Computed tomography-guided percutaneous thermal ablation of pulmonary metastases: safety, local tumor control, and factors associated with treatment failure-a single-centre experience.

PURPOSE: This study aimed to evaluate local tumor control, procedural safety, factors associated with treatment failure, and overall survival after computed tomography (CT)-guided percutaneous thermal ablation of pulmonary metastases. METHODS: This retrospective single-center study included 21 consecutive patients (10 men, 11 women; median age 58 years) who underwent CT-guided thermal ablation of pulmonary metastases by cryoablation (n = 14), microwave ablation (n = 5), or radiofrequency ablation (n = 2). Local tumor control at 6, 12, and 24 months was estimated by Kaplan-Meier analysis, and factors associated with failure were assessed by univariate analysis. Median follow-up was 50.8 months. RESULTS: Technical success was 100%. Kaplan-Meier local control was 89.9% at 6 months and 84.7% at both 12 and 24 months. Five patients (23.8%) developed local failure. On univariate analysis, larger tumor size (P = 0.042), ablation-zone diameter (P = 0.008), and ablation margin (P = 0.009) were associated with local failure; these associations are exploratory and hypothesis-generating. Pneumothorax, the only complication, occurred in 57.1% of patients, with no procedure-related mortality. The number of probes was not correlated with complications (Ρ = -0.033, P = 0.886), and pneumothorax was not associated with nodule location (laterality P = 1.000, lobe category P = 0.396, pleural proximity P = 0.659). Five-year overall survival was 82.5% (95% confidence interval, 46.1-95.3%). Distant disease progression occurred in 66.7%, and repeat ablation of the treated lesion was required in 1 patient (4.8%). CONCLUSION: CT-guided thermal ablation of pulmonary metastases achieved favorable local control with an acceptable safety profile. Larger tumor size was associated with local failure on univariate analysis. These associations are exploratory and, given the small number of events, require validation in larger multicenter cohorts. CLINICAL SIGNIFICANCE: In real-world practice, CT-guided thermal ablation offers a safe, lung-preserving option for selected patients with pulmonary metastases, achieving durable local control and favorable long-term survival. Tumor size may help refine patient selection and procedural planning.