Adam Wellikoff

Dramatic Reduction of CEA Post Spray Cryotherapy in a Patient with Pleural Based Malignancy

Malignancy of the parietal pleural is a therapeutic challenge; current therapies largely target patients regional symptoms related to effusions/tumor burden and restrictive physiology. Seldom are tumor ablation procedures considered. If alternatives to the current standard approaches could promote tumor ablation, address symptoms and be cost effective, studies to assess clinical impact of these alternatives may be warranted. We present a novel cryo- based technology for treating pleural malignant disease with a dramatic reduction in a tumor biomarker. We present a case of a 67-year-old man with mucinous adenocarcinoma of the pleura with elevated Carcinoembryonic Antigen (CEA) level who had an inadequate response to standard treatment. He underwent cryospray ablation of the parietal pleura with tumor destruction being documented both visually and with a significant decrease in his CEA level. This case demonstrates tumor necrosis, a rapid drop in serum CEA, as well as ease of treatment and continued evidence of safety and the feasibility of cryospray ablation in the pleural space. This case demonstrated that spray cryotherapy promoted tumor ablation and addressed symptoms within the pleura thereby indicating the need for further study. The degree of tumor necrosis in multiple clinical presentations (bulky, flat, studding, etc) awaits definition, as does the rate and timing of post-treatment pleurodesis and the possibility of an immunoregulatory or mortality effect.