Cryosurgery for neoplasia

Breast cryoablation for the palliative treatment of indolent subtype of multicentric triple-negative breast cancer

Breast cryoablation for palliative and curative treatment of breast cancer has been performed for decades. Although there is a recent resurgence of interest in breast cryoablation with curative intent for unifocal, hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer, this report highlights the essential role that cryoablation can play in the palliative treatment of multicentric oestrogen and progesterone receptor-negative and human epidermal growth factor receptor 2-negative (triple-negative) breast cancer, meeting the select pretreatment objectives such as breast or nipple pain relief and prevention of tumour erosion through the skin or nipple in patients who have failed or cannot tolerate the standard of care treatment.

Cryosurgery for Tumors — A Clinical Overview

Cryosurgery, a method of treating disease by the production of freezing temperatures in the tissue, is a useful technique for the treatment of tumors. When the modern era of cryosurgery began in the mid 1960's, the technique was used only for tumors easily accessible by direct observation or via endoscopy, such as those of the skin, oral cavity, and prostate gland. In general, the technique had limited usefulness in the next two decades. However, with the advent of intraoperative ultrasound as a method of monitoring the process of freezing and with the development of more effective cryosurgical apparatus, the cryosurgical treatment of tumors of the viscera and other deep tissues became practical in the 1990's. This review assesses the present day status of cryosurgery in the management of diverse tumors.

Initial combined cryotherapy and irradiation for unresectable non-small cell lung cancer. Preliminary results

In unresectable non-small cell lung cancer (NSCLC) with a patent mainstem bronchus, some studies of obstructive tumors, showed (1) a poor role for irradiation in obtaining efficient debulking and (2) an interest in preliminary laser treatment in these patients. Cryotherapy is another method to obtain debulking. Moreover, several studies showed that cryotherapy would increase the radiosensitivity of a tumor. We performed a preliminary protocol combining successively initial cryotherapy followed by irradiation in inoperable NSCLC (either for local or functional contraindications). Thirty-eight patients were included and treated first by cryotherapy performed under general anesthesia and then with external irradiation in a curative intent. The efficiency of cryotherapy assessed on bronchoscopy was found to be volume-efficient (VE) in 26 of the 38 patients and non-volume-efficient (NVE) in the other 12 patients. After irradiation in the VE group, 17 of the 26 patients had no bronchial residual tumor (NRT). In contrast, all of the patients in the NVE group had a bronchial residual tumor (RT). Survival in the VE group (median, 397 days) was significantly higher than the survival of the NVE group (median, 144 days). Survival was found to be independent of the surgical contraindication (local or functional). The best survival was associated both with the efficiency of the initial debulking (VE) by cryotherapy and with the local control (NRT) induced by the irradiation (median, 560 days). Local control was obtained in 65 percent (17/26) of the cases in the VE group and was never observed in the NVE group. In our study the VE group's local control is better than the 35 percent usually reported after irradiation alone. These results argue for the efficient potentiation of irradiation by cryotherapy.

Cryotherapy for advanced carcinoma of the trachea and bronchi

Cryotherapy was used to relieve symptoms in 75 patients suffering from advanced carcinoma of the trachea or bronchi. In all patients surgical resection, radiotherapy, or chemotherapy had been tried and been unsuccessful or had been thought to be unsuitable because of the patients' poor general condition. In cryotherapy the intraluminal tumour was frozen through a Stortz bronchoscope. Localised necrosis increased the patency of the lumen of the trachea or bronchi, resulting in relief of symptoms. Cryotherapy is effective and easily performed and causes the patient little discomfort.

Cryosurgery for the treatment of cancer

Cryosurgery is that branch of cryobiology and surgery which deals with the therapeutic application of cold at profoundly low temperatures (those below 0 degrees C) for the purpose of destroying tissues in selected target sites. The freezing process induces coagulation necrosis and is confined to the tissues within the region of the probe application and the ice ball. The degree and extent of tissue destruction depend largely on the size of the ice ball and the temperatures within it. Various types of equipment and probes are commercially available for cryosurgery, but it was only after the development of reliable, versatile cryosurgical systems cooled by liquid nitrogen that numerous applications for cryosurgery were proposed, including therapy for cancer. In the treatment of cancer, clinical success with cryosurgery has led to the more wide-spread application of this modality in selected patients. Cryosurgery has been used for readily accessible lesions in specific anatomic areas, most frequently the skin and oral cavity. It is an attractive alternative to extirpative surgery, particularly in the head and neck, where removal of large portions of the mandible or maxilla are often required to control cancer. Therefore, it is not surprising that many of the pioneering efforts in the treatment of cancer have been conducted by otorhinolaryngologists. The full theoretic potential of cryotherapy was somewhat slow to be realized because many early endeavors were directed toward palliation, especially of accessible tumors of the skin and oral cavity, after failure of tumor control by radiation or surgery or both. This limited application during the early period of evaluation reflected a naturally timorous course that was taken by those who introduced the new modality into clinical practice. This period paralleled the development of new apparatus, early clinical trials, and the assessment of the clinical potential of cryosurgery in patients with incurable cancer--those whose conditions were deemed hopeless. Today, cryosurgery is selectively applied for the treatment of patients with tumors involving structures such as bone, oropharyngeal mucosa, temporal bone, skin, brain, retina, prostate, uterine cervix, and tracheobronchial tree. Although general guidelines for the application of cryosurgery to cancer can be gleaned from various clinical reports, the optimal conditions of freezing have not been specially defined. Animal experiments are necessary to study the variables methodically and in detail. The temporal and physical conditions for cryogenic necrosis of cancer require delineation so that cell death can be predictably and consistently reproduced. This is the thrust of this paper.

Cryosurgery, and its application to oral surgery

The biological mechanisms of tissue necrosis by controlled freezing are discussed, with particular reference to their importance in cryosurgical technique. The clinical events following cryosurgery are decribed, together with common complications. As the oral mucosa is particularly amenable to this form of treatment, it has been used on a wide variety of oral lesions. From observations based on the treatment of over 300 patients, the advantages, disadvantages, relative indications and suitable variations in technique of cryosurgery are discussed.