Cryoablation Successfully Treats Recurrent Mesothelioma

Radiologists at the UCLA Medical Center are successfully killing tumor cells with extreme cold, also known as cryoablation, in patients with recurrent pleural mesothelioma.

An outpatient procedure with few complications, cryoablation freezes the localized tumors with argon gas or liquid nitrogen, allowing patients to fight the almost-inevitable cancer recurrence after surgery.

Dr. Fereidoun Abtin, a UCLA radiologist who performs the procedure, told Asbestos.com he is “convinced it works well for these patients.”

“The results have been impressive, a lot better than what else is out there in the literature now,” Abtin said. “I’m not trying to boast, but it’s something we want people to know about.”

Cryoablation, also known as cryotherapy and cryosurgery, is mostly performed for prostate, liver and kidney cancers. Unfortunately, doctors across the country have underutilized it for mesothelioma. It’s a viable option in the few places that offer the procedure.

“Sometimes the best advocates are the patients themselves. They have more stakes in the game,” Abtin said. “We’re trying to expose it to the medical community so others will begin using it.”

Impressive Cryoablation Results for Mesothelioma

Abtin presented his findings earlier this year at the 6th International Symposium on Malignant Pleural Mesothelioma in Los Angeles. UCLA and the Pacific Meso Center hosted the event.

Among his findings from the 110 mesothelioma cryoablation procedures performed at UCLA, Abtin said all patients experienced 30 days of freedom from local recurrence after treatment.

The percentage of patients without recurrence dropped six months to three years after cyroablation:

• Six months: 92.5 percent
• One year: 90.8 percent
• Two years: 87.3 percent
• Three years: 73.7 percent

Abtin reported only a 7 percent complication rate, and none of those patients required hospitalization. The procedure involves only local anesthesia and a long, thin cryoprobe that carries the freezing substance to rupture the tumor cells.

“Compared to more surgery, it’s considerably safer with much less morbidity,” he said. “We can do this without harm. We’ve had patients come for the procedure and fly home the next day.”

Cryoablation Is Best for Local Mesothelioma Recurrence

Abtin emphasized the procedure is not meant for first-line therapy or diffuse tumor coverage. It is only intended for local recurrence after standard treatment — surgery, chemotherapy and radiation therapy.

“These patients should not be left without aggressive options if there is recurrence,” he said. “I think it’s a good solution for them.”

The use of cryotherapy isn’t new. The practice, in different forms, has been around or more than a century. In theory, it works like the liquid nitrogen used for the last 50 years to freeze warts off the skin.

Cryoablation has been used to manage cancerous tumors around the lungs since the late-1990s. The UCLA Medical Center began using it in 2003, and it was first used on mesothelioma in 2008.

“Cryo is quite common in urology, but radiologists are not always comfortable doing it around the lungs, and even fewer doing it with mesothelioma,” he said. “Mesothelioma is a rare disease, and many centers don’t deal with it surgically. They don’t provide the type of treatment which would make them candidates for cryoablation down the line.”

Stimulates Immunotherapy Response in Cancer Patients

Abtin also believes cryoablation and the resulting rupture of the tumor cells stimulate immune responses within patients, allowing them to better fight eventual cancer metastasis.

“It’s like a bonus,” he said. “But it’s a hypothesis at this point and not fact.”

Abtin is part of ongoing research at UCLA that combines immunotherapy with cryoablation and its effect on tumor cells. He works closely with the Pacific Meso Center and renowned mesothelioma specialist Dr. Robert Cameron.

The Mayo Clinic in Rochester, Minnesota, is conducting a clinical trial measuring the anti-tumor effect of cryotherapy before surgery for mesothelioma. Researchers hope the use of cryotherapy can reduce the aggressiveness of the surgery and preserve a greater portion of the damaged lung.

The trial also measures the immunotherapy effect of the procedure before surgery. Cryotherapy also has been used as a palliative measure to control tumor growth for nonsurgical patients.

“It’s an option that patients should explore,” Abtin said.