Stage 1 lung adenocarcinoma: complete response to cryoablation

What happened, in summary

This 78-year-old man had a 120 pack-year smoking history and developed a persistent cough. Workup arranged before referral had already confirmed lung adenocarcinoma. Thoracic CT showed a 16 mm lesion in the upper lobe of the left lung. PET imaging showed abnormal uptake only at that lung lesion, and brain MRI showed no evidence of metastasis. The cancer was staged T1bN0M0 / Stage IA2. Although the cancer was early stage, his lung function made standard surgery a poor fit. Spirometry showed a severe obstructive pattern, with FEV1 of 440 mL, about 15% of predicted, and FVC of 2130 mL, about 48% of predicted. He could not complete DLCO testing because of respiratory muscle fatigue. His WHO/ECOG performance status was 2, meaning he was symptomatic but spent less than half the day in bed. After multidisciplinary review, the team selected image-guided thermal ablation, described in follow-up as cryoablation, as the most appropriate local treatment. The procedure was uncomplicated, and he stayed in the hospital for 1 day only for monitoring. CT scans at 1 and 3 months showed no residual tumor and no local recurrence. A PET scan 6 months after the procedure showed no metabolic uptake at the treated lesion or anywhere else in the body. As of 2 years after ablation, he remained clinically stable, with no sign of local or distant metastasis. His course shows a local treatment path for early lung adenocarcinoma when surgery is limited by severe lung impairment. Follow-up therefore supported durable local control without evidence of spread.