Lung: Cryoablation
Lung: Cryoablation
Discuss lung cryoablation here.
Dr.Littrup contact info here
Changed on Sept. 26 2012.
My son had cryo ablation for the lung mets done few times during the course of few years, In Detroit by Dr.Littrup and in Vancouver by Dr.Liu. We found this procedure being extremely helpful and easy to tolerate, it might be used when you only need to destroy 1-2 mets at the time and the surgery is not desirable - to many scars from the previous surgeries already, that would complicate the surgery a lot. My son has already had 5 lung surgeries so the cryo is more appropriate now as he only has few nodules to deal with. The surgery is the most reliable local treatment for the mets though and other local treatments - ablations, radio surgeries etc. should be only used in cases when there is a need to avoid the surgery.
The cryo probe is inserted percutaneously from the outside trough the skin and pleura into the lung under the CT guidance and then the tip of the probe cools the met up to freezing temperature and it kills the tumour on the contact, also some healthy tissue around it is getting frozen to get a safety margins around it. It is getting done by the interventional radiologists. It is done on the outpatient basis or one night stay.
The interventional radiologist who have the most experience and done it for our patients it is Dr.Peter Littrup, he works at the at the Barbara Ann Karmanos Cancer Institute, he does cryo therapy for the sarcoma mets in the liver, abdomen, soft tissue, lungs etc.,, this is his page
http://www.karmanos.org/profile.asp?id=372
At the current moment of the post he has a clinical trial open: Cryotherapy in Treating Patients With Primary Lung Cancer or Lung Metastases That Cannot Be Removed By Surgery
http://www.clinicaltrials.gov/ct/show/N ... 01?order=7
(Clinical Trials Office - Barbara Ann Karmanos Cancer Institute 800-527-6266 )
There are limitation when cryo ablation can be used due to the location and number of the mets, so consult Dr.Littrup reg. the case. To get evaluated you need to contact his office and sent him a copy of the recent CT scan on a CD incl. the brief history of the patient (when was Dx, treatments, other metastatic sites and illnesses).
My son had cryo ablation for the lung mets done few times during the course of few years, In Detroit by Dr.Littrup and in Vancouver by Dr.Liu. We found this procedure being extremely helpful and easy to tolerate, it might be used when you only need to destroy 1-2 mets at the time and the surgery is not desirable - to many scars from the previous surgeries already, that would complicate the surgery a lot. My son has already had 5 lung surgeries so the cryo is more appropriate now as he only has few nodules to deal with. The surgery is the most reliable local treatment for the mets though and other local treatments - ablations, radio surgeries etc. should be only used in cases when there is a need to avoid the surgery.
The cryo probe is inserted percutaneously from the outside trough the skin and pleura into the lung under the CT guidance and then the tip of the probe cools the met up to freezing temperature and it kills the tumour on the contact, also some healthy tissue around it is getting frozen to get a safety margins around it. It is getting done by the interventional radiologists. It is done on the outpatient basis or one night stay.
The interventional radiologist who have the most experience and done it for our patients it is Dr.Peter Littrup, he works at the at the Barbara Ann Karmanos Cancer Institute, he does cryo therapy for the sarcoma mets in the liver, abdomen, soft tissue, lungs etc.,, this is his page
http://www.karmanos.org/profile.asp?id=372
At the current moment of the post he has a clinical trial open: Cryotherapy in Treating Patients With Primary Lung Cancer or Lung Metastases That Cannot Be Removed By Surgery
http://www.clinicaltrials.gov/ct/show/N ... 01?order=7
(Clinical Trials Office - Barbara Ann Karmanos Cancer Institute 800-527-6266 )
There are limitation when cryo ablation can be used due to the location and number of the mets, so consult Dr.Littrup reg. the case. To get evaluated you need to contact his office and sent him a copy of the recent CT scan on a CD incl. the brief history of the patient (when was Dx, treatments, other metastatic sites and illnesses).
-
edwardchee
- New Member
- Posts: 7
- Joined: Sun Oct 21, 2012 9:14 pm
Re: Lung: Cryoablation
Hello there,
My name is Ed. My wife, Rene, is a synovial sarcoma pt who just had her 2nd cryo w Dr. Aoun & Dr. Littrup at Karmanos, Detroit.
I thought I would post to add our experience with cryo of a juxta-pleural lesion. This was a 1cm cyst that started filling in in the beginning of 2012. Her sarcoma oncologist from MDA believes it was high risk to be a lung met. For 3 months, we visited 3 surgeons + Dr. Littrup to gather information on the pros and cons of surgery vs cryo.
In particular, my wife's lung experienced pneumothorax 1 year ago and subsequently had mechanical pleurodesis + apical wedge resection of "blebs". Because of the induced pleural adhesions, we felt that the juxta-pleural lung lesion might risk rupture or mechanical dissemination during surgery.
As many of you know, surgery requires first collapsing the lung. To do this, the existing pleural adhesions would have to be removed either with blunt dissection or cutting through. The surgeons we talked to said they would first collapse the lung and observe to see if it was "stuck" at that spot. If it was "stuck", that would imply obvious chest wall invasion of the juxtapleural lesion into the chest wall. Only then, would they cut out the chest wall.
However, if the lung "peeled off" the chest wall easily, then it would be assumed that there was no chest wall invasion and that the lesion might be confined to within the lung or on the surface of the lung. They would then only operate on the lung itself, ignoring the chest wall.
Because the lesion was small (1cm), and the induced adhesions from mechanical pleurodesis were supposedly of the "weaker" type, we felt there was significant enough danger of the lung "peeling off" the chest wall, but still leaving contaminated sarcoma cells on the chest wall, or mixed among the adhesions. Secondly, we also felt that during the process of collapsing the lung, the surgical tools used might accidentally disseminate sarcoma cells.
In summary, we chose cryoablation to achieve "en bloc" sterilization of a small juxta-pleural lung lesion, including ablating right into the chest wall. No hydrodissection or air was injected to separate the lung away from the chest wall (as is sometimes done to minimize chest wall collateral damage).
The procedure was just completed successfully a few hours ago under conscious sedation. Dr. Littrup & Dr. Aoun wedged the lesion between 2 cryoprobes and attempted for 1cm margins around the 1cm lesion. This included ablating into the chest wall.
My wife is now awake and groggy from the propofol. She is also very fatigued from not having any food since 20 hours ago. However, she says she feels zero pain. Dr. Aoun said there was no pneumothorax during procedure. He said there was some hemorrhage but nothing serious. Since my wife had "spontaneous" pneumothorax last year, Dr. Littrup wants her hospitalized overnight for observation.
I hope this post is useful to others. During our fact-finding, we were warned by leading surgeons and other physicians that cryo might cause a lot of pain, especially if it hit the chest wall. This warning was in contradiction to Dr. Littrup's opinion of no pain/less pain. Since propofol is short acting, the analgesic effects should have worn out by now and she should already be feeling pain. Perhaps Dr. Littrup was correct and there is / will be little pain (let's hope).
We were also warned about pneumothorax being a higher risk for pleural lesions by some doctors. So far, that has not happened. We will see in the coming days.
I will keep this thread updated for others to benefit.
Thanks,
Ed
My name is Ed. My wife, Rene, is a synovial sarcoma pt who just had her 2nd cryo w Dr. Aoun & Dr. Littrup at Karmanos, Detroit.
I thought I would post to add our experience with cryo of a juxta-pleural lesion. This was a 1cm cyst that started filling in in the beginning of 2012. Her sarcoma oncologist from MDA believes it was high risk to be a lung met. For 3 months, we visited 3 surgeons + Dr. Littrup to gather information on the pros and cons of surgery vs cryo.
In particular, my wife's lung experienced pneumothorax 1 year ago and subsequently had mechanical pleurodesis + apical wedge resection of "blebs". Because of the induced pleural adhesions, we felt that the juxta-pleural lung lesion might risk rupture or mechanical dissemination during surgery.
As many of you know, surgery requires first collapsing the lung. To do this, the existing pleural adhesions would have to be removed either with blunt dissection or cutting through. The surgeons we talked to said they would first collapse the lung and observe to see if it was "stuck" at that spot. If it was "stuck", that would imply obvious chest wall invasion of the juxtapleural lesion into the chest wall. Only then, would they cut out the chest wall.
However, if the lung "peeled off" the chest wall easily, then it would be assumed that there was no chest wall invasion and that the lesion might be confined to within the lung or on the surface of the lung. They would then only operate on the lung itself, ignoring the chest wall.
Because the lesion was small (1cm), and the induced adhesions from mechanical pleurodesis were supposedly of the "weaker" type, we felt there was significant enough danger of the lung "peeling off" the chest wall, but still leaving contaminated sarcoma cells on the chest wall, or mixed among the adhesions. Secondly, we also felt that during the process of collapsing the lung, the surgical tools used might accidentally disseminate sarcoma cells.
In summary, we chose cryoablation to achieve "en bloc" sterilization of a small juxta-pleural lung lesion, including ablating right into the chest wall. No hydrodissection or air was injected to separate the lung away from the chest wall (as is sometimes done to minimize chest wall collateral damage).
The procedure was just completed successfully a few hours ago under conscious sedation. Dr. Littrup & Dr. Aoun wedged the lesion between 2 cryoprobes and attempted for 1cm margins around the 1cm lesion. This included ablating into the chest wall.
My wife is now awake and groggy from the propofol. She is also very fatigued from not having any food since 20 hours ago. However, she says she feels zero pain. Dr. Aoun said there was no pneumothorax during procedure. He said there was some hemorrhage but nothing serious. Since my wife had "spontaneous" pneumothorax last year, Dr. Littrup wants her hospitalized overnight for observation.
I hope this post is useful to others. During our fact-finding, we were warned by leading surgeons and other physicians that cryo might cause a lot of pain, especially if it hit the chest wall. This warning was in contradiction to Dr. Littrup's opinion of no pain/less pain. Since propofol is short acting, the analgesic effects should have worn out by now and she should already be feeling pain. Perhaps Dr. Littrup was correct and there is / will be little pain (let's hope).
We were also warned about pneumothorax being a higher risk for pleural lesions by some doctors. So far, that has not happened. We will see in the coming days.
I will keep this thread updated for others to benefit.
Thanks,
Ed
Re: Lung: Cryoablation
Olga
Do you know if the Cryoablation is a covered procedure for ASPS in the USA?
Just thinking ahead to the future for Joshua
Sincerely
Debbie
Do you know if the Cryoablation is a covered procedure for ASPS in the USA?
Just thinking ahead to the future for Joshua
Sincerely
Debbie
Debbie
Re: Lung: Cryoablation
Debbie may be some of our patients from US know better, we had lots of ASPS patients from US treated by dr.Littrup. I think they usually get it covered by the insurance.
Olga
Re: Lung: Cryoablation
Olga and Ivan and Ed
We are now 1 year from dx and a little over 11 months from our first surgery with Dr. Rolle on our left lung .
Our lung volume is at 68% which is as a result of having had the right lung operated on as well
If scans showed marked growth on the left lung, performed 10 months ago AND the opportunity arises, would you personally opt for Cryoblation surgery on the left lung knowing that your lung volume was 68% ?
Thanks in advance
Debbie
We are now 1 year from dx and a little over 11 months from our first surgery with Dr. Rolle on our left lung .
Our lung volume is at 68% which is as a result of having had the right lung operated on as well
If scans showed marked growth on the left lung, performed 10 months ago AND the opportunity arises, would you personally opt for Cryoblation surgery on the left lung knowing that your lung volume was 68% ?
Thanks in advance
Debbie
Debbie
Re: Lung: Cryoablation
Hello Debbi <3
I just saw your question about insurance covering this procedure an i was covered by Cigna.
Now it maybe the type of coverage i have but that would be ridiculous and i'm also thinking illegal for an insurance company to deny treatments because of the type of coverage a patient has.
So i think as of 8/2014 they are now from what i am seeing covering this procedure and are not creating a flood of proof an drama.
It is also cheaper for them to pay fr this treatment rather then the surgeries...
$4000.00 compared to $70,000.00 ... this is ruff amounts but there is a huge difference.
As a mommy i would call an make sure the insurance you have does cover this treatment so if needed in the future you don't face greedy corrupt insurance practises
In less than 72 hours i will have my first treatment at UCLA an i will be posting back here as soon as i can..
I just saw your question about insurance covering this procedure an i was covered by Cigna.
Now it maybe the type of coverage i have but that would be ridiculous and i'm also thinking illegal for an insurance company to deny treatments because of the type of coverage a patient has.
So i think as of 8/2014 they are now from what i am seeing covering this procedure and are not creating a flood of proof an drama.
It is also cheaper for them to pay fr this treatment rather then the surgeries...
$4000.00 compared to $70,000.00 ... this is ruff amounts but there is a huge difference.
As a mommy i would call an make sure the insurance you have does cover this treatment so if needed in the future you don't face greedy corrupt insurance practises
In less than 72 hours i will have my first treatment at UCLA an i will be posting back here as soon as i can..
“Many times it is much more important to know what kind of patient has the disease, than what kind of disease the patient has”.
"The microbe is nothing, the soil is everything)""
Claude Bernard~
Amanda
"The microbe is nothing, the soil is everything)""
Claude Bernard~
Amanda
Re: Lung: Cryoablation
Amanda, before you go for the cryo, you will be asked not to eat of drink since the previous night - please comply with this as they are trying to prevent you from starting to vomit during the procedure while being intubated. They will hook you up to the IV fluids during admitting so do not worry, you will be property hydrated with all the element you need for a day. After the procedure is done, and in few hours after the anesthesia wears out, you will be given something small to eat and drink.
Olga
Re: Lung: Cryoablation
Olga, he said it could go bad an they may have to take my right lobe.. but he said they have to tell you the bad stuff also an that he felt this wouldn't happen 
Does Dr L tell you that stuff also?
WHY AM I SO FRIGHTENED!!! its ridiculous! I keep thinking it will be like my other surgeries.. i am simply ridiculous..
Shove Ivan in a big box an overnight him to UCLA please lol
Thank you an i will not put anything in my mouth after 10PM the night before
They are doing it at 7:30 AM the next day so thats over 8 hours .. should i do it for longer? I will if you think so
Does Dr L tell you that stuff also? WHY AM I SO FRIGHTENED!!! its ridiculous! I keep thinking it will be like my other surgeries.. i am simply ridiculous..
Shove Ivan in a big box an overnight him to UCLA please lol
Thank you an i will not put anything in my mouth after 10PM the night before
They are doing it at 7:30 AM the next day so thats over 8 hours .. should i do it for longer? I will if you think so
“Many times it is much more important to know what kind of patient has the disease, than what kind of disease the patient has”.
"The microbe is nothing, the soil is everything)""
Claude Bernard~
Amanda
"The microbe is nothing, the soil is everything)""
Claude Bernard~
Amanda
-
Bonni Hess
- Senior Member
- Posts: 1677
- Joined: Mon Aug 14, 2006 11:32 pm
- Location: Sammamish, WA USA
Re: Lung: Cryoablation
Dear Amanda,
I am so sorry that you are so frightened about your tomorrow's lung met Cryoablation, but based on Brittany's Cryo experiences I think/Hope that you will find it to be a much easier procedure than your previous surgeries with a much easier and speedier recovery. I am grateful that the Cryo is being done early in the morning so that you can try to get a good night's sleep tonight and then go directly to the hospital for the procedure without the stress of waiting for it to be done later in the day. We always feel better when Brittany's procedures/surgeries are scheduled early in the morning because we feel that the doctor will be more rested and alert having not already spent many hours in surgery. Hopefully you can find a good way to spend today doing things which will help to take your mind off of your fear of tomorrow's Cryo (which I know is easier said than done!!) Know that you are being held very close in the hearts and special thoughts of our ASPS Family and feel the positive energy, healing wishes, strengthening support, warm friendship, love, and continued Hope that surround you,
Bonni
I am so sorry that you are so frightened about your tomorrow's lung met Cryoablation, but based on Brittany's Cryo experiences I think/Hope that you will find it to be a much easier procedure than your previous surgeries with a much easier and speedier recovery. I am grateful that the Cryo is being done early in the morning so that you can try to get a good night's sleep tonight and then go directly to the hospital for the procedure without the stress of waiting for it to be done later in the day. We always feel better when Brittany's procedures/surgeries are scheduled early in the morning because we feel that the doctor will be more rested and alert having not already spent many hours in surgery. Hopefully you can find a good way to spend today doing things which will help to take your mind off of your fear of tomorrow's Cryo (which I know is easier said than done!!) Know that you are being held very close in the hearts and special thoughts of our ASPS Family and feel the positive energy, healing wishes, strengthening support, warm friendship, love, and continued Hope that surround you,
Bonni
Re: Lung: Cryoablation
Hi Bonnie,
Did cryoablation kill Brittany's lung mets?
I have a 1.5cm lung met that's growing and 2 others, below 5mm that are stable.
I'm on keytruda and axitinib. Currently looking at radiation to the largest met and starting on treatment, or stopping treatment and going on anlotinib trial.
I'm wondering if cryoablation can be used on all 3 meets and I stay on current treatment. What are your thoughts? I had 2 lung surgeries last year( July and mid August, left and right lung). Radiated a 1.9cm lung met in Dec. Met now 1.2cm. Right lung clear. Left lung is the one with nodules. I'm worried about making the wrong choice and risk having further growth or spread.
Thank you,
Miranda.
Did cryoablation kill Brittany's lung mets?
I have a 1.5cm lung met that's growing and 2 others, below 5mm that are stable.
I'm on keytruda and axitinib. Currently looking at radiation to the largest met and starting on treatment, or stopping treatment and going on anlotinib trial.
I'm wondering if cryoablation can be used on all 3 meets and I stay on current treatment. What are your thoughts? I had 2 lung surgeries last year( July and mid August, left and right lung). Radiated a 1.9cm lung met in Dec. Met now 1.2cm. Right lung clear. Left lung is the one with nodules. I'm worried about making the wrong choice and risk having further growth or spread.
Thank you,
Miranda.
Re: Lung: Cryoablation
Miranda,
Hi,
Bonni is not often here.
I think that out of all patients, Ivan has the most extensive experience with cryoablations. He had about 20 of them during his life with ASPS since 2003. His cryoablations were done after he already had 5 lung surgeries. Most of his lung mets were ablated completely with no recurrence ever. They look bigger after the ablation while inflammed, but they have to start shrink at 3 months and be dead at 6 months. Sometimes the round scars stay there forever without dissolving, on a much smaller size than the original ones. He had one or two of them recurred, and it was when the less experienced cryo doctor was used. We highly recommend to use someone who has done hundreds if not thousands of them. Our best choice was Dr.Littrup, he was one of the drs who developed this technology in its beginning. The next best one was Dr.Aoun his apprentice who is already very experienced by now as he works like more than 10 years already. The procedure is reliable and safe only if it is done by the very experienced dr. There are other cryo drs elsewhere but you have to make sure they work for a long time with these tools. The best size for this technology is 10-15 mm.
I have the question though - Is the progression in these mets confirmed by the consecutive scans? sometimes the response to ICI treatments also looks as a size increase, but it happens as a result of the inflammatory reaction in it and around it.
Hi,
Bonni is not often here.
I think that out of all patients, Ivan has the most extensive experience with cryoablations. He had about 20 of them during his life with ASPS since 2003. His cryoablations were done after he already had 5 lung surgeries. Most of his lung mets were ablated completely with no recurrence ever. They look bigger after the ablation while inflammed, but they have to start shrink at 3 months and be dead at 6 months. Sometimes the round scars stay there forever without dissolving, on a much smaller size than the original ones. He had one or two of them recurred, and it was when the less experienced cryo doctor was used. We highly recommend to use someone who has done hundreds if not thousands of them. Our best choice was Dr.Littrup, he was one of the drs who developed this technology in its beginning. The next best one was Dr.Aoun his apprentice who is already very experienced by now as he works like more than 10 years already. The procedure is reliable and safe only if it is done by the very experienced dr. There are other cryo drs elsewhere but you have to make sure they work for a long time with these tools. The best size for this technology is 10-15 mm.
I have the question though - Is the progression in these mets confirmed by the consecutive scans? sometimes the response to ICI treatments also looks as a size increase, but it happens as a result of the inflammatory reaction in it and around it.
Olga
Re: Lung: Cryoablation
Hello Olga and Miranda,
I was wondering if it would be a good idea to perform a scan sooner than 3 months ?
Just to see how the offending lung tumor is doing?
I was wondering if it would be a good idea to perform a scan sooner than 3 months ?
Just to see how the offending lung tumor is doing?
Debbie
Re: Lung: Cryoablation
Hello Olga and Debbie,
The scan was done on 3/18/22.
Radiation ended 12/7/21 and a week later, I added axitinib to keytruda, after a 6 month hiatus( had to stop axi for 6 months prior due to lung surgeries). So, it was 3 months after Radiation and the start of axitinib that the scan was taken. There are 2 other nodules, under 5mm that did not change. Is it possible for this initial inflammation effect to o only affect some nodules?
Debbie, if I go on the anlotinib trial, I'll have to do another scan if it's over a month from last scan. I don't know if insurance will cover an earlier one.
Should I wait to see what the next scan will do? Prior to surgery, nodules were increasing, so I'm wondering if there's reason to believe that the same treatment will suddenly start to work. I'm I wasting valuable time by indecision, while this tumor grows?
Currently, the radiated one is reduced (1.9cm to 1.2cm), I hope, dying. Wondering what the best option at this point is for getting rid of the three nodules? Ablating or radiating the biggest will disqualify me for anlotinib as I lose demonstrable tumor growth.
Is Dr. Littrup in the US?
Miranda
The scan was done on 3/18/22.
Radiation ended 12/7/21 and a week later, I added axitinib to keytruda, after a 6 month hiatus( had to stop axi for 6 months prior due to lung surgeries). So, it was 3 months after Radiation and the start of axitinib that the scan was taken. There are 2 other nodules, under 5mm that did not change. Is it possible for this initial inflammation effect to o only affect some nodules?
Debbie, if I go on the anlotinib trial, I'll have to do another scan if it's over a month from last scan. I don't know if insurance will cover an earlier one.
Should I wait to see what the next scan will do? Prior to surgery, nodules were increasing, so I'm wondering if there's reason to believe that the same treatment will suddenly start to work. I'm I wasting valuable time by indecision, while this tumor grows?
Currently, the radiated one is reduced (1.9cm to 1.2cm), I hope, dying. Wondering what the best option at this point is for getting rid of the three nodules? Ablating or radiating the biggest will disqualify me for anlotinib as I lose demonstrable tumor growth.
Is Dr. Littrup in the US?
Miranda
Re: Lung: Cryoablation
Hi Miranda,Tamira47 wrote: ↑Thu Apr 07, 2022 3:45 am Hello Olga and Debbie,
The scan was done on 3/18/22.
Radiation ended 12/7/21 and a week later, I added axitinib to keytruda, after a 6 month hiatus( had to stop axi for 6 months prior due to lung surgeries). So, it was 3 months after Radiation and the start of axitinib that the scan was taken. There are 2 other nodules, under 5mm that did not change. Is it possible for this initial inflammation effect to o only affect some nodules?
Debbie, if I go on the anlotinib trial, I'll have to do another scan if it's over a month from last scan. I don't know if insurance will cover an earlier one.
Should I wait to see what the next scan will do? Prior to surgery, nodules were increasing, so I'm wondering if there's reason to believe that the same treatment will suddenly start to work. I'm I wasting valuable time by indecision, while this tumor grows?
Currently, the radiated one is reduced (1.9cm to 1.2cm), I hope, dying. Wondering what the best option at this point is for getting rid of the three nodules? Ablating or radiating the biggest will disqualify me for anlotinib as I lose demonstrable tumor growth.
Is Dr. Littrup in the US?
Miranda
6 months off axitinib and currently at 15mm at the max , isn’t too bad of a growth history.
I assume it was small back before your surgeries?
Your surgeries were VATS?
I’d wait for the next 3 month scan but in the mean time do a consult with Dr. Auon in Michigan. You could have your team send scans for his review. Your team needs to be of the mind set that his expertise advice is needed as ASPS is such an incredibly rare sarcoma and he has seen a lot of ASPS patients , Josh included .
Your insurance company should be following your doctors advice with this decision.
How big were the surgically removed tumors of your right and left lung ? How many were removed and was it a VATS surgery?
I’d much rather see your tumors removed ablated , than banking on Anlotinib to systemically take care of them .
There maybe a time for you to start Anlotinib..keep it in mind .
www.karmanos.org/karmanos/karmanos-phys ... ssein-8261
Ps in reference to growth while on Keytruda and axitinib, it can happen. We had a very good response with Josh on multiple levels with Opdivo ie brain , adrenal, kidney , lungs . But after 3 years his liver developed a tumor that Opdivo wouldn’t stop .
We then changed to Keytruda/ axitinib. They still didn’t stop it. Surgery has taken care of to date . 1 year this April .
Debbie