The Feasibility Of CT-guided Percutaneous Argon-helium Cryoablation In The Treatment Of Adrenal Tumors

BackgroundThe morbidity of adrenal tumors is about1%. With the rapid development of medical imaging technology in recent years,the number of incidentally-found cases of adrenal tumor are more and more.These cases of tumor can be called incidental oma,which includes hamartoma,lipoma,pheochromocytoma,metastatic tumor,adrenocortical adenoma etc. Some adrenal tumors are also found with combined endocrine dyscrasia.There are mainly two kinds of traditional treatment methods for adrenal tumor:traditional open surgery and laparoscopic adrenalectomy. There are relative bigger wound and high complications rate in the traditional open surgery. Therefore, it is not indicated for the benign tumor with the aim of relieving the patients’ misgiving. The lapaprscopic adrenalectomy for adrenal tumor requires higher operation technique of the operator,and operation cost is relatively expensive.Considering the complex anatomical position of adrenal glands and the restricted vision under laparoscopic,the clinical application of laparoscopic resectionis limited.Therefore, Percutaneous treatment techniques under local anesthesia is brought into being for the patients who suffer from the intolerance or are unwilling to accept open surgical and laparoscopic adrenalectomy.Cryotherapy was first approved by United States for the treatment of prostate cancer and hepatic cancer in1998.In recent years, percutaneous cryoablation is usually applied in the treatment for hepatic cancer,pulmonary cancer,renal carcinoma and etc. However, this method was rarely applied in the treatment for adrenal tumors.Therefore,On the base of the previous research,Further the method in practice the objective of the current study is to explore the safety and feasibility of CT-guided percutaneous argon-helium cryoablation in the treatment for adrenal tumors.Methods:From July2011to November2013,This study collected19cases of patients with adrenal tumors.Before cryoablation CT,ultrasound,MRI and other imaging methods (two or more than two) or biopsy confirmed the diagnosis of adrenal tumors.Using the argon helium cryoablation system (Cryo-HitTM) on tumor effect of percutaneous CT guided argon helium cryoablation.The refrigerant used for ultra high pressure argon gas,heat medium is helium.Guidingdevice was Philips PQ6000spiral CT.A11procedures were obtain informed consent of patients or patients with my client before operation.Of the19patients,3patients were retreated with CT-guided percutaneous cryoablation three months after cryoablation due to lager tumor diameters,4patients with rich blood supply of tumors was treated with percutaneous transcatheter arterial embolizations1-4weeks before cryoablation,and3patients with tumor close to the intestines used hydraulic separation technology.In addition,there were8of19patients with catecholamine-secreting neuroendocrine pheochromocytomas fluid expansion (using alpha blockers)before cryoablation,and there was continuously monitored radial or femoral arterial blood pressure.With values pertaining to hemodynamics recorded before, during and after the procedures.The effects of alpha and beta blockers for technical success and control of hypertensive crisis were evaluated.Follow up with enhanced CT/MRI scan the tumor showed no enhancement and/or FDG PET-CT no uptake effect was evaluated as the success criteria.Results:Technical success was achieved in all19patients.No procedural or postoperative serious complications were noted.8pheochromocytomas patients experienced a significant increase in systolic blood pressure and diastolic pressure when compared with the basic values recorded before cryoablation (P<0.05).The hypertensive crisis produced by cryoablation can be managed effectively with intravenous administration of alpha and beta blockers.During the follow-up period (3-24months), there were no enhancement on contrast enhanced CT and/or up-take on FDG PET-CT in the abalated zones.Conclusion:CT-guided percutaneous argon-helium cryoablation is a safe and effective method for adrenal tumor, it might be initial treatment of choice for the patients who were not suitable for surgical procedures.