Percutaneous cryoablation of adrenal metastases: technical feasibility and safety



To assess the technical feasibility and outcomes of adrenal metastases cryoablation.

Materials and methods

This is an IRB approved retrospective review of adrenal metastases cryoablation between April 2003 and October 2018. Forty percutaneous cryoablation procedures were performed on 40 adrenal metastases in 34 patients. Histology, tumor size, ablation zone size, major vessel proximity, local recurrences, complications, and anesthesia-managed hypertension monitoring was collected. Complications were graded according to the Common Terminology of Complications and Adverse Events (CTCAE).


Mean tumor and ablation size was 3.2 cm and 5.2 cm, respectively. Local recurrence rate was 10.0% (N = 4/40) for a mean follow-up time of 1.8 years. Recurrences for tumors > 3 cm (21.0%, N = 4/19) was greater than for tumors ≤ 3 cm (0.0%, N = 0/21) (p = 0.027). Proximity of major vasculature (i.e., IVC & aorta) did not statistically effect recurrence rates (p = 0.52), however, those that recurred near vasculature were > 4 cm. Major complication (≥ grade 3) rate was 5.0% (N = 2/40), with one major complication attributable to the procedure. Immediate escalation of blood pressure during the passive stick phase (between freeze cycles) or post procedure thaw phase was greater in patients with residual adrenal tissue (N = 21/38) versus masses replacing the entire adrenal gland (N = 17/38), (p = 0.0020). Lower blood pressure elevation was noted in patients with residual adrenal tissue who were pre-treated with alpha blockade (p = 0.015).


CT-guided percutaneous cryoablation is a safe, effective and low morbidity alternative for patients with adrenal metastases. Transient hypertension is related only to residual viable adrenal tissue but can be safely managed and prophylactically treated.

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  1. 1.

    Arnold, D.T., J.B. Reed, and K. Burt, Evaluation and management of the incidental adrenal mass. Proc (Bayl Univ Med Cent), 2003. 16(1): p. 7-12

    Article  Google Scholar 

  2. 2.

    Brunt, L.M. and J.F. Moley, Adrenal incidentaloma. World J Surg, 2001. 25(7): p. 905-13

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Thippeswamy, R., et al., Stage IV lung cancer: Is cure possible? Indian J Med Paediatr Oncol, 2013. 34(2): p. 121-5

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Popper, H.H., Progression and metastasis of lung cancer. Cancer Metastasis Rev, 2016. 35(1): p. 75-91

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Gryn, A., et al., Patient selection for laparoscopic excision of adrenal metastases: A multicenter cohort study. Int J Surg, 2015. 24(Pt A): p. 75-80

    Article  PubMed  Google Scholar 

  6. 6.

    Strong, V.E., et al., Laparoscopic adrenalectomy for isolated adrenal metastasis. Ann Surg Oncol, 2007. 14(12): p. 3392-400

    Article  PubMed  Google Scholar 

  7. 7.

    Tamura, T., et al., Specific organ metastases and survival in metastatic non-small-cell lung cancer. Mol Clin Oncol, 2015. 3(1): p. 217-221

    Article  PubMed  Google Scholar 

  8. 8.

    Patel, J.K., et al., Metastatic pattern of malignant melanoma. A study of 216 autopsy cases. Am J Surg, 1978. 135(6): p. 807–10 DOI:

  9. 9.

    Ng, L. and J.M. Libertino, Adrenocortical carcinoma: diagnosis, evaluation and treatment. J Urol, 2003. 169(1): p. 5-11

    Article  PubMed  Google Scholar 

  10. 10.

    Allolio, B. and M. Fassnacht, Clinical review: Adrenocortical carcinoma: clinical update. J Clin Endocrinol Metab, 2006. 91(6): p. 2027-37

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Elder, E.E., G. Elder, and C. Larsson, Pheochromocytoma and functional paraganglioma syndrome: no longer the 10% tumor. J Surg Oncol, 2005. 89(3): p. 193-201

    Article  PubMed  Google Scholar 

  12. 12.

    Kebebew, E., et al., Results of laparoscopic adrenalectomy for suspected and unsuspected malignant adrenal neoplasms. Arch Surg, 2002. 137(8): p. 948–51; discussion 952–3 DOI:

  13. 13.

    Muth, A., et al., Prognostic factors for survival after surgery for adrenal metastasis. Eur J Surg Oncol, 2010. 36(7): p. 699-704

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Rudra, S., et al., Stereotactic body radiation therapy for curative treatment of adrenal metastases. Technol Cancer Res Treat, 2013. 12(3): p. 217-24

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Ahmed, K.A., et al., Stereotactic body radiotherapy in the treatment of adrenal metastases. Am J Clin Oncol, 2013. 36(5): p. 509-13

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Holy, R., et al., Stereotactic body radiation therapy (SBRT) for treatment of adrenal gland metastases from non-small cell lung cancer. Strahlenther Onkol, 2011. 187(4): p. 245-51

    Article  PubMed  Google Scholar 

  17. 17.

    Scorsetti, M., et al., Long-term local control achieved after hypofractionated stereotactic body radiotherapy for adrenal gland metastases: a retrospective analysis of 34 patients. Acta Oncol, 2012. 51(5): p. 618-23

    Article  PubMed  Google Scholar 

  18. 18.

    Frenk, N.E., et al., Local Control and Survival after Image-Guided Percutaneous Ablation of Adrenal Metastases. J Vasc Interv Radiol, 2018. 29(2): p. 276-284

    Article  PubMed  Google Scholar 

  19. 19.

    Aoun, H.D., et al., Percutaneous Cryoablation of Renal Tumors: Is It Time for a New Paradigm Shift? J Vasc Interv Radiol, 2017. 28(10): p. 1363-1370

    Article  PubMed  Google Scholar 

  20. 20.

    Welch, B.T., et al., Percutaneous image-guided adrenal cryoablation: procedural considerations and technical success. Radiology, 2011. 258(1): p. 301-7

    Article  PubMed  Google Scholar 

  21. 21.

    Welch, B.T., et al., A single-institution experience in image-guided thermal ablation of adrenal gland metastases. J Vasc Interv Radiol, 2014. 25(4): p. 593-8

    Article  PubMed  Google Scholar 

  22. 22.

    Littrup, P.J., et al., CT-guided percutaneous cryotherapy of renal masses. J Vasc Interv Radiol, 2007. 18(3): p. 383-92

    Article  PubMed  Google Scholar 

  23. 23.

    Littrup, P.J., et al., Lethal isotherms of cryoablation in a phantom study: effects of heat load, probe size, and number. J Vasc Interv Radiol, 2009. 20(10): p. 1343-51

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Weber, S.M., et al., Perivascular and intralesional tissue necrosis after hepatic cryoablation: results in a porcine model. Surgery, 1997. 122(4): p. 742-7

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Park, M.H., et al., Spectrum of CT findings after radiofrequency ablation of hepatic tumors. Radiographics, 2008. 28(2): p. 379–90; discussion 390–2

  26. 26.

    Team, R.C., R: A language and environment for statistical computing. R Foundation for Statistical Computing, 2013.

  27. 27.

    Guiou, M., et al., Stereotactic body radiotherapy for adrenal metastases from lung cancer. Journal of Radiation Oncology, 2012. 1(2): p. 155-163

    Article  Google Scholar 

  28. 28.

    Casamassima, F., et al., Stereotactic radiotherapy for adrenal gland metastases: university of Florence experience. Int J Radiat Oncol Biol Phys, 2012. 82(2): p. 919-23

    Article  PubMed  Google Scholar 

  29. 29.

    Wood, B.J., et al., Radiofrequency ablation of adrenal tumors and adrenocortical carcinoma metastases. Cancer, 2003. 97(3): p. 554-60

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Wolf, F.J., et al., Adrenal neoplasms: Effectiveness and safety of CT-guided ablation of 23 tumors in 22 patients. Eur J Radiol, 2012. 81(8): p. 1717-23

    Article  PubMed  Google Scholar 

  31. 31.

    Hasegawa, T., et al., Unresectable Adrenal Metastases: Clinical Outcomes of Radiofrequency Ablation. Radiology, 2015. 277(2): p. 584-93

    Article  PubMed  Google Scholar 

  32. 32.

    Men, M., et al., Short-Term Outcomes and Safety of Computed Tomography-Guided Percutaneous Microwave Ablation of Solitary Adrenal Metastasis from Lung Cancer: A Multi-Center Retrospective Study. Korean J Radiol, 2016. 17(6): p. 864-873

    Article  PubMed  PubMed Central  Google Scholar 

  33. 33.

    Zerrweck, C., et al., Renal origin and size are independent predictors of survival after surgery for adrenal metastasis. Ann Surg Oncol, 2012. 19(11): p. 3621-6

    Article  PubMed  Google Scholar 

  34. 34.

    Fintelmann, F.J., et al., Catecholamine Surge during Image-Guided Ablation of Adrenal Gland Metastases: Predictors, Consequences, and Recommendations for Management. J Vasc Interv Radiol, 2016. 27(3): p. 395-402

    Article  PubMed  Google Scholar 

  35. 35.

    Nguyen, M.C., et al., The Adrenal Gland as a Sanctuary Site of Metastases After Pembrolizumab Treatment: A Case Series. J Natl Compr Canc Netw, 2018. 16(11): p. 1279-1283

    Article  PubMed  Google Scholar 

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Correspondence to Hussein D. Aoun.

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Aoun, H.D., Littrup, P.J., Nahab, B. et al. Percutaneous cryoablation of adrenal metastases: technical feasibility and safety. Abdom Radiol (2021).

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