumors, and then for additional tumors that either got missed or appear, they can be removed by cryoablation. At least one sarcoma doc told us that because lung blood vessels are terminal - they don't tend to form distal metastases...that means they are unlikely to 'break off' and go to other parts of the body.

Usually these procedures are covered by insurance, but they may require pre-authorization. Radiofrequency ablation or RFA can also be performed for lung, but from what I've read, it can be harder to perform because the burn zone can't be easily visualized by CT (by cryoablation you can see the 'ice ball') and the great vessels can pull away the heat. RFA is a great option for liver mets though (http://www.medicinenet.com/radiofrequency_ablation/article.htm).

Whether a met or group of mets can be treated by cryoablation completely depends upon the appearance of the scan (the doctor will look at size and location etc.), so scans need to be sent to the doctor who is considering ablation. Usually the procedure takes about an hour or less, no ICU time afterward, small incision, and home the next day. No flying for 1 week due to the risk of pneumothorax. The most common complication is a pneumothorax, especially if a patient hasn't had a prior surgery before.

Hope that helps!