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
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)
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.
2.1 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
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
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
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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