Lung Cancer Cryoablation: 94.7% 3-Year Survival and BOOSTER Trial

Lung cancer cryoablation is an image-guided procedure in which a thin needle-like probe is placed into a lung tumor under CT, and an ice ball freezes and destroys the cancer cells. In a University of California, Los Angeles (UCLA) series of 176 patients with stage IA non-small cell lung cancer who could not have surgery, 3-year overall survival was 94.7% and 89.4% had no regrowth at the treated site. In the randomized phase 2 BOOSTER trial from China, removing residual lung lesions with cryoablation or thermal ablation during immunotherapy extended median progression-free survival to 26.7 months, more than twice the 11.7 months seen with immunotherapy alone.

Endovascular Today selected both studies for its October 2026 "Year in Review: Top Papers in Interventional Oncology". This article explains the two original papers in plain language: who was treated, the results, side effects and where the treatment is offered.

How lung cryoablation works

A cryoprobe expands argon gas at its tip to create an ice ball tens of degrees below zero. Repeated freezing and thawing forms ice crystals inside and around cells and blocks small vessels, so the cancer cells break down. Because the ice ball is clearly visible on CT, the doctor can check that it covers the whole tumor during the procedure.

The UCLA team used general anesthesia and a triple freeze-thaw cycle. There is no incision, only a few needle punctures, which is why it is used for people with weak lungs or advanced age. For comparison with heat-based treatment, see the table below and our lung cancer radiofrequency ablation (RFA) guide.

Based on Rehman S, et al. JVIR 2026 and Yang S, et al. Signal Transduct Target Ther 2025.

Study 1: 176 patients with inoperable stage IA lung cancer

This study appeared in the March 2026 issue of the Journal of Vascular and Interventional Radiology (JVIR; online December 24, 2025). The UCLA thoracic and interventional radiology team included every patient treated with cryoablation from July 2020 to July 2025. All had biopsy-proven stage IA non-small cell lung cancer up to 3 cm. They were unable to have surgery because of lung disease or chose not to, and more than 80% were aged 70 or older.

Rehman S, Naidu S, Suh R, et al. Lung Ablation Outcomes for Inoperable Stage IA Non–Small Cell Lung Cancer. JVIR 2026;37:107974.

About 95 in 100 patients were alive three years after treatment, an encouraging figure for an older group with fragile lungs. Twelve patients whose tumor regrew were treated again with cryoablation; because it is a needle procedure, it can be repeated when needed.

Tumor size shapes the results

In the adjusted analysis, tumor size was the only factor that predicted regrowth at the treated site. Stage IA2 tumors (over 1 cm up to 2 cm) made up just over half of cases and stage IA3 tumors (over 2 cm up to 3 cm) 43.2%.

IA3 tumors had about 4.7 times the risk of local progression (adjusted hazard ratio 4.71). JVIR 2026.

The interventional radiologists who reviewed the paper for Endovascular Today called the results for tumors up to 2 cm especially impressive and stressed that "tumor size matters". Seeking an opinion while a tumor is small keeps more options open. The reviewers named prospective comparisons with stereotactic radiotherapy or surgery as the next step.

Study 2: ablation plus immunotherapy (BOOSTER)

BOOSTER is a randomized phase 2 trial run by Shanghai Pulmonary Hospital, Tongji University, from March 2021 to March 2024, published in Signal Transduction and Targeted Therapy in November 2025. It enrolled people with selected stage IIIB or stage IV non-small cell lung cancer whose tumors shrank or stayed stable on first-line immunotherapy (with or without chemotherapy). Residual disease had to involve no more than 5 lesions in no more than 3 organs.

Sixty-five patients were randomized 2:1 to ablation of residual lung lesions followed by continued immunotherapy, or to immunotherapy alone. After 3 withdrew consent, 42 and 20 patients were analyzed. Median follow-up was 17.8 months.

Hazard ratio for progression 0.213 (from immunotherapy start) and 0.198 (from randomization). Yang S, et al. Signal Transduct Target Ther 2025;10:365.

The risk of progression fell to about one fifth with the combination. Overall survival also trended in favor of ablation (hazard ratio 0.242), and so many patients were alive that median survival was not reached in either group. In an exploratory analysis, median PFS was not reached in the 13 cryoablation patients, compared with 22.4 months after thermal ablation. The authors also reported a trend toward higher interferon-alpha after cryoablation and proposed a phase 3 trial to confirm the findings.

Combining immunotherapy with local procedures is also advancing in liver cancer; see TACE plus immunotherapy: the EMERALD-3 trial.

Side effects and how they are managed

The most common event in both studies was pneumothorax, air leaking from the needle track in the lung. It is found right after the procedure on CT or X-ray and, when needed, a small chest tube removes the air; most people recover within a few days.

Original papers. Grades follow the US National Cancer Institute CTCAE criteria.

In the UCLA series no patient died within two months, and there were no air emboli or bronchopleural fistulas. Grade 3 or higher immunotherapy-related events were uncommon in both BOOSTER groups. Knowing in advance whom to call for breathlessness or chest pain after the procedure brings peace of mind.

Who may be suitable

• Stage I lung cancer when surgery is difficult: weak lung function or heart and lung disease that raises surgical risk, or a wish to avoid surgery. Tumors up to 3 cm were studied, with the best results at 2 cm or smaller.
• Advanced lung cancer well controlled on immunotherapy: tumors shrank or stayed stable after first-line immunotherapy, with limited residual disease (up to 5 lesions in up to 3 organs).
• General condition: both studies included people who could manage daily life on their own (ECOG performance status 0 to 1).
• Location: the lesion must be safely reachable by needle; next to large vessels or airways, other methods are considered as well.

The choice is usually made together by thoracic surgery, medical oncology, radiation oncology and interventional radiology. See our interventional radiology (IVR) overview and radiofrequency ablation (RFA) overview.

Japan and overseas

International patients are usually not covered by the host country's public insurance, so confirm costs and schedules directly with the hospital.

For an overseas consultation, prepare recent chest CT and PET-CT images, the biopsy report and lung function test results. Results of cryoablation in other organs are in long-term kidney cancer cryoablation results and breast cancer cryoablation and FDA criteria.

Questions to ask your doctor

• For my tumor size and location, is cryoablation or thermal ablation a better fit?
• How does it compare with stereotactic radiotherapy or surgery for me?
• If a pneumothorax occurs, how many extra days will I stay?
• If I am on immunotherapy, when do I pause and restart it around the procedure?
• When and how often will I have CT and PET-CT afterwards?

Our five questions before an RFA consultation may also help.

Frequently asked questions

Can lung cancer cryoablation replace surgery?

The UCLA study reported 94.7% three-year survival in people with stage I lung cancer who could not have surgery. It did not compare cryoablation directly with surgery, so patients who can have an operation should first talk with a thoracic surgeon. The reviewers also named direct comparisons as the next step.

How long is the hospital stay after cryoablation?

As a needle procedure it is less demanding than open surgery. The stay depends on the hospital and on whether a pneumothorax occurs, so ask in advance. If a chest tube is needed, you may stay a few extra days until the air has cleared.

Can I have ablation while on immunotherapy?

In BOOSTER, patients whose tumors shrank or stayed stable on immunotherapy had residual lung lesions ablated and then continued immunotherapy, and progression-free survival extended to 26.7 months. The timing of any pause in treatment is planned with the medical oncologist.

Is cryoablation better than radiofrequency ablation?

The exploratory BOOSTER analysis showed longer progression-free survival after cryoablation, but lesions treated with heat were larger. The choice usually depends on tumor size, location and the hospital's experience.

This article summarises overseas official sources and studies as general information and is not medical advice. Discuss treatment choices with a doctor who has examined you.