CT-guided percutaneous chemical ablation of adrenal neoplasms

OBJECTIVE. The objective of our study was to evaluate the feasibility and effectiveness of percutaneous chemical ablation of primary and metastatic adrenal neoplasms under CT guidance. MATERIALS AND METHODS. Thirty-seven patients with 46 adrenal tumors underwent CT-guided percutaneous chemical ablation. The average (+/- SD) tumor diameter was 4.2 +/- 2.0 cm. Acetic acid was injected in lesions with a diameter of more than 3 cm, and ethanol was injected in lesions with a diameter of less than 3 cm. Eleven adrenal lesions were nonfunctional adenomas, six lesions were corticosteroid adenomas ( bilateral lesions in one patient), nine lesions were aldosteronomas ( bilateral lesions in two patients), and 20 were metastases (bilateral metastases in six patients). RESULTS. Tumor volume decreased gradually during the first 2 years after the procedure. For primary tumors, a complete response (CR) rate of 92.3% (24/26) and a partial response (PR) rate of 7.7% (2/26) were obtained, but for metastasis, a CR rate of 30% (6/20) and PR rate of 70% (14/20) were obtained 24 months after therapy. The level of corticosteroid in five patients (six tumors) with Cushing's syndrome was in the normal range 3 months after the procedure. Seven patients ( nine tumors) with Conn's syndrome began receiving oral antihypertensive medications during the first month after the procedure to maintain normal blood pressure and the dose was gradually decreased after 1 month. No severe complications were encountered. CONCLUSION. CT-guided percutaneous chemical ablation of adrenal tumors is an effective, minimally invasive, and easily performed procedure.