Application of percutaneous cryoablation for pulmonary nodules and influence in pulmonary function

Cryoablation has been reported as a non-surgical option for early-stage lung cancer and a palliative cytoreductive therapy for advanced disease and pulmonary metastases; however, evidence remains relatively limited. To evaluate the efficacy and safety of cryoablation in patients with different types of pulmonary nodules and to identify appropriate clinical scenarios for its application. This retrospective study included 94 patients with 107 pulmonary nodules who underwent CT-guided percutaneous cryoablation between May 2022 and May 2024. Patients were classified into curative-intent (early-stage lung cancer) and palliative-intent (advanced/recurrent lung cancer or pulmonary metastases) groups. The curative group was further subdivided into solitary pulmonary nodules, synchronous multiple primary nodules (sMPN), and second primary lung cancer (SPLC). Primary outcomes were local recurrence-free survival (LRFS) and recurrence-free survival (RFS) in the curative group, and progression-free survival (PFS) in the palliative group. Secondary outcomes included residual nodule progression in sMPN patients, pulmonary function changes and adverse events. Seventy-three patients with 86 nodules received curative treatment, and 21 patients received palliative treatment. Cryoablation achieved 100% local control in pure ground-glass nodules (pGGNs), while local recurrence occurred in one part-solid and two solid nodules. Among 22 patients with sMPN, all the patients showed 100% LRFS and RFS, regardless of whether they received combined surgery and cryoablation or cryoablation alone. In 15 patients with SPLC, local control was 100%, but three developed recurrence or metastasis outside the ablation zone. The median PFS in the palliative group was 409 days. Pulmonary function did not show significant deterioration after cryoablation. Pneumothorax and hemoptysis were the most common adverse events (21.4% each), with a fatal complication rate of 0.9%. Cryoablation preserves pulmonary function and may benefit patients ineligible for surgery. It may serve as a treatment option for patients with unresectable pure ground-glass nodules or GGN-dominant MPN. Careful avoidance of vascular injury during the procedure is critical to minimizing the risk of potentially fatal complications.