Image-guided Cryoablation of Head, Neck and Spine Tumors
Image-guided Cryoablation of Head, Neck and Spine Tumors
This research study is evaluating a procedure called cryoablation (the removal of diseased
 tissue using extreme freezing temperatures) as a possible treatment for head, neck and spine
 tumors.
The participant will be assigned to either group 1 for MRI-guided cryoablation or group 2 for
 PET/CT guided cryoablation. Each participant's placement will be made by a team of
 radiologists, medical oncologists, surgical oncologists, and radiation oncologists.

 After the eligibility screening

 Group 1:

 The investigators will assess the participant's tumor by Magnetic Resonance Imaging (MRI).
 This is a safe and standard exam that will show the physician where the participant's tumor
 is located. MRI scans typically take 60 minutes. The investigator will ask the participant to
 complete a "Quality of Life" questionnaire.

 Following the participant's baseline scan, the physician will schedule the participant's
 procedure in the Advanced Multimodality Image-Guided Operating (AMIGO) suite. The participant
 will be placed under general anesthesia for the procedure. A cryoablation needle will be
 inserted through the skin and into the tumor using MRI guidance. The tip of the cryoablation
 needle forms an iceball which will be used to ablate the tumor cells.

 The physician will be able to see the tumor during the procedure through the MRI scan. The
 procedure will take about 3 hours, and the participant will be spending approximately 2 hours
 in the post-treatment anesthesia care unit. The participant will spend the subsequent night
 in the hospital, and will be discharged the next day.

 The investigators will ask that the participant to return 1 month, 3 months and 6 months post
 procedure. The participant will be asked to complete the Quality of Life questionnaire at the
 1, 3 and 6 month follow up visits.

 Group 2:

 The investigators will assess the participant's tumor by a Positron Emission Tomography (PET)
 scan and Computerized Tomography (CT). These are safe and standard exams that will show the
 physician where the participant's tumor is located. PET/CT scans typically take 60 minutes.
 The investigator will ask the participant to complete a "Quality of Life" questionnaire.

 Following the participant's baseline scan, the physician will schedule the participant's
 procedure in the AMIGO suite. The participant will be placed under general anesthesia for the
 procedure. A cryoablation needle will be inserted through the skin and into the tumor using
 PET/CT guidance. The tip of the cryoablation needle forms an iceball which will be used to
 ablate the tumor cells.

 The physician will be able to see the tumor during the procedure through the PET/CT scan. The
 procedure will take about 3 hours, and the participant will spend approximately 2 hours in
 the post-treatment anesthesia care unit. The participant will spend the subsequent night in
 the hospital, and will be discharged the next day.

 The investigators ask that the participant return 1 month, 3 months and 6 months post
 procedure. The participant will be asked to complete the Quality of Life questionnaire at the
 1, 3 and 6 month follow up visits.
Inclusion Criteria:

 -  Participants must meet the following criteria on screening examination to be eligible
 to participate in the study:

 -  Participants must have histologically confirmed malignant tumor that is metastatic or
 unresectable and for which standard curative or palliative measures do not exist or
 are no longer effective.

 -  Participants with malignant locally recurrent and/or metastatic tumors will be
 eligible for cryoablation. All tumor shapes and sizes will be eligible for ablation.

 -  Participants must have sustained all available treatment options (radiation,
 chemotherapy, surgery) as verified by the Dana Farber Cancer Institute's Head and Neck
 Tumor Board. These cases will be reviewed by a team of medical oncologists,
 radiologists, radiation oncologists, and surgical oncologists.

 -  Participants must have an advanced head, neck or spine malignant tumor that would
 potentially benefit from a minimally invasive procedure.

 -  Age 18 years or older

 -- Because no dosing or adverse event data are currently available on the use of
 cryoablation in participants < 18 years of age, children are excluded from this study
 but will be eligible for future pediatric III trials.

 -  Life expectancy of greater than 8 weeks in the opinion of the referring clinician.

 -  Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2 (see Appendix A).

 -  Participants must have normal organ and marrow function as defined below:

 -  Leukocytes ≥ 3,000/microliter (mcL)

 -  Absolute neutrophil count ≥ 1,500/mcL

 -  Platelets ≥ 100,000/microliter (mcL)

 -  Total bilirubin within normal institutional limits

 -  Aspartate aminotransferase (AST)/Alanine aminotransferase (ALT) ≤ 2.5 X
 institutional upper limit of normal

 -  Creatinine within normal institutional limits or creatinine clearance ≥ 60
 mL/min/1.73 m2 for subjects with creatinine levels about institutional normal .

 -  Cryoablation can be performed near vessels of the head and neck, and if deemed
 necessary tumor may be displaced using a saline injection (hydro-displacement). Tumor
 displacement from nerves may be required and will be performed as deemed appropriate
 to avoid nerve injury.

 -  The effects of cryoablation on the developing human fetus are unknown. For this reason
 women of child-bearing potential and men must agree to use adequate contraception
 (hormonal or barrier method of birth control; abstinence) prior to study entry and for
 the duration of study participation. Should a woman become pregnant or suspect she is
 pregnant while participating in this study, she should inform her treating physician
 immediately.

 -  Ability to understand and the willingness to sign a written informed consent document.

 -  MRI-Guided Cryoablation Criteria-Cohort 1

 -- Participants must have a mass that is well-visualized under MRI. Since positron
 emission tomography-computed tomography (PET-CT) guidance requires the nuclear
 medicine department to administer a radionuclide material, the default will be to try
 to use MRI guidance.

 -  PET/CT-Guided Cryoablation Criteria-Cohort 2 -- Patients must have a mass that is well
 visualized under PET/CT. Tumors that are not clearly seen by MRI but showing on PET/CT
 will be ablated with PET/CT guidance.

 Exclusion Criteria:

 -  Participants who exhibit any of the following conditions at screening will not be
 eligible for admission into the study.

 -  Participants with tumors involving the optic chiasm, brain, or spinal cord will not be
 eligible for participation in this study. Furthermore, tumors that encase any major
 blood vessel (carotid, jugular, vertebral) will be excluded from the study due to
 inability to displace these masses.

 -  Participants who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for
 nitrosoureas or mitomycin C) prior to entering the study or those who have not
 recovered from adverse events due to agents administered more than 4 weeks earlier.

 -  Participants may not be receiving any other study agents.

 -  Participants with known brain metastases should be excluded from this clinical trial
 because of their poor prognosis and because they often develop progressive neurologic
 dysfunction that would confound the evaluation of neurologic and other adverse events.

 -  History of allergic reactions attributed to compounds of similar chemical or biologic
 composition to gadolinium contrast agents, if contrast use is anticipated during the
 procedure.

 -  Participants with a blood glucose level of > 200mg/dl prior to the baseline study,
 known ischemic disease, and/or impaired renal function (eGFR < 60ml/min) will not be
 eligible for this study.

 -  Uncontrolled intercurrent illness including, but not limited to ongoing or active
 infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
 arrhythmia, or psychiatric illness/social situations that would limit compliance with
 study requirements.

 -  Pregnant women are excluded from this study because gadolinium is a contrast agent
 with the potential for teratogenic or abortifacient effects. Because there is an
 unknown but potential risk of adverse events in nursing infants secondary to treatment
 of the mother with gadolinium, breastfeeding should be discontinued if the mother is
 treated with gadolinium.

 -  MRI-Guided Cryoablation Exclusion Criteria-Cohort 1

 -  -Pregnant women are excluded from this study because gadolinium is a contrast agent
 with the potential for teratogenic or abortifacient effects. Because there is an
 unknown but potential risk of adverse events in nursing infants secondary to treatment
 of the mother with gadolinium, breastfeeding should be discontinued if the mother is
 treated with gadolinium.

 -  PET/CT-Guided Cryoablation Exclusion Criteria-Cohort 2

 -  Based on potential risks of fetal loss, teratogenicity, fetal growth retardation
 and carcinogenesis, PET/CT is contraindicated in the pregnant patient.

 -  Pregnant women are excluded from this study because PET/CT utilizes a radioactive
 diagnostic agent with the potential for teratogenic or abortifacient effects.
 Because there is an unknown but potential risk of adverse events in nursing
 infants secondary to treatment of the mother with a radionclide, breastfeeding
 should be discontinued if the mother is treated.