Image-guided cryoablation of soft-tissue metastases in patients with oligoprogressive disease: analysis of feasibility, safety, and efficacy

Abstract Purpose To evaluate the feasibility, safety, and efficacy of image-guided percutaneous cryoablation for the treatment of soft-tissue metastatic tumours in patients with oligoprogressive disease. Methods Consecutive patients undergoing percutaneous cryoablation between March 2017 and December 2024 were identified from a prospectively maintained database. Patient demographics, disease characteristics, procedural details, and outcomes were recorded. The Kaplan–Meier method was used to calculate local tumour progression-free survival (LTPFS), progression-free survival (PFS), and overall survival (OS). Technical success, technique efficacy, complications, and oncologic outcomes were analysed. The primary endpoints were technical success, major complications, LTPFS, and PFS. The secondary endpoint was OS. Results Fifty-two metastatic tumours (median size: 20 mm [interquartile range, 12–36 mm]) were treated across 46 sessions in 38 patients. The technical success rate (defined as complete tumour coverage by the ablation zone with a 5-mm margin) was 100%, with 4% major complications (CTCAE grade ≥ 3). Eleven tumours were treated with palliative intent, while 41 were treated for local tumour control. Residual unablated tumour was observed at first follow-up imaging in 7% of cases. Local tumour progression occurred in 20% during the follow-up period. The 2-year LTPFS was 76%. The 2-year PFS was 27%, with a median PFS of 5.8 months. The 2-year OS was 68%. Conclusion Image-guided percutaneous cryoablation of soft-tissue metastases in oligoprogressive disease is technically feasible, safe, and effective for achieving local control. Prospective controlled studies are warranted to further define its role within the evolving oncologic treatment paradigm.