Minimally invasive treatment of metastatic pheochromocytoma and paraganglioma: Efficacy and safety of radiofrequency ablation and cryoablation therapy

Purpose: To evaluate the safety and efficacy of percutaneous ablation methods for the treatment of metastatic pheochromocytomas (PCCs) and paragangliomas (PGLs). Materials and Methods: From May 2001 to November 2009, 10 patients (mean age 45 years) with metastatic PCCs and PGLs were identified and treated with percutaneous ablation. All patients were given appropriate medication before the ablation procedure. Vital signs were monitored before, during, and after the procedure. There were 47 tumor ablations performed using radiofrequency (RF) ablation, cryoablation, or ethanol injection as determined by tumor location. Results: In all patients, all metastatic lesions amendable to percutaneous ablation were treated; for 2 of 10 patients, all known metastases were treated. Successful ablation without evidence of recurrence was achieved in 56% (15 of 27) of primarily treated lesions in patients with available follow-up imaging. The time to disease progression after ablation was 7.2 months ± 4.0. Amelioration of breakthrough hypertensive symptoms or metastasis-related pain was achieved in two of two patients and four of four patients, respectively, at clinical follow-up. Comparison of intra-arterial blood pressure before, during, and after the procedures showed statistically significant differences in these median blood pressures (P =.004.05). Major complications occurred after 2 of 18 (11%) ablation sessions, including one unplanned increase in level of patient care and one periprocedural death from complications related to bowel perforation. Conclusions: Local control of metastatic PCCs and PGLs with percutaneous ablation can play an important role in disease management when the lesions are unresectable surgically, and there is potential for prolongation of patient function or amelioration of metastasis-related symptoms.