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The Clinical Observation of the Patients with Non-Small cell Lung Cancer Treated by Percutaneous Argon-Helium Targeted Ablation


An Yonghui,Zhang Futong,Li Xiuli,Zhang Guangen,Zhang Yan,Li na,Xue Zhancang.
Crycare Surgical Center, The First Hospital, ShiJiaZhuang, China.

(Abstract) objection: to eveluate the clinical value .of Percutaneous Argon-Helium targeted ablation therapy for treatment of lung cancer . Methods: By Inifinix NS inducing and monitoring,37 patients with non-small cell lung cance were treated by percutaneous Argon-Helium targeted ablation therapy. Results: After treatment, the Life quality of the most patients was obviously become well. The radical and palliative ablation rates are respectively 56.71%(21/37) and 37.84%(14/37). After percutaneous Argon-Helium targeted ablation therapy, The result of CT scan showed that the tumor tissue of patients has been destroyed, CT value was be found to be obviously decreased in 72.97% patients (27/37). Thranscription activity of PBTL is obviously increased in the postoperative patients . It is a significant difference Compared with preoperation (p<0.05), suggesting targeted cryoablation can increase the immunological function of patient . Complications: 13.51% patients have postoperative pectoralgia (5/37) , and 2.71% patients find cardical effusion(1/37). Conclusion: The percutomeous Ar-He targeted ablation is a effective therapy for lung cancer.
Key words: Cryocare surgical system, Ar-He targeted ablation, Lung cancer

Argon-Helium (Ar-He) targeted ablation is a local physiotherapy technique by directly destroying tumor histology. In recent years. it has been applied to treat lung and liver cancer entersively (1-2). From June 2001 to February 2002, guiding by Inifinix NS, percutancous Ar-He targeted. cryoablation had been successfully used to treate 37 cases of patients with non-small cell lung cancer in our hospital. The results of clinical observation is reported as follow.
1. Date and Methods
1.1 Clinical data
37 cases of patients with non-small cell lung cancer (Table 1)
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Gender Men 30 cases
Women 7 cases
Medium age 69 ages
Focal pant Central 9 cases
Peripheral 28 cases
Lesion ≤3cm 6 cases
3-5cm 18 cases
>5cm 9 cases
>2focuses 4 cases
Pathological type Squamous cell carcinoma 19 cases
Adenocarcinoma 15 cases
Large cell carcinoma 2 cases
Unclassified 1 cases
Clinical stage Ⅰ stage 1 cases
Ⅱ stage 17 cases
Ⅲ stage 13 cases
Ⅳ stage 6 cases

1.2 Therapeutic Methods
1.2.1 Preoperative localization. CT orientation scans before operation, the target point will be confirmed according to tumor size, shapes, peripheral viscera and tissue structure. According to the size of the tumor, choose the cryprobe and decide on the treating plan which must contain tumor tissue in the frozen ball and the cryoablation area should be 1cm distance from tumor edge.
1.2.2 Operative Methods(1-4)

According to preoperation localization plan, guided by Inifinix NS, insert probe to tumor and confirm target point. After examination and proof, startup the cryocare surgical system to freeze quickly .Then the temperature reach to about -130℃ 30 seconds later, with prolong of freezing, the temperature is between -135℃ to -145℃ constantly and 15-20 minutes are needed. After stopping the cryoablation and startup heating system, when the temperature reaches 0℃ restart the cryocare surgical system and begin the second circulating cryoablation like the first. Restart heating system, when the temperature reach +15℃, probes become moved, then retreat, If tumor is bigger, cryoablation once cannot contain all the tumor tissue, after moving 3-3.5cm from frozen ball, retreat again.

2 Results
2.1 Postoperation eveluation
2.1.1 Recent curative effect
Clinical curative effect is association with the area of tumor tissue distroyied by cryoablation, the clinical stage, the original cancer focus limitation, transfering focus.. According the suggestion of China Cooperation Group for , Ar-He Targeted cryoaslation , Clinical curative effect can be divided into tow kinds as follow. ⑴ Radical cryoablation: If the effective cryoablation area is above 1cm from the tumor edge and the ice ball contains all the tumor tissue, the curative effect is as alike as operation. It can be cured clinically if no local recrudescence and lymphocute didn't transfer faramay. In our clinical goup, radical cryoablation rate is 56.76% (21/37).

⑵ Palliative cryoablation
The effective cryoablation area is over 80% of the valume of tumor focus. It is named as palliative cryoablation. In our clinical group. The palliative cryoablation rate is 37.84% .
2.1.2 Clinical symptom amelioration
After cryoablation operation, 62.16% (23/37) patients become better and clinical symptom amelioration. 70.27%(26/37) patient had good appetites and increased body weight over 3kg in one month.

2.1.3 CT assessment
The CT value of preoperative lung cancer focus is 130-140HU, It was found to be obviously decreased to 30HU in 72.91% patients (26/37) after cryoablation therapy, such as follow pictures. The result of clinical evaluation by CT scan, suggested that Compared with the preoperative, CT value of tumor tissue destroyed by cryoablation is found to be decreased in the most of patinets, suggesting tumor cells have been destroyed.

2.1.4 Immunological function changes
In order to investigste the change of immuniological founction, the rDNA transcription activities of the peripheral blood T lymphocytes was analysed in 37 patient before and after cryoablation(5-6). It is showed that after cryoablation, the he rDNA transcription activities of the peripheral blood T lymphocytes is increased comparison with peroperation. (Table 2)

Table 2: rDNA transcription activities of the peripheral blood T lymphocytes
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Group Case I.S% Value (X±S)
Preoperation 37 5.02±0.65
Postoperation 37 6.10±0.46

※ Statistics analyses there is significant differences P<0.05
2.2 The observation of postoperative reactions and complications
2.2.1 Postoperative reactions

8.11% patients(3/37) had fever at 37.5--38℃ for 2-5 days. It can recover soon after treatment. 32.43% patients (12/37) had blood phlegm which could be stopped during 1 week, no cough blood happened. 5.41% pateints (2/37) had a little thoracic hydrops which was absorbed after one month.
2.2.2 Postoperation complications
No heamthorax and aerothorax complication were observated in 37 patients by treatment of cryoablation therapy. 13.51% patient (5/37) felt little pain in their chest after operation , and disappeared one month later. One case had membranes hydrops after operation because bump conglatinates membrans after treatment, the symptom relieves.

3. Discussion
At present, the first therapeutic methods for treatment of lung cancer is still operative removal. Because the early diagnosis of lung cancer is dificult for clinical oncologist, the most of patients with lung cancer lose operative chance when they come to hospital. In clinical oncology, non-small lung cancer is found to be insensiveness for radiotherapy and chemotherapy. Developing an effective therapy for treatment of lung cancer has become a new task in therapeutic research. With the development of cryocare surgical system, a good and effective therapeutic method for patients with lung cancer, a new cryoablation technology has been used in American and China in recent tow years. (1-3) The systems can refrigerate and destroy tumor cells quickly, and regulate the immunological founction of patient after cryoablation therapy(2, 4).

It has been used to treat with liver cancer, lung cancer , prostate cancer, brain tumor and breast cancer in China. A significant curative effects has been observated in clinical oncology. More than 200 cases of lung cancer have been successfully treated by perentaneas Ar-He targeted cryoablation in 2002(7). The merits of pereutaneous Ar-He targeted cryoablation are microtrauma, safe and reliable. Patients can easily recover after operation. In hospital, many patients wouldn't like to accept operation , because their much bigger tumors in late stage, too old and weak, and big traumas. This technique will resolves the clinical problem of lung cancer , enlarges the operative indication and has a entensively applied in the future.

In this article, 56.76% patients are radical cryoablation and 37.84% are palliative cryoablation. The patients' clinical symptoms has changes in different degrees. That is to say, whether it reaches the criteria of radical cryoablation or not, after reducing tumor burden, recent curative effect of patient after operation will be significance. But the future curative effect need to be observed in our collaboration hospital . We judge the cryoablation effects through the CT value changes of preoperation and postoperation. Generally one week later, the tumor tissue can be found to be destroyed in effective cryoablative ranse. 72.97% patients' CT values were below 30 HU in our observations. but some patients' CT values didn't decrease after operation, the reasons might be relation with the different tumor tissue origin, tissue density and range of cryablation. The comparative research still need to be discussed and observated. Many researches proved that T lymphocyte kernel Agnor is a good index for indication of the thranscription activity of rRNA . In our research, T lymphocytes rRNA transcriptive activity of patient was significant differences after one week in contrast with postoperative. Patients' immunological function was obviously recovered after operation. Guided by Infinix NS, it's easy to observe changes of illness state and size of the ice ball, the complications are less and no aeothorax happens. Postoperative reactions and chest pain can be relieved after 1-2 works in our observations. Ar-He targeted cryoablation has the characteristics of omirotrauma , less complications and quick recovery.

Although the Ar-He targeted cryotherapy can destroy tumor tissue cells quickly, most patients need long time to absorb the cryoablative necrotic cells, the objective assessment criteria of the clinical effect need to be studied and further observation. At the same time the combining therapy is still need for lung cancer treatment. According to the state of the illnessn, we choose the radiotherapy, chemotherapy or biologic therapy for further treatment after cryoablation therapy.

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