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J Urol 2001 Oct;166(4):1333-7; discussion 1337-8

cryotherapy using an argon based system for locally recurrent prostate cancer after radiation therapy: the Columbia experience.

Ghafar MA, Johnson CW, De La Taille A, Benson MC, Bagiella E, Fatal M, Olsson CA, Katz AE.

Department of Urology, College of Physicians and Surgeons of Columbia University, New York, New York, USA.
PURPOSE: Cryosurgical ablation of the prostate has been reported as potential treatment for radioresistant clinically localized prostate cancer. We report our experience with the safety and efficacy of salvage cryosurgery using the argon based CRYOCare system (Endocare, Inc, Irvine, California). MATERIALS AND METHODS: Between October 1997 and September 2000, 38 men with a mean age of 71.9 years underwent salvage cryosurgery for recurrent prostate cancer after radiation therapy failed. All patients had biochemical disease recurrence, defined as an increase in prostate specific antigen (PSA) of greater than 0.3 ng./ml. above the post-radiation PSA nadir. Subsequently prostate biopsy was positive for cancer. Pre-cryosurgery bone scan demonstrated no evidence of metastatic disease. In addition, these patients received 3 months of neoadjuvant androgen deprivation therapy before cryotherapy. RESULTS: The PSA nadir was 0.1 or less, 1 or less and greater than 1 ng./ml. in 31 (81.5%), 5 (13.2%) and 2 (5.3%) patients, respectively. Biochemical recurrence-free survival calculated from Kaplan-Meier curves was 86% at 1 year and 74% at 2 years. Reported complications included rectal pain in 39.5% of cases, urinary tract infection in 2.6%, incontinence in 7.9%, hematuria in 7.9% and scrotal edema in 10.5%. The rate of rectourethral fistula, urethral sloughing and urinary retention was 0%. CONCLUSIONS: Our study supports cryosurgery of the prostate as safe and effective treatment in patients in whom radiation therapy fails. Using the CRYOCare machine resulted in a marked decrease in complications.

PMID: 11547068 [PubMed - indexed for MEDLINE]
2: J Endourol 2000 Mar;14(2):139-43 Related Articles, Links
Acute histologic changes in human renal tumors after cryoablation.
Edmunds TB Jr, Schulsinger DA, Durand DB, Waltzer WC.
Department of Urology, State University of New York at Stony Brook, 11794, USA.

BACKGROUND AND PURPOSE: Cryoablation is a treatment option for some patients with small, exophytic lesions of the kidney. Several investigators have evaluated the effects of cryoablation in normal renal tissue of animals. The purpose of this study was to investigate the tissue changes following cryoablation in human renal tumors. PATIENTS AND METHODS: We prospectively evaluated patients with solid renal lesions (1.5-1.8 cm) confirmed by CT, MRI, or both. Metastatic work-up for all patients was negative. All lesions were biopsied prior to freezing. Two patients with bilateral renal tumors underwent argon-gas-based CRYOcare System (Endocare, Irvine, CA) treatment via an open approach. A 3-mm cryoprobe was placed directly into each tumor. A single 15-minute freeze preceded an active thaw (helium gas) for each lesion. Iceball dimensions were monitored by intraoperative ultrasonography. After successful cryoablation, partial nephrectomy was performed to remove the lesion, and the renal tissue underwent histologic evaluation. RESULTS: The cryoprobes achieved a temperature of -135 degrees C. No bleeding was noted, and there were no intraoperative or postoperative complications with a mean follow-up of 3 months. Histologically, freezing of renal tissue resulted in coagulative necrosis and hemorrhage beyond the boundaries of the lesions. There was a zone of demarcation between the viable and nonviable tissue. CONCLUSIONS: In our series, cryoablation was effective in destroying tumor tissue in vivo in human kidneys. Freezing was sufficient to achieve a negative surgical margin. Cryoablation of renal tumor is an alternative to the currently available nephron-sparing surgical techniques. The long-term effect of tumor tissue destruction by cryosurgery requires further investigation.

PMID: 10772505 [PubMed - indexed for MEDLINE]

3: Cryobiology 1997 Dec;35(4):303-8 Related Articles, Links

Hewitt PM, Zhao J, Akhter J, Morris DL.A comparative laboratory study of liquid nitrogen and argon gas cryosurgery systems. Cryobiology 1997 Dec;35(4):303-8
Hewitt PM, Zhao J, Akhter J, Morris DL.

Department of Surgery, University of New South Wales, St. George Hospital, Kogarah, Sydney, Australia.

Cryotherapy can now be applied using a variety of delivery systems and cryogens. We compared the Cryotech LCS 3000 liquid nitrogen system (Spembly, Andover, UK) with the CRYOcare argon gas-based system (Irvine, CA, U.S.A.) using three different 3-mm cryoprobes: an old liquid nitrogen probe (N-probe), a new N-probe featuring gas bypass and an argon gas probe. Each probe was tested in two models: (i) fresh sheep liver at 20 degrees C--the probe was inserted to a depth of 1.5 cm; the rate of ice ball formation was monitored by recording radial temperatures every 15 s at 5, 10, 15, and 20 mm from the cryoprobe, and the ice-ball diameter was measured every 2.5 min. After 10 min, the probe was warmed and the time taken until it could be extracted from the liver was recorded. (ii) Warm water bath--the probe was immersed in warm water (42 degrees C) for 15 min and the ice-ball diameter was measured at 5-min intervals. Radial temperatures in liver declined more rapidly (P < 0.001) and time to probe extraction was less (P < 0.01) when the argon gas system was used. The new N-probe performed better than its older counterpart, but was still slower than the argon gas system. In liver (20 degrees C), ice-ball diameters were similar after 10 min, but in warm water, they were larger when the new N-probe was used (P < 0.02). It would appear that the argon gas system is initially faster, but it does not achieve as large an ice ball in a warm environment as the liquid nitrogen system.

: Br J Surg 2003 Mar;90(3):272-89 Related Articles, Links

Interstitial ablative techniques for hepatic tumours.
Erce C, Parks RW.

Department of Clinical and Surgical Sciences (Surgery), University of Edinburgh, Edinburgh, UK.

BACKGROUND: Most patients with liver tumours are not suitable for surgery but interstitial ablative techniques may control disease progression and improve survival rates. METHODS: A review was undertaken using Medline of all reported studies of cryoablation, radiofrequency ablation, microwave ablation, interstitial laser photocoagulation, high-intensity focused ultrasound and ethanol ablation of primary liver tumours and hepatic metastases. RESULTS: Although there are no randomized clinical trials, cryoablation, thermal ablation and ethanol ablation have all been shown to be associated with improved palliation in patients with primary and secondary liver cancer. The techniques can be undertaken safely with minimal morbidity and mortality. CONCLUSION: Although surgical resection remains the first line of treatment for selected patients with primary and secondary liver malignancies, interstitial ablative techniques are promising therapies for patients not suitable for hepatic resection or as an adjunct to liver surgery. Copyright 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Publication Types:
· Review
· Review Literature

PMID: 12594662 [PubMed - indexed for MEDLINE]

2: Ann Surg 2003 Feb;237(2):171-9 Related Articles, Links

Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future.

Lau WY, Leung TW, Yu SC, Ho SK.

Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China. josephlau@cuhk.edu.hk

OBJECTIVE: To review and compare treatment result for percutaneous local ablative therapy (PLAT) with surgical resection in the treatment of small hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA: PLAT is indicated for small unresectable HCC localized to the liver. From the use of ethanol to the latest technology of radiofrequency ablation, ablative techniques have been refined and their role in the management of HCC established. This review aims to give an overview of various ablative methods, including their efficacy, indications, and limitations, and also tries to look into the future of clinical trials in PLAT. METHODS: The authors reviewed recent papers in the English medical literature about the use of local ablative therapy for HCC. Focus was given to the results of treatment in terms of local control, progression-free survival, and overall survival, and to compare treatment results with those of surgery. RESULTS: PLAT for small HCC (<5 cm) with thermal ablation (radiofrequency ablation or microwave coagulation) can achieve effective local control of disease and is superior to ethanol injection. Progressive disease in untreated areas is a common reason for failure. Overall progression-free survival is similar to that of surgical resection. CONCLUSIONS: Thermal ablation gives good local control of small HCC, is superior to ethanol, and may be comparable to surgical resection in long-term outcome.

Publication Types:
· Review
· Review, Tutorial

PMID: 12560774 [PubMed - indexed for MEDLINE]

3: Urology 2003 Jan;61(1):83-8 Related Articles, Links

Retroperitoneal laparoscopic cryoablation of small renal tumors: intermediate results.

Lee DI, McGinnis DE, Feld R, Strup SE.

Department of Urology, University of California, Irvine Medical Center, Orange, California, USA.

OBJECTIVES: To present our experience with laparoscopic renal cryoablation with up to 3 years of follow-up. Laparoscopic renal cryoablation remains a viable option for the treatment of small peripheral renal masses in patients with significant comorbidities. Although partial nephrectomy has been shown to be a safe and reliable method of renal parenchymal preservation, laparoscopic cryoablation still requires longer term data to prove its efficacy. METHODS: Twenty patients with small renal masses (1.4 to 4.5 cm) underwent laparoscopic renal cryosurgery at our institution. A retroperitoneal laparoscopic approach was used to expose the kidney. Intraoperative ultrasound guidance was used to localize the lesions and monitor iceball formation. A double-freeze technique was used. Needle biopsies of solid masses were performed intraoperatively. RESULTS: Renal biopsies revealed renal cell carcinoma in 11 of the 20 patients. Of these 11 patients, none had evidence of recurrent disease at last follow-up, and follow-up scans showed no enhancement of any lesions. Of the 8 patients with follow-up of 2 years or greater, 4 had complete resolution of the renal lesions. The remainder had lesions that were reduced and stable in size. Complications included surgical re-exploration to evaluate pancreatic injury in 1 patient and failure to ablate a lesion in another. CONCLUSIONS: Laparoscopic renal cryoablation appears to be an effective tool for ablation of small renal lesions. A moderate length of follow-up continues to demonstrate efficacy because no patients had growth of treated pathologic lesions or developed metastasis to date. Continued maturation of data is necessary to determine the long-term efficacy.

PMID: 12559272 [PubMed - indexed for MEDLINE]

4: Curr Urol Rep 2003 Feb;4(1):87-92 Related Articles, Links

Adrenal-preserving minimally invasive surgery: the role of laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation of the adrenal gland.

Munver R, Del Pizzo JJ, Sosa RE.

Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, Starr 900, 525 East 68th Street, New York, NY 10021, USA. rm89@cornell.edu

Adrenalectomy has become the standard of care for the management of hormonally active adrenal masses. Various surgical therapies have been proposed to excise completely or destroy these adrenal lesions, which may be benign or malignant. New minimally invasive, adrenal-sparing procedures have recently been introduced, among them laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation. These procedures focus on reducing patient morbidity and hastening postoperative recovery while preserving normal adrenal tissue. However, questions remain about the risks and benefits associated with routine application of minimally invasive therapies for adrenal-sparing surgery in terms of complete tumor extirpation. Clearly, more experience and longer follow-up is necessary to validate these procedures. Herein we describe the surgical techniques and early results of treatment with adrenal-sparing surgery.

Publication Types:
· Review
· Review, Academic

PMID: 12537947 [PubMed - indexed for MEDLINE]

5: Curr Urol Rep 2003 Feb;4(1):13-20 Related Articles, Links

Laparoscopic partial nephrectomy and minimally invasive nephron-sparing surgery.

Phelan MW, Perry KT, Gore J, Schulam PG.
*Department of Urology, University of California, Los Angeles, Box 951738, Los Angeles, CA 90095, USA. mphelan@mednet.ucla.edu
Surgical extirpation remains the most effective therapy for renal cell carcinoma. The surgical management of renal masses has evolved away from radical nephrectomy and now includes nephron-sparing surgery for small tumors. Nephron-sparing surgery has similar cure rates and does not appear to compromise cancer control. As the detection of small renal masses by widespread abdominal imaging continues to increase, so will the demand for minimally invasive nephron-sparing procedures. Despite progress in surgical techniques, laparoscopic partial nephrectomy remains a technically challenging procedure. In this review, we discuss the challenges and recent advances in laparoscopic partial nephrectomy and other minimally invasive approaches to renal masses.

Publication Types:
· Review
· Review, Academic

PMID: 12537934 [PubMed - indexed for MEDLINE]

6: Drugs Today (Barc) 2002 Mar;38(3):153-65 Related Articles, Links

Three-dimensional visualization and analysis in prostate cancer.
Robb RA.

Biomedical Engineering and Biomedical Imaging, Mayo Foundation Clinic, Rochester, Minnesota 55905, USA.

Current and emerging three- and four-dimensional medical imaging modalities, along with development of efficient 3-D computer rendering and modeling of multidimensional volume image data and image-guided navigation, are significantly advancing our capabilities for improved and minimally invasive diagnosis and treatment of prostate cancer, obviating the need for exploratory surgery, physical dissection, blind biopsies and mental reconstruction of anatomy and pathology. Currently, both diagnostic and therapeutic procedures require x-ray fluoroscopy, transrectal ultrasound, CT and/or MRI for assessing the condition of the prostate and/or the outcome of any therapeutic procedure. New imaging approaches based on three-dimensional ultrasound transducers placed on catheters for easy insertion into the urethra are demonstrating significant promise for improved diagnosis and treatment of prostate disease. Microwave thermal ablation shows promise for reduction of prostate size and tumor volume, and preliminary data from cryosurgery suggests improvements in tumor reduction and/or management while minimizing the risk of serious complications. Prostate brachytherapy is becoming a more popular and effective alternative to surgery. All of these methods, either independently or combined through image fusion, are providing an exciting and rapid evolution in capabilities for visualizing the prostate and its anatomic environment, extending from physical to functional forms and from macro to micro orders of scale. Traversing the scale distances between these imaged objects within the prostate and its environs will be made automatic and instantaneous in the near future with the expected advances in miniaturization of powerful computing and electronic sensing elements. Imaging devices will continue to improve in resolution, speed and affordability and will be deployed harmlessly within the body, as well as outside of it. Diagnosis and therapy of prostate disease will become fully noninvasive and synchronous.

PMID: 12532172 [PubMed - indexed for MEDLINE]
Related Articles, Links

Erce C, Parks RW.Interstitial ablative techniques for hepatic tumours.

Erce C, Parks RW. Br J Surg 2003 Mar;90(3):272-89

Department of Clinical and Surgical Sciences (Surgery), University of Edinburgh, Edinburgh, UK.

BACKGROUND: Most patients with liver tumours are not suitable for surgery but interstitial ablative techniques may control disease progression and improve survival rates. METHODS: A review was undertaken using Medline of all reported studies of cryoablation, radiofrequency ablation, microwave ablation, interstitial laser photocoagulation, high-intensity focused ultrasound and ethanol ablation of primary liver tumours and hepatic metastases. RESULTS: Although there are no randomized clinical trials, cryoablation, thermal ablation and ethanol ablation have all been shown to be associated with improved palliation in patients with primary and secondary liver cancer. The techniques can be undertaken safely with minimal morbidity and mortality. CONCLUSION: Although surgical resection remains the first line of treatment for selected patients with primary and secondary liver malignancies, interstitial ablative techniques are promising therapies for patients not suitable for hepatic resection or as an adjunct to liver surgery. Copyright 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Publication Types:
· Review
· Review Literature

PMID: 12594662 [PubMed - indexed for MEDLINE]

2: Related Articles, Links

Lau WY, Leung TW, Yu SC, Ho SK.Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg 2003 Feb;237(2):171-9

Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China. josephlau@cuhk.edu.hk

OBJECTIVE: To review and compare treatment result for percutaneous local ablative therapy (PLAT) with surgical resection in the treatment of small hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA: PLAT is indicated for small unresectable HCC localized to the liver. From the use of ethanol to the latest technology of radiofrequency ablation, ablative techniques have been refined and their role in the management of HCC established. This review aims to give an overview of various ablative methods, including their efficacy, indications, and limitations, and also tries to look into the future of clinical trials in PLAT. METHODS: The authors reviewed recent papers in the English medical literature about the use of local ablative therapy for HCC. Focus was given to the results of treatment in terms of local control, progression-free survival, and overall survival, and to compare treatment results with those of surgery. RESULTS: PLAT for small HCC (<5 cm) with thermal ablation (radiofrequency ablation or microwave coagulation) can achieve effective local control of disease and is superior to ethanol injection. Progressive disease in untreated areas is a common reason for failure. Overall progression-free survival is similar to that of surgical resection. CONCLUSIONS: Thermal ablation gives good local control of small HCC, is superior to ethanol, and may be comparable to surgical resection in long-term outcome.

Publication Types:
· Review
· Review, Tutorial

PMID: 12560774 [PubMed - indexed for MEDLINE]

3: Related Articles, Links

Lee DI, McGinnis DE, Feld R, Strup SE.
Retroperitoneal laparoscopic cryoablation of small renal tumors: intermediate results. Urology 2003 Jan;61(1):83-8


Department of Urology, University of California, Irvine Medical Center, Orange, California, USA.

OBJECTIVES: To present our experience with laparoscopic renal cryoablation with up to 3 years of follow-up. Laparoscopic renal cryoablation remains a viable option for the treatment of small peripheral renal masses in patients with significant comorbidities. Although partial nephrectomy has been shown to be a safe and reliable method of renal parenchymal preservation, laparoscopic cryoablation still requires longer term data to prove its efficacy. METHODS: Twenty patients with small renal masses (1.4 to 4.5 cm) underwent laparoscopic renal cryosurgery at our institution. A retroperitoneal laparoscopic approach was used to expose the kidney. Intraoperative ultrasound guidance was used to localize the lesions and monitor iceball formation. A double-freeze technique was used. Needle biopsies of solid masses were performed intraoperatively. RESULTS: Renal biopsies revealed renal cell carcinoma in 11 of the 20 patients. Of these 11 patients, none had evidence of recurrent disease at last follow-up, and follow-up scans showed no enhancement of any lesions. Of the 8 patients with follow-up of 2 years or greater, 4 had complete resolution of the renal lesions. The remainder had lesions that were reduced and stable in size. Complications included surgical re-exploration to evaluate pancreatic injury in 1 patient and failure to ablate a lesion in another. CONCLUSIONS: Laparoscopic renal cryoablation appears to be an effective tool for ablation of small renal lesions. A moderate length of follow-up continues to demonstrate efficacy because no patients had growth of treated pathologic lesions or developed metastasis to date. Continued maturation of data is necessary to determine the long-term efficacy.

PMID: 12559272 [PubMed - indexed for MEDLINE]

4: Related Articles, Links

Munver R, Del Pizzo JJ, Sosa RE.Adrenal-preserving minimally invasive surgery: the role of laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation of the adrenal gland. Curr Urol Rep 2003 Feb;4(1):87-92

Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, Starr 900, 525 East 68th Street, New York, NY 10021, USA. rm89@cornell.edu

Adrenalectomy has become the standard of care for the management of hormonally active adrenal masses. Various surgical therapies have been proposed to excise completely or destroy these adrenal lesions, which may be benign or malignant. New minimally invasive, adrenal-sparing procedures have recently been introduced, among them laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation. These procedures focus on reducing patient morbidity and hastening postoperative recovery while preserving normal adrenal tissue. However, questions remain about the risks and benefits associated with routine application of minimally invasive therapies for adrenal-sparing surgery in terms of complete tumor extirpation. Clearly, more experience and longer follow-up is necessary to validate these procedures. Herein we describe the surgical techniques and early results of treatment with adrenal-sparing surgery.

Publication Types:
· Review
· Review, Academic

PMID: 12537947 [PubMed - indexed for MEDLINE]

5: Curr Urol Rep 2003 Feb;4(1):13-20 Related Articles, Links

Laparoscopic partial nephrectomy and minimally invasive nephron-sparing surgery.

Phelan MW, Perry KT, Gore J, Schulam PG.

*Department of Urology, University of California, Los Angeles, Box 951738, Los Angeles, CA 90095, USA. mphelan@mednet.ucla.edu

Surgical extirpation remains the most effective therapy for renal cell carcinoma. The surgical management of renal masses has evolved away from radical nephrectomy and now includes nephron-sparing surgery for small tumors. Nephron-sparing surgery has similar cure rates and does not appear to compromise cancer control. As the detection of small renal masses by widespread abdominal imaging continues to increase, so will the demand for minimally invasive nephron-sparing procedures. Despite progress in surgical techniques, laparoscopic partial nephrectomy remains a technically challenging procedure. In this review, we discuss the challenges and recent advances in laparoscopic partial nephrectomy and other minimally invasive approaches to renal masses.

Publication Types:
· Review
· Review, Academic

PMID: 12537934 [PubMed - indexed for MEDLINE]

6: Drugs Today (Barc) 2002 Mar;38(3):153-65 Related Articles, Links

Three-dimensional visualization and analysis in prostate cancer.

Robb RA.

Biomedical Engineering and Biomedical Imaging, Mayo Foundation Clinic, Rochester, Minnesota 55905, USA.

Current and emerging three- and four-dimensional medical imaging modalities, along with development of efficient 3-D computer rendering and modeling of multidimensional volume image data and image-guided navigation, are significantly advancing our capabilities for improved and minimally invasive diagnosis and treatment of prostate cancer, obviating the need for exploratory surgery, physical dissection, blind biopsies and mental reconstruction of anatomy and pathology. Currently, both diagnostic and therapeutic procedures require x-ray fluoroscopy, transrectal ultrasound, CT and/or MRI for assessing the condition of the prostate and/or the outcome of any therapeutic procedure. New imaging approaches based on three-dimensional ultrasound transducers placed on catheters for easy insertion into the urethra are demonstrating significant promise for improved diagnosis and treatment of prostate disease. Microwave thermal ablation shows promise for reduction of prostate size and tumor volume, and preliminary data from cryosurgery suggests improvements in tumor reduction and/or management while minimizing the risk of serious complications. Prostate brachytherapy is becoming a more popular and effective alternative to surgery. All of these methods, either independently or combined through image fusion, are providing an exciting and rapid evolution in capabilities for visualizing the prostate and its anatomic environment, extending from physical to functional forms and from macro to micro orders of scale. Traversing the scale distances between these imaged objects within the prostate and its environs will be made automatic and instantaneous in the near future with the expected advances in miniaturization of powerful computing and electronic sensing elements. Imaging devices will continue to improve in resolution, speed and affordability and will be deployed harmlessly within the body, as well as outside of it. Diagnosis and therapy of prostate disease will become fully noninvasive and synchronous.

PMID: 12532172 [PubMed - indexed for MEDLINE]

7: Related Articles, Links

Nordin P, Stenquist B.Five-year results of curettage-cryosurgery for 100 consecutive auricular non-melanoma skin cancers. J Laryngol Otol 2002 Nov;116(11):893-8

Departments of Dermatology, Frolunda Specialist Hospital and Lundby Hospital, Gothenburg, Sweden.

Large excisions or Mohs' micrographic surgery (MMS) are often the suggested treatments for non-melanoma skin cancers (NMSCs) of the external ear. This five-year follow-up attempts to evaluate whether curettage-cryosurgery could be an alternative therapy for selected auricular NMSCs. One hundred auricular NMSCs, selected at a skin tumour clinic, were treated by a thorough curettage, with different-sized curettes, followed by cryosurgery in a double freeze-thaw cycle. Seventy-seven basal cell carcinomas (BCCs), 13 squamous cell carcinomas (SCCs), six SCCs in situ, and four basosquamous carcinomas were included. The mean diameter of the tumours was 18 mm (range 5-70). Morphoeiform BCCs, recurrent BCCs with fibrotic component, and most of the SCCs were selected for MMS. Seventy-one patients with 81 tumours were followed-up for at least five years with only one recurrence. Nineteen patients with 19 tumours, followed-up for two to four years, died from other causes with no sign of recurrence at their last visit. Patients followed-up for less than two years were excluded. No major problems were registered after treatment. The cosmetic result was good or acceptable in most patients. In carefully selected patients a thorough curettage followed by freezing with liquid nitrogen in a double freeze-thaw cycle could be a safe and inexpensive therapy even for large NMSCs of the external ear.

PMID: 12487665 [PubMed - indexed for MEDLINE]

8: Ai Zheng 2002 Feb;21(2):217-9 Related Articles, Links

[Application of cryosurgery in the treatment of liver carcinoma]

[Article in Chinese]

Lu J, Xu J, Qin Z.

Department of General Surgery, First Affiliated Hospital of Medical College of Shantou University, Shantou, Guangdong 515031, P. R. China.

Friotherapy, using liquid N2 as cryogen, may be applied for all stages of liver cancer, which mechanism is tissue destruction due to low temperature, directly and improvement of immunity. At present, using multiprobe cryosurgical device result in many treatment options, such as procedure under open abdomen and staring blankly forward or percutaneously under Trus guidance. The advantages of cold therapy include its convenience, few complications, approval results, ect. With the invention of new probes and cryogen, cryosurgery as a treatment for liver cancer will have a good prospect.

Publication Types:
· Review
· Review, Tutorial

PMID: 12479078 [PubMed - indexed for MEDLINE]

9: Arch Surg 2002 Dec;137(12):1332-9; discussion 1340 Related Articles, Links

Adam R, Hagopian EJ, Linhares M, Krissat J, Savier E, Azoulay D, Kunstlinger F, Castaing D, Bismuth H.A comparison of percutaneous cryosurgery and percutaneous radiofrequency for unresectable hepatic malignancies. Arch Surg 2002 Dec;137(12):1332-9; discussion 1340

Adam R, Hagopian EJ, Linhares M, Krissat J, Savier E, Azoulay D, Kunstlinger F, Castaing D, Bismuth H.

Department of Hepatobiliary Surgery and Liver Transplantation, Centre Hepato-Biliaire, Hopital Paul Brousse, Universite Paris Sud, Villejuif, France. rene.adam@pbr.ap-hop-paris.fr

HYPOTHESIS: The complication and success rates in patients treated with either percutaneous cryosurgery (PCS) or percutaneous radiofrequency (PRF) for unresectable hepatic malignancies are similar. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS AND METHODS: Sixty-four patients were treated with either PCS (n = 31) or PRF (n = 33). Patient treatment was based on the random availability of the probes. Tumors were evaluated by a blinded comparison of pretreatment and posttreatment helical computed tomographic scans. All living patients had at least a 6-month follow-up. MAIN OUTCOME MEASURES: Complication rate, initial treatment success (complete devascularization of the tumor), and local recurrence (tumor revascularization within or at its periphery). RESULTS: The distribution of tumor types was similar in the 2 groups (P =.76). One patient with cirrhosis died of variceal hemorrhage on day 30 after PCS (mortality, 3.2%), while no mortality was observed after PRF (P =.48). Complications occurred in 9 (29%) of the patients following PCS and in 8 (24%) of the patients following PRF (P =.66). Initial treatment success was comparable in the 2 treatment groups (30 [83%] of 36 tumors following PCS vs 34 [83%] of 41 tumors following PRF). However, local recurrences occurred more frequently after PCS than after PRF (16 [53%] of 30 vs 6 [18%] of 34; P =.003). The higher rate of local recurrence was identified for metastases (10 [71%] of 14 after PCS vs 3 [19%] of 16 after PRF; P =.004), while the difference was not significant for hepatocellular carcinoma (6 [38%] of 16 after PCS vs 3 [17%] of 18 after PRF; P =.25). Multivariate analysis demonstrated that the use of PCS (P =.003) and more than 1 treatment (P =.05) were independent risk factors for local tumor recurrence. CONCLUSION: While similar initial treatment success and complication rates are observed following either PCS or PRF, local recurrences occur more frequently following PCS, particularly for metastases.

PMID: 12470093 [PubMed - indexed for MEDLINE]

10: Related Articles, Links

Klein S, Dabritz T, Marg S, Ebel T, Melchert UH, Leibecke T.Development of a cryo-device for minimal-invasive application under MRI-control. Biomed Tech (Berl) 2002;47 Suppl 1 Pt 1:104-5

Labor fur Geratetechnik, Fachhochschule Lubeck, Deutschland. klein@fh-luebeck.de

This paper describes the development of a cryo-device for the treatment of tumors. The probes are intended to form an iceball inside of an organ, e.g. the liver, to destroy degenerated cells. After successful preliminary tests and the development and construction of several probes, the emphasis is now being placed on the realization of a complete device prototype which will enable clinical studies to be carried out. Important for the functionality of the device is an integrated temperature sensor inside the probes. The device may also be used for cryo-analgesic purposes in pain treatment.

PMID: 12451785 [PubMed - indexed for MEDLINE]

11: Related Articles, Links

Tait IS, Yong SM, Cuschieri SA.Laparoscopic in situ ablation of liver cancer with cryotherapy and radiofrequency ablation. Br J Surg 2002 Dec;89(12):1613-9

Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. i.z.tait@dundee.ac.uk

BACKGROUND: In situ ablation has potential for the treatment of patients with liver cancer either as a single-modality treatment or in combination with liver resection. METHODS: Laparoscopy and intraoperative ultrasonography was used to target cryotherapy and radiofrequency ablation. Thirty-eight patients with 146 liver lesions were treated between January 1995 and December 2000 using cryotherapy alone (nine patients), combined cryotherapy and radiofrequency (eight), radiofrequency alone (15) and in situ ablation with liver resection (six). Cancers treated were metastases from colorectal tumours (n = 25), hepatocellular carcinoma (n = 5), and neuro endocrine (n = 5), melanoma (n = 2) and renal cell (n = 1) metastases. Complications and survival after in situ ablation were compared with age- and disease-matched controls treated with systemic chemotherapy. RESULTS: The mean age was 61.6 years. At mean follow-up of 26.6 (range 3-62, median 26) months, 22 patients were alive. Survival was increased following in situ ablation compared with that in controls (P < 0.001). Local recurrence at the ablation site was noted in 12 of 44 lesions following cryotherapy and in 20 of 102 lesions after radiofrequency ablation, and new disease in the liver was found in six of 17 and six of 29 patients respectively. The complication rate was higher with cryotherapy than with radiofrequency ablation (four of 17 versus one of 29). Intraoperative ultrasonography identified 14 new hepatic lesions (10 per cent) not seen on preoperative imaging. CONCLUSION: Laparoscopic in situ ablation should include ultrasonography to stage the disease. In situ ablation appears to have a survival benefit and should be considered for the treatment of liver cancer in appropriate patients.

PMID: 12445075 [PubMed - indexed for MEDLINE]

12: Related Articles, Links

Pfleiderer SO, Freesmeyer MG, Marx C, Kuhne-Heid R, Schneider A, Kaiser WA Cryotherapy of breast cancer under ultrasound guidance: initial results and limitations. Eur Radiol 2002 Dec;12(12):3009-14

.

Institute of Diagnostic and Interventional Radiology, Friedrich Schiller University Jena, Bachstrasse 18, 07740 Jena, Germany. stefan.pfleiderer@med.uni-jena.de

The aim of this study was to investigate the potential and feasibility of ultrasound-guided cryotherapy in breast cancer. Fifteen female patients with 16 breast cancers (mean tumour diameter 21+/-7.8 mm) were treated. A 3-mm cryo probe was placed in the tumour under ultrasound guidance. Two freeze/thaw cycles with durations of 7-10 min and 5 min, respectively, were performed. The size of the iceballs was measured sonographically in 1-min intervals. The patients underwent surgery within 5 days and the specimens were evaluated histologically. The mean diameter of the iceball was 28+/-2.7 mm after the second freezing cycle. No severe side effects were observed. Five tumours with a diameter below 16 mm did not show any remaining invasive cancer after treatment. Two of these had ductal carcinoma in situ (DCIS) in the surrounding tissue. In 11 patients cryotherapy of tumours reaching diameters of 23 mm or more resulted in incomplete necrosis. This study shows that the invasive components of small tumours can be treated using cryotherapy. Remnant DCIS components which may not be detected preinterventionally represent a challenging problem for complete ablation. In tumours larger than 15 mm two or more cryo probes should be used to achieve larger iceballs.

Publication Types:
· Evaluation Studies

PMID: 12439583 [PubMed - indexed for MEDLINE]

13: Related Articles, Links

Kaufman CS, Bachman B, Littrup PJ, White M, Carolin KA, Freman-Gibb L, Francescatti D, Stocks LH, Smith JS, Henry CA, Bailey L, Harness JK, Simmons R.
Office-based ultrasound-guided cryoablation of breast fibroadenomas. Am J Surg 2002 Nov;184(5):394-400


Department of Surgery, University of Washington, Bellingham Breast Center, 2940 Squalicum Pkwy., Suite 101, Bellingham, WA 98225, USA. Breastcare@aol.com

BACKGROUND: Fibroadenomas commonly found by palpation and routine mammography account for approximately 20% of open surgical breast biopsies. Alternatives to open surgery include tumor removal using an automated coring device and tumor ablation using heating or cooling elements. We report our initial experience with cryoablation of biopsy-proven benign fibroadenomas. METHODS: A table-top cryoablation system employing a 2.4-mm cryoprobe was used to treat biopsy-proven benign fibroadenomas up to 4 cm in maximum diameter in a prospective nonrandomized fashion. The cryoprobe was placed under ultrasound guidance. Using a treatment algorithm based on fibroadenoma size, all tumors were subjected to two freeze cycles with an interposing thaw. Skin appearance and temperature, probe temperature, iceball size, and patient comfort were closely monitored during the procedure. Follow-up examinations including ultrasonography and photographs were scheduled for up to 12 months postablation. RESULTS: Fifty patients with 57 core biopsy-proven benign fibroadenomas were treated. Seven early cases were treated in an ambulatory surgery center setting. The remaining procedures were completely office-based using only local anesthetic. Tumor diameter varied from 7 mm to 42 mm (mean 21 mm). The iceball engulfed the target lesion in each case. Transient postoperative side effects were local swelling and ecchymosis. Postoperative discomfort rarely required medication beyond acetaminophen or ibuprofen. Lesions showed progressive shrinkage and disappearance over 3 to 12 months. No skin injury was noted and appearance remained excellent. Patient satisfaction was excellent. CONCLUSIONS: With office-based use of ultrasound-guided cryoablation for fibroadenomas there was little or no pain, target lesions were reduced in size or eliminated, scarring was minimal, cosmesis outstanding, and patient satisfaction was excellent. Cryoablation offers a useful office-based alternative to surgical excision of benign fibroadenomas.

PMID: 12433600 [PubMed - indexed for MEDLINE]

14: Suppl Tumori 2002 May-Jun;1(3):S7-14 Related Articles, Links

[Cryoablation and thermal ablation with radiofrequency in the treatment of neoplasms of the liver]

[Article in Italian]

Paganini AM, Feliciotti F, Guerrieri M, Sarnari J, Lezoche E.

Clinica di Chirurgia Generale e Metodologia Chirurgica, Universita di Ancona.

PMID: 12415778 [PubMed - indexed for MEDLINE]

15: Related Articles, Links

Goldberg SN, Ahmed M.Minimally invasive image-guided therapies for hepatocellular carcinoma. J Clin Gastroenterol 2002 Nov-Dec;35(5 Suppl 2):S115-29

Goldberg SN, Ahmed M.

Minimally Invasive Tumor Therapy Laboratory, Department of Radiology, Beth Israel Deaconess medical Center, Harvard Medical School, Boston Massachusetts 02215, USA. sgoldber@caregroup.harvard.edu

Minimally invasive therapies are gaining increasing attention as an alternative to standard surgical therapies in the treatment of primary hepatocellular carcinoma. These include therapies administered transcatheterally (arterial embolization, intraarterial chemoinfusion, and combination chemoembolization) and percutaneously (chemical ablation with ethanol or acetic acid, and thermal ablation with radiofrequency, microwave, or laser energies). Benefits over surgical resection include the anticipated reduction in morbidity and mortality, low cost, suitability for real time image guidance, the ability to perform ablative procedures on outpatients, and the potential application in a wider spectrum of patients, including nonsurgical candidates. This review examines reported clinical success, potential complications, current limitations, and future directions of development of chemoembolization, ethanol and acetic acid instillation, and radiofrequency, microwave, and laser thermal ablation.

Publication Types:
· Review
· Review, Tutorial

PMID: 12394215 [PubMed - indexed for MEDLINE]

16: Br J Surg 2002 Nov;89(11):1396-401 Related Articles, Links

Comment in:
· Br J Surg. 2003 Feb;90(2):248.

Sheen AJ, Poston GJ, Sherlock DJ.
Cryotherapeutic ablation of liver tumours. Br J Surg 2002 Nov;89(11):1396-401


Department of Surgery, North Manchester Healthcare NHS Trust, Manchester, UK.

BACKGROUND: This paper reports a 7-year experience of cryoablation for colorectal and non-colorectal liver metastases. METHODS: A retrospective review was undertaken of patients treated in two adjacent UK centres in the north-west of England. RESULTS: Over a 7-year period (1993-2000), 57 patients underwent cryotherapy for malignant hepatic tumours (41 colorectal, 16 non-colorectal). In the patients with colorectal metastases, preoperative carcinoembryonic antigen (CEA) levels fell significantly, from a mean of 444.1 to 6.22 micro g/l (P = 0.002). One patient died, two developed cryoshock and six had cardiorespiratory complications. All patients with colorectal metastases subsequently received 5-fluorouracil-based chemotherapy. The remaining 16 patients with non-colorectal tumours (seven neuroendocrine metastases, five hepatocellular carcinomas, three sarcomas, one cholangiocarcinoma) all received cryotherapy alone, with no major complications. The median survival for patients with non-colorectal metastases was 37 months, compared with 22 months for those with colorectal metastases (P = 0.005). CONCLUSION: Hepatic cryotherapy is effective and safe, as demonstrated by the significant reduction in postoperative CEA concentration and the low risk of complications. However, this initial short-term success was not reflected in 5-year survival rates. Cryotherapy for non-colorectal metastases had a greater long-term survival benefit and is a useful means of controlling symptoms.

Publication Types:
· Multicenter Study

PMID: 12390380 [PubMed - indexed for MEDLINE]

17: Urology 2002 Oct;60(4):645-9 Related Articles, Links

Prospective trial of cryosurgical ablation of the prostate: five-year results.

Donnelly BJ, Saliken JC, Ernst DS, Ali-Ridha N, Brasher PM, Robinson JW, Rewcastle JC.

Department of Surgery, Tom Baker Cancer Centre and University of Calgary, Calgary, Alberta, Canada.

OBJECTIVES: To determine in a prospective pilot study the safety and efficacy of cryosurgical ablation for localized prostate carcinoma. METHODS: A total of 87 cryosurgical procedures were performed on 76 consecutive patients between December 1994 and February 1998. All patients had histologically proved adenocarcinoma of the prostate, with prostate-specific antigen (PSA) readings of less than 30 ng/mL. Clinical evaluations, PSA determinations, and patient self-reported quality-of-life questionnaires (functional assessment of cancer treatment-prostate; FACT-P) were used to determine biochemical and clinical disease-free status and complications. Patients had a mean follow-up of 50 months (minimum 36). RESULTS: Follow-up biopsies were performed in 73 patients, and 72 were negative for malignancy after one or more treatments. Ten patients required two treatments and 1 patient required three treatments. The 5-year overall and cancer-specific survival rate was 89% (95% confidence interval, 83% to 97%) and 98.6% (95% confidence interval, 96% to 100%), respectively. The undetectable PSA rate (less than 0.3 ng/mL) for low-risk patients (n = 13) was 60% at 5 years; for moderate-risk patients (n = 23), it was 77%, and for high-risk patients (n = 40), 48%. The corresponding percentage of patients with a PSA level less than 1.0 ng/mL at 5 years was 75%, 89%, and 76%. Sloughing occurred in 3 patients (3.9%), incontinence in 1 (1.3%), and testicular abscess in 1 (1.3%). At 3 years, 18 (47%) of 38 patients capable of unassisted intercourse at the time of cryosurgery had resumed sexual intercourse, 5 spontaneously and 13 with sildenafil or prostaglandin. CONCLUSIONS: The results of this prospective evaluation show cryosurgery to be both a safe and an effective option in the treatment of localized prostate cancer.

 

 

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