Objective：To evaluate the clinical value of CT - guided percutaneous nitrogen cryoablation for elderly patients with pulmonary malignancies. Methods：Clinical data of 56 elderly patients（49 in the radical group，7 in the palliative group）who underwent CT-guided percutaneous cryoablation from January to December 2023 were retrospectively analyzed. Treatment efficacy was assessed by modified response evaluation criteria in solid tumors（mRECIST），with complications，visual analogue scale（VAS），C - reactive protein（CRP）and Eastern Cooperative Oncology Group Score（ECOG）scores recorded. Results：All 56 procedures were successfully completed，with a pneumothorax incidence of 28.57%（16/56），all recovering well after treatment. The complete response rates in the radical group at 1，3，and 6 months postoperatively were 100.00%，91.83%，and 83.67%，respectively，whereas the partial response rates in the palliative group were 100.00%，85.71%，and 57.14%. The ECOG score decreased from a preoperative value of 3.2±0.6 to 1.3±0.4 at 6 months postoperatively（P ＜ 0.01）. Conclusion：This technique is safe and effective，particularly suitable for elderly patients ineligible for surgery. Radical ablation demonstrates significant short-term efficacy，while palliative treatment improves quality of life.