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Gu C, Yuan H, Yang C, Xie F, Chen J, Zhu L, Jiang Y, Sun J. Transbronchial cryoablation in peripheral lung parenchyma with a novel thin cryoprobe and initial clinical testing. Thorax 2024; 79:633-643. [PMID: 38242710 PMCID: PMC11187365 DOI: 10.1136/thorax-2023-220227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 12/23/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Transbronchial cryoablation shows potential as a local therapy for inoperable peripheral lung cancer. However, its clinical application for peripheral pulmonary lesions has not been reported yet. METHODS An improved cryoprobe with an 8-mm-long, 1.9-mm-wide cryotip was used. Initially, the safety and effectiveness of this cryoprobe were assessed in an in vivo porcine model. Transbronchial cryoablation with 2 or 3 freeze-thaw cycles (10 min or 15 min in each freezing time) was performed in 18 pigs under CT monitoring. Radiological and pathological examinations were performed to evaluate the extent of cryoablation. Subsequently, nine patients with stage IA peripheral lung cancer or metastases underwent transbronchial cryoablation with this cryoprobe under the guidance of navigation bronchoscopy and cone-beam CT. Technical success, safety and outcomes were assessed. RESULTS 36 cryoablation procedures were performed successfully without any major complications in the porcine model. The extent of cryoablation increased with freezing time and the number of freeze-thaw cycles, which peaked at 24 hours and then gradually decreased. Pathological results showed a change from massive haemorrhage at 24 hours to fibrous hyperplasia with chronic inflammation after 4 weeks. In the clinical trial, 10 cryoablations were performed on 9 tumours with a technical success rate of 100%. One mild treatment-related complication occurred. Of the nine tumours, seven achieved complete ablation, while two exhibited incomplete ablation and subsequent local progression at 6 months. CONCLUSION Our initial experience indicated that transbronchial cryoablation was a safe and feasible procedure for non-surgical peripheral stage IA lung cancer or pulmonary metastases. TRIAL REGISTRATION NUMBER ChiCTR2200061544.
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Affiliation(s)
- Chuanjia Gu
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Haibin Yuan
- Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chi Yang
- Research and Development Department, AccuTarget MediPharma (Shanghai) Co., Ltd, Shanghai, China
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Fangfang Xie
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Junxiang Chen
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Lei Zhu
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yifeng Jiang
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
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2
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Chen Z, Meng L, Zhang J, Zhang X. Progress in the cryoablation and cryoimmunotherapy for tumor. Front Immunol 2023; 14:1094009. [PMID: 36761748 PMCID: PMC9907027 DOI: 10.3389/fimmu.2023.1094009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
With the rapid advancement of imaging equipment and minimally invasive technology, cryoablation technology is being used more frequently in minimally invasive treatment of tumors, primarily for patients with early tumors who voluntarily consent to ablation as well as those with advanced tumors that cannot be surgically removed or cannot be tolerated. Cryoablation is more effective and secure for target lesions than other thermal ablation methods like microwave and radiofrequency ablation (RFA). The study also discovered that cryoablation, in addition to causing tumor tissue necrosis and apoptosis, can facilitate the release of tumor-derived autoantigens into the bloodstream and activate the host immune system to elicit beneficial anti-tumor immunological responses against primary. This may result in regression of the primary tumor and distant metastasis. The additional effect called " Accompanying effects ". It is the basis of combined ablation and immunotherapy for tumor. At present, there is a lot of research on the mechanism of immune response induced by cryoablation. Trying to solve the question: how positively induce immune response. In this review, we focus on: 1. the immune effects induced by cryoablation. 2. the effect and mechanism of tumor immunotherapy combined with cryoablation. 3.The clinical research of this combination therapy in the treatment of tumors.
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Affiliation(s)
- Zenan Chen
- Department of Radiology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Liangliang Meng
- Department of Radiology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.,Department of Radiology, Chinese People's Armed Police (PAP) Force Hospital of Beijing, Beijing, China
| | - Jing Zhang
- Department of Radiology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xiao Zhang
- Department of Radiology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
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3
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Demir M, Akpolat C, Karapapak M, Sendul SY, Guven D. A double-blinded randomized clinical trial for pain perception: The efficacy and safety of topical cold saline solution anesthesia in phacoemulsification. Indian J Ophthalmol 2021; 70:124-130. [PMID: 34937223 PMCID: PMC8917576 DOI: 10.4103/ijo.ijo_876_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: To compare the efficacy and safety of cold saline solution (0.9% NaCl) with topical ophthalmic proparacaine for maintaining topical anesthesia of patients undergoing phacoemulsification surgery. Methods: The prospective, double-blinded, and randomized clinical study was randomly assigned to two groups that underwent phacoemulsification surgery due to cataracts. The cold saline group included 86 eyes of 86 patients with topical anesthesia of cold saline solution alone. The proparacaine group included 84 eyes of 84 patients with topical ophthalmic proparacaine (room temperature) anesthesia alone. The patients were scored according to a pain survey questionnaire of Visual Analog Scale (VAS) ranked between 0 and 10. The surgeon scored surgical experience by a Surgeon Questionnaire Scale (SQS) in three parameters, each of which was ranked from 1 to 3 based on questions regarding ease and comfort during the surgery. Results: The mean VAS scores were 1.29 ± 0.65 and 1.22 ± 0.66 for the cold saline and proparacaine groups, respectively (P = 0.182). The mean scores of SQS (lower values represented favorable results) were 4.11 ± 0.76 and 3.97 ± 0.74 in the cold saline and proparacaine groups, respectively (P = 0.163). Ten patients in the proparacaine group experienced corneal epitheliopathy in the postoperative period. Conclusion: As an easily accessible and cost-effective method, cold saline solution alone might be an alternative to topical ophthalmic proparacaine alone with comparable safe and effective results. The absence of allergic or toxic effects also provided a significant advantage in the cold saline application.
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Affiliation(s)
- Mehmet Demir
- Department of Ophthalmology, Sisli Hamidiye Training and Research Hospital, Istanbul, Turkey
| | - Cetin Akpolat
- Department of Ophthalmology, Sisli Hamidiye Training and Research Hospital, Istanbul, Turkey
| | - Murat Karapapak
- Department of Ophthalmology, Basaksehir Cam and Sakura City Hospital, Turkey
| | - Selam Yekta Sendul
- Department of Ophthalmology, Sisli Hamidiye Training and Research Hospital, Istanbul, Turkey
| | - Dilek Guven
- Department of Ophthalmology, Sisli Hamidiye Training and Research Hospital, Istanbul, Turkey
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4
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Debela DT, Muzazu SGY, Heraro KD, Ndalama MT, Mesele BW, Haile DC, Kitui SK, Manyazewal T. New approaches and procedures for cancer treatment: Current perspectives. SAGE Open Med 2021; 9:20503121211034366. [PMID: 34408877 PMCID: PMC8366192 DOI: 10.1177/20503121211034366] [Citation(s) in RCA: 277] [Impact Index Per Article: 92.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/05/2021] [Indexed: 01/11/2023] Open
Abstract
Cancer is a global health problem responsible for one in six deaths worldwide. Treating cancer has been a highly complex process. Conventional treatment approaches, such as surgery, chemotherapy, and radiotherapy, have been in use, while significant advances are being made in recent times, including stem cell therapy, targeted therapy, ablation therapy, nanoparticles, natural antioxidants, radionics, chemodynamic therapy, sonodynamic therapy, and ferroptosis-based therapy. Current methods in oncology focus on the development of safe and efficient cancer nanomedicines. Stem cell therapy has brought promising efficacy in regenerating and repairing diseased or damaged tissues by targeting both primary and metastatic cancer foci, and nanoparticles brought new diagnostic and therapeutic options. Targeted therapy possessed breakthrough potential inhibiting the growth and spread of specific cancer cells, causing less damage to healthy cells. Ablation therapy has emerged as a minimally invasive procedure that burns or freezes cancers without the need for open surgery. Natural antioxidants demonstrated potential tracking down free radicals and neutralizing their harmful effects thereby treating or preventing cancer. Several new technologies are currently under research in clinical trials, and some of them have already been approved. This review presented an update on recent advances and breakthroughs in cancer therapies.
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Affiliation(s)
- Dejene Tolossa Debela
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Seke GY Muzazu
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Enteric Diseases and Vaccines Research Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Kidist Digamo Heraro
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Wachemo University, Hossana, Ethiopia
| | - Maureen Tayamika Ndalama
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Betelhiem Woldemedhin Mesele
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | - Dagimawi Chilot Haile
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- University of Gondar, Gondar, Ethiopia
| | - Sophia Khalayi Kitui
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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5
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Abstract
Cryotherapy is an ablation modality relying on freeze-thaw cycles to promote cell death through intracellular ice crystal formation, ischemia, and apoptosis. Currently, 2 different cryotherapy systems are available for esophageal use. The first is cryospray ablation, which involves repetitive applications of liquid nitrogen. The second system, cryoballoon ablation, freezes the esophageal mucosa with liquid nitrous oxide using a compliant balloon. To date, studies have shown that cryotherapy is an effective and safe method for eradicating Barrett's esophagus; however, larger prospective series with longer follow-up are warranted to determine the clinical utility of cryotherapy in the treatment of Barrett's esophagus.
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6
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Yakkala C, Chiang CLL, Kandalaft L, Denys A, Duran R. Cryoablation and Immunotherapy: An Enthralling Synergy to Confront the Tumors. Front Immunol 2019; 10:2283. [PMID: 31608067 PMCID: PMC6769045 DOI: 10.3389/fimmu.2019.02283] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/10/2019] [Indexed: 12/15/2022] Open
Abstract
Treatment of solid tumors by ablation techniques has gained momentum in the recent years due to their technical simplicity and reduced morbidity as juxtaposed to surgery. Cryoablation is one of such techniques, known for its uniqueness to destroy the tumors by freezing to lethal temperatures. Freezing the tumor locally and allowing it to remain in situ unleashes an array of tumor antigens to be exposed to the immune system, paving the way for the generation of anti-tumor immune responses. However, the immune responses triggered in most cases are insufficient to eradicate the tumors with systemic spread. Therefore, combination of cryoablation and immunotherapy is a new treatment strategy currently being evaluated for its efficacy, notably in patients with metastatic disease. This article examines the mechanistic fabric of cryoablation for the generation of an effective immune response against the tumors, and various possibilities of its combination with different immunotherapies that are capable of inducing exceptional therapeutic responses. The combinatorial treatment avenues discussed in this article if explored in sufficient profundity, could reach the pinnacle of future cancer medicine.
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Affiliation(s)
- Chakradhar Yakkala
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Cheryl Lai-Lai Chiang
- Vaccine Development Laboratory, Ludwig Center for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Lana Kandalaft
- Vaccine Development Laboratory, Ludwig Center for Cancer Research, University of Lausanne, Lausanne, Switzerland.,Department of Oncology, Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Alban Denys
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Rafael Duran
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
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7
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Okajima J. Generalized solution and estimation method for cooling performance of downscaled cryoprobe. J Therm Biol 2019; 82:213-221. [PMID: 31128650 DOI: 10.1016/j.jtherbio.2019.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 10/27/2022]
Abstract
In cryosurgery, downscaling of cryoprobes is important to minimize surgical invasion. In this study, a set of analytical solutions to the freezing phenomenon around a cryoprobe in a dimensionless form is derived and the general trend is discussed to clarify the relationship between the freezing ability of a biological tissue and the cooling power of a cryoprobe. A one-dimensional axisymmetric model in the steady-state condition is considered. The relationship between the size of the frozen region, fluid temperature in the cryoprobe, and heat transfer coefficient on the wall of the cryoprobe in the dimensional form is derived under the condition mentioned above. The fluid temperature and heat transfer coefficient are eliminated from the solutions by introducing the steady-state cryoprobe surface temperature. This transformation indicates that the steady-state surface temperature directly affects the size of the frozen region and combination of fluid temperature and heat transfer coefficient occurs, which has the same cooling effect. The derived solutions are transformed into a dimensionless form using the characteristic length of bioheat transfer and normalizing the temperature distribution in an unfrozen tissue. The applicability of these analytical solutions is evaluated by comparing them with numerical simulation results from existing studies. The dimensionless solutions describe the general trend of the relationship between the frozen region and the cooling power of a cryoprobe, which is independent of the type of organ, fluid temperature, and heat transfer coefficient. Finally, the concept of freezing limit is established using the derived solutions. The freezing limit describes the minimum requirements to freeze a tissue, and it can be used as guideline to design future downscaled cryoprobes with a suitable cooling mechanism.
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Affiliation(s)
- Junnosuke Okajima
- Institute of Fluid Science, Tohoku University, 2-1-1, Katahira, Aoba-ku, Sendai, Miyagi, 980-8577, Japan.
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8
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Putra IB, Jusuf NK, Dewi NK. Utilisation of Cryolipolysis among Asians: A Review on Efficacy and Safety. Open Access Maced J Med Sci 2019; 7:1548-1554. [PMID: 31198471 PMCID: PMC6542401 DOI: 10.3889/oamjms.2019.318] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 12/21/2022] Open
Abstract
Cryolipolysis is a non-invasive fat reduction method that is capable of reducing subcutaneous fat significantly without damaging surrounding tissues, by applying cold temperature to induce adipocyte apoptosis. Most of the clinical studies in cryolipolysis were conducted in the Caucasian population, and only a few numbers in Asian, who has darker skin with Fitzpatrick skin type III to V. Higher rate of pigmentary changes were reported with the use of cryotherapy in darker skin. Therefore, this report is aimed to provide a comprehensive review regarding utilisation, efficacy and safety profiles of cryolipolysis among Asians. Currently, there are only four clinical trials conducted exclusively in an Asian population. Two studies were conducted in Korea, whereas others in China and Thailand. Cryolipolysis was performed in the abdomen, arm, inner thighs, and submental regions. The reported side effects were mild and transient, including erythema, hematoma, numbness, and pain. There were no pigmentary changes reported. Although only limited data available, those studies have proved that cryolipolysis utilisation among Asians or darker skin types provides the same efficacy and safety profiles as in Caucasians. Therefore, cryolipolysis might be proposed as the first treatment choice for Asian patients who opted to do body contouring.
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Affiliation(s)
- Imam Budi Putra
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Sumatera Utara, Medan, Indonesia
| | - Nelva Karmila Jusuf
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Sumatera Utara, Medan, Indonesia
| | - Nani Kumala Dewi
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Sumatera Utara, Medan, Indonesia
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9
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Korpan NN, Xu K, Schwarzinger P, Watanabe M, Breitenecker G, Patrick LP. Cryo-Assisted Resection En Bloc, and Cryoablation In Situ, of Primary Breast Cancer Coupled With Intraoperative Ultrasound-Guided Tracer Injection: A Preliminary Clinical Study. Technol Cancer Res Treat 2019; 17:1533034617746294. [PMID: 29347887 PMCID: PMC5784566 DOI: 10.1177/1533034617746294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of the study was to perform cryosurgery on a primary breast tumor, coupled with simultaneous peritumoral and intratumoral tracer injection of a blue dye, to evaluate lymphatic mapping. We explored the ability of our strategy to prevent tumor cells, but not that of injected tracers, to migrate to the lymphovascular drainage during conventional resection of frozen breast malignancies. Seventeen patients aged 51 (14) years (mean [standard deviation]), presenting primary breast cancer with stage I to IV, were randomly selected and treated in The Rudolfinerhaus Private Clinic in Vienna, Austria, and included in this preliminary clinical study. Under intraoperative ultrasound, 14 patients underwent curative cryo-assisted tumor resection en bloc, coupled with peritumoral tracer injection, which consisted of complete tumor freezing and concomitant peritumor injection with a blue dye, before resection and sentinel lymph node dissection (group A). Group B consists of 3 patients previously refused any standard therapy and had palliative tumor cryoablation in situ combined with intratumoral tracer injection. The intraoperative ultrasound facilitated needle positioning and dye injection timing. In group A, the frozen site extruded the dye that was distributed through the unfrozen tumor, the breast tissue, and the resection cavity for 12 patients. One to 4 lymph nodes were stained for 10 of 14 patients. The resection margin was evaluable. Our intraoperative ultrasound-guided performance revealed the injection and migration of a blue dye during the frozen resection en bloc and cryoablation in situ of primary breast tumors. Sentinel lymph node mapping, pathological determination of the tumor, and resection margins were achievable. The study paves the way for intraoperative cryo-assisted therapeutic strategies for breast cancer.
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Affiliation(s)
- Nikolai N Korpan
- 1 International Institute of Cryosurgery, The Rudolfinerhaus Private Clinic, Vienna, Austria.,2 1st Department of Surgery, National Medical University, Kyiv, Ukraine
| | - Kecheng Xu
- 2 1st Department of Surgery, National Medical University, Kyiv, Ukraine.,3 Jinan University School of Medicine, Fuda Cancer Hospital, Guangzhou, China
| | | | | | - Gerhard Breitenecker
- 6 Pathologic-Histological Central Laboratory, The Rudolfinerhaus Private Clinic, Vienna, Austria
| | - Le Pivert Patrick
- 7 Interventional Drug Delivery Systems and Strategies, Jupiter, FL, USA
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10
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He Z, Liu P, Zhang S, Yan J, Wang M, Cai Z, Wang J, Dong Y. A Freezing-Induced Turn-On Imaging Modality for Real-Time Monitoring of Cancer Cells in Cryosurgery. Angew Chem Int Ed Engl 2019; 58:3834-3837. [PMID: 30600879 DOI: 10.1002/anie.201813239] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/23/2018] [Indexed: 11/07/2022]
Abstract
Cryosurgery has attracted much attention for the treatment of tumors owing to its clear advantages. However, determining the volume of frozen tissues in real-time remains a challenge, which greatly lowers the therapeutic efficacy of cryosurgery and hinders its broad application for the treatment of cancers. Herein, we report a freezing-induced turn-on strategy for the selective real-time imaging of frozen cancer cells. As a type of aggregation-induced emission (AIE) fluorogen, TABD-Py molecules interact specifically with ice crystals and form aggregates at the ice/water interface. Consequently, bright fluorescent emission appears upon freezing. TABD-Py molecules are enriched mostly in the cancer cells and exhibit high biocompatibility as well as low cytotoxicity; therefore, a freezing-induced turn-on imaging modality for cryosurgery is developed, which will certainly maximize the therapeutic efficacy of cryosurgery in treating tumors.
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Affiliation(s)
- Zhiyuan He
- Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190, China.,School of Future Technology, University of Chinese Academy of Sciences, Beijing, 100190, China
| | - Pai Liu
- School of Materials Science and Engineering, Beijing Institute of Technology, 5 South Zhongguancun Street, Beijing, 100081, China
| | - Shizhong Zhang
- Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190, China.,School of Future Technology, University of Chinese Academy of Sciences, Beijing, 100190, China
| | - Jie Yan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing, 100081, China
| | - Mengni Wang
- School of Materials Science and Engineering, Beijing Institute of Technology, 5 South Zhongguancun Street, Beijing, 100081, China
| | - Zhengxu Cai
- School of Materials Science and Engineering, Beijing Institute of Technology, 5 South Zhongguancun Street, Beijing, 100081, China
| | - Jianjun Wang
- Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190, China.,School of Future Technology, University of Chinese Academy of Sciences, Beijing, 100190, China
| | - Yuping Dong
- School of Materials Science and Engineering, Beijing Institute of Technology, 5 South Zhongguancun Street, Beijing, 100081, China
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11
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He Z, Liu P, Zhang S, Yan J, Wang M, Cai Z, Wang J, Dong Y. A Freezing‐Induced Turn‐On Imaging Modality for Real‐Time Monitoring of Cancer Cells in Cryosurgery. Angew Chem Int Ed Engl 2019. [DOI: 10.1002/ange.201813239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Zhiyuan He
- Institute of ChemistryChinese Academy of Sciences Beijing 100190 China
- School of Future TechnologyUniversity of Chinese Academy of Sciences Beijing 100190 China
| | - Pai Liu
- School of Materials Science and EngineeringBeijing Institute of Technology 5 South Zhongguancun Street Beijing 100081 China
| | - Shizhong Zhang
- Institute of ChemistryChinese Academy of Sciences Beijing 100190 China
- School of Future TechnologyUniversity of Chinese Academy of Sciences Beijing 100190 China
| | - Jie Yan
- Center for Reproductive MedicineDepartment of Obstetrics and GynecologyPeking University Third Hospital Beijing 100081 China
| | - Mengni Wang
- School of Materials Science and EngineeringBeijing Institute of Technology 5 South Zhongguancun Street Beijing 100081 China
| | - Zhengxu Cai
- School of Materials Science and EngineeringBeijing Institute of Technology 5 South Zhongguancun Street Beijing 100081 China
| | - Jianjun Wang
- Institute of ChemistryChinese Academy of Sciences Beijing 100190 China
- School of Future TechnologyUniversity of Chinese Academy of Sciences Beijing 100190 China
| | - Yuping Dong
- School of Materials Science and EngineeringBeijing Institute of Technology 5 South Zhongguancun Street Beijing 100081 China
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12
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Lal P, Thota PN. Cryotherapy in the management of premalignant and malignant conditions of the esophagus. World J Gastroenterol 2018; 24:4862-4869. [PMID: 30487696 PMCID: PMC6250921 DOI: 10.3748/wjg.v24.i43.4862] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/13/2018] [Accepted: 10/21/2018] [Indexed: 02/06/2023] Open
Abstract
Endoscopic cryotherapy is a relatively new thermal ablative modality used for the treatment of neoplastic lesions of the esophagus. It relies on cycles of rapid cooling and thawing to induce tissue destruction with a cryogen (liquid nitrogen or carbon dioxide) leading to intra and extra-cellular damage. Surgical treatment was once considered the standard therapeutic intervention for neoplastic diseases of the esophagus and is associated with considerable rates of morbidity and mortality. Several trials that evaluated cryotherapy in Barrett’s esophagus (BE) associated neoplasia showed reasonable efficacy rates and safety profile. Cryotherapy has also found applications in the treatment of esophageal cancer, both for curative and palliative intent. Cryotherapy has also shown promising results as salvage therapy in cases refractory to radiofrequency ablation treatment. Cryoballoon focal ablation using liquid nitrogen is a novel mode of cryogen delivery which has been used for the treatment of BE with dysplasia and squamous cell carcinoma. Most common side effects of cryotherapy reported in the literature include mild chest discomfort, esophageal strictures and bleeding. In conclusion, cryotherapy is an effective and safe method for the treatment of esophageal neoplastic processes, ranging from early stages of low grade dysplasia to esophageal cancer.
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Affiliation(s)
- Pooja Lal
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Prashanthi N Thota
- Department of Gastroenterology, Digestive Disease Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, United States
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13
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Kuperavage J. Visualizing Risk: Images, Risk and Fear in a Health Campaign. THE JOURNAL OF MEDICAL HUMANITIES 2017; 38:115-132. [PMID: 25735620 DOI: 10.1007/s10912-015-9333-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This essay considers the structure of risk in health campaign formation and design by examining an early 20th century federal campaign to reduce infant mortality. Health campaigns navigate the gap between study and practice, translating quantitative findings into prescriptive responses for individual consumers of the text. By focusing specifically on the visual rhetoric of risk, this campaign serves as a case study to examine how the public was taught to see and understand risk and preventive health at a critical point in the development of public health in the United States.
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Affiliation(s)
- Jessica Kuperavage
- Department of Communication Arts and Sciences, Pennsylvania State University, University Park, PA, 16802, USA.
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14
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Magalov Z, Shitzer A, Degani D. An efficient technique for estimating the two-dimensional temperature distributions around multiple cryo-surgical probes based on combining contributions of unit circles. Comput Methods Biomech Biomed Engin 2016; 19:1462-74. [PMID: 26963943 DOI: 10.1080/10255842.2016.1154546] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study presents an efficient, fast and accurate method for estimating the two-dimensional temperature distributions around multiple cryo-surgical probes. The identical probes are inserted into the same depth and are operated simultaneously and uniformly. The first step in this method involves numerical derivation of the temporal performance data of a single probe, embedded in a semi-infinite, tissue-like medium. The results of this derivation are approximated by algebraic expressions that form the basis for computing the temperature distributions of multiple embedded probes by combining the data of a single probe. Comparison of isothermal contours derived by this method to those computed numerically for a variety of geometrical cases, up to 15 inserted probes and 2-10 min times of operation, yielded excellent results. Since this technique obviates the solution of the differential equations of multiple probes, the computational time required for a particular case is several orders of magnitude shorter than that needed for obtaining the full numerical solution. Blood perfusion and metabolic heat generation rates are demonstrated to inhibit the advancement of isothermal fronts. Application of this method will significantly shorten computational times without compromising the accuracy of the results. It may also facilitate expeditious consideration of the advantages of different modes of operation and the number of inserted probes at the early design stage.
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Affiliation(s)
- Zaur Magalov
- a Department of Mechanical Engineering , Technion, Israel Institute of Technology , Haifa , Israel
| | - Avraham Shitzer
- a Department of Mechanical Engineering , Technion, Israel Institute of Technology , Haifa , Israel
| | - David Degani
- a Department of Mechanical Engineering , Technion, Israel Institute of Technology , Haifa , Israel
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Wei WZ, Jones RF, Juhasz C, Gibson H, Veenstra J. Evolution of animal models in cancer vaccine development. Vaccine 2015; 33:7401-7407. [PMID: 26241945 DOI: 10.1016/j.vaccine.2015.07.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 07/02/2015] [Indexed: 12/29/2022]
Abstract
Advances in cancer vaccine development are facilitated by animal models reflecting key features of human cancer and its interface with host immunity. Several series of transplantable preneoplastic and neoplastic mouse mammary lesions have been used to delineate mechanisms of anti-tumor immunity. Mimicking immune tolerance to tumor-associated antigens (TAA) such as HER2/neu, transgenic mice developing spontaneous mammary tumors are strong model systems for pre-clinical vaccine testing. In these models, HER2 DNA vaccines are easily administered, well-tolerated, and induce both humoral and cellular immunity. Although engineered mouse strains have advanced cancer immunotherapy, basic shortcomings remain. For example, multiple mouse strains have to be tested to recapitulate genetic regulation of immune tolerance in humans. Outbred domestic felines more closely parallel humans in the natural development of HER2 positive breast cancer and their varying genetic background. Electrovaccination with heterologous HER2 DNA induces robust adaptive immune responses in cats. Importantly, homologous feline HER2 DNA with a single amino acid substitution elicits unique antibodies to feline mammary tumor cells, unlocking a new vaccine principle. As an alternative approach to targeted vaccination, non-surgical tumor ablation such as cryoablation induces anti-tumor immunity via in situ immunization, particularly when combined with toll-like receptor (TLR) agonist. As strategies for vaccination advance, non-invasive monitoring of host response becomes imperative. As an example, magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning following administration of tryptophan metabolism tracer [11C]-alpha-methyl-tryptophan (AMT) provides non-invasive imaging of both tumor growth and metabolic activities. Because AMT is a substrate of indoleamine-pyrrole 2,3-dioxygenase (IDO), an enzyme that produces the immune regulatory molecule kynurenine, AMT imaging can provide novel insight of host response. In conclusion, new feline models improve the predictive power of cancer immunotherapy and real-time PET imaging enables mechanistic monitoring of host immunity. Strategic utilization of these new tools will expedite cancer vaccine development.
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Affiliation(s)
- Wei-Zen Wei
- Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, United States.
| | - Richard F Jones
- Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, United States
| | - Csaba Juhasz
- Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, United States
| | - Heather Gibson
- Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, United States
| | - Jesse Veenstra
- Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, United States
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16
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van Leeuwen MCE, Bulstra AEJ, van der Veen AJ, Bloem WB, van Leeuwen PAM, Niessen FB. Comparison of two devices for the treatment of keloid scars with the use of intralesional cryotherapy: An experimental study. Cryobiology 2015; 71:146-50. [PMID: 25920961 DOI: 10.1016/j.cryobiol.2015.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/14/2015] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Intralesional (IL) cryotherapy is a new technique for the treatment of keloid scars, in which the scar is frozen from inside. Two cryodevices are available, which were recently evaluated. Both devices showed promising results, but differed in clinical outcome. To explain these differences, more understanding of the working mechanism of both devices is required. OBJECTIVE This experimental study was designed to investigate and compare the thermal behavior of an argon gas- and a liquid nitrogen-based device. Thermal behavior constitutes: (1) minimum tissue temperature (°C), (2) the freezing rate (°C/min). The thermal behavior was measured inside and on the outer surface of the scar. Both devices were tested ex vivo and in vivo. RESULTS Ex vivo, when determining the maximum freezing capacity, the argon gas device showed a higher end temperature compared to the liquid nitrogen device (argon gas: -120°C, liquid nitrogen: -140°C) and a faster freezing rate (argon gas: -1300°C/min, liquid nitrogen: -145°C/min). In vivo, measured inside the keloid, the argon gas device showed a lower end temperature than the liquid nitrogen device (argon gas: -36.4°C, liquid nitrogen: -8.1°C) and a faster freezing rate (argon gas: -14.7°C/min, liquid nitrogen: -5°C/min). The outer surface of the scar reached temperatures below -20°C with both devices as measured with the thermal camera. CONCLUSION In conclusion, the argon gas device displayed a lower end temperature and a faster freezing rate in vivo compared to the liquid nitrogen device. Although this resulted in lower recurrence rates for the argon gas device, more hypopigmentation was seen compared to the liquid nitrogen device following treatment. Finally, the low outer surface temperatures measured with both devices, suggest that some hypopigmentation following treatment is inevitable.
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Affiliation(s)
- Michiel C E van Leeuwen
- Department of Plastic and Reconstructive Surgery, VU University Medical Center, Amsterdam, The Netherlands.
| | - Anne Eva J Bulstra
- Department of Plastic and Reconstructive Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - A J van der Veen
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | - W B Bloem
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | - P A M van Leeuwen
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - F B Niessen
- Department of Plastic and Reconstructive Surgery, VU University Medical Center, Amsterdam, The Netherlands
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17
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Coelho RP, Biaggi RH, Jorge R, de Lourdes Veronese Rodrigues M, Messias A. Clinical study of pain sensation during phacoemulsification with and without cryoanalgesia. J Cataract Refract Surg 2015; 41:719-23. [DOI: 10.1016/j.jcrs.2014.06.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 06/10/2014] [Accepted: 06/11/2014] [Indexed: 11/27/2022]
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18
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Cho S, Kang SH. Current status of cryotherapy for prostate and kidney cancer. Korean J Urol 2014; 55:780-8. [PMID: 25512811 PMCID: PMC4265711 DOI: 10.4111/kju.2014.55.12.780] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 10/02/2014] [Indexed: 11/20/2022] Open
Abstract
In terms of treating diseases, minimally invasive treatment has become a key element in reducing perioperative complications. Among the various minimally invasive treatments, cryotherapy is often used in urology to treat various types of cancers, especially prostate cancer and renal cancer. In prostate cancer, the increased incidence of low-risk, localized prostate cancer has made minimally invasive treatment modalities an attractive option. Focal cryotherapy for localized unilateral disease offers the added benefit of minimal morbidities. In renal cancer, owing to the increasing utilization of cross-sectional imaging, nearly 70% of newly detected renal masses are stage T1a, making them more susceptible to minimally invasive nephron-sparing therapies including laparoscopic and robotic partial nephrectomy and ablative therapies. This article reviews the various outcomes of cryotherapy compared with other treatments and the possible uses of cryotherapy in surgery.
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Affiliation(s)
- Seok Cho
- Department of Urology, Korea University Anam Hospital, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Anam Hospital, Seoul, Korea
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19
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Abstract
Cryoablation is increasingly being used as a primary treatment for localized cancers and as a salvage therapy for metastatic cancers. Anecdotal clinical reports and animal experiments have confirmed an induction of systemic antitumor immune response by tumor cryoablation. To capitalize on the stimulatory effects of cryoablation for cancer immunotherapy, this response must be intensified using other immunomodulatory agents. This article reviews the preclinical and clinical evidence and discusses the mechanism of the antitumor immune response generated by cryoablation. The rationale and evidence behind several immunotherapy approaches that can be combined with cryoablation to devise a cryoimmunotherapeutic strategy with a potential to impact the progression of metastatic disease are described.
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Affiliation(s)
- Abhinav Sidana
- Division of Urology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Suite 2513, Cincinnati, OH 45229, USA.
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20
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Veenstra JJ, Gibson HM, Littrup PJ, Reyes JD, Cher ML, Takashima A, Wei WZ. Cryotherapy with concurrent CpG oligonucleotide treatment controls local tumor recurrence and modulates HER2/neu immunity. Cancer Res 2014; 74:5409-20. [PMID: 25092895 DOI: 10.1158/0008-5472.can-14-0501] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Percutaneous cryoablation is a minimally invasive procedure for tumor destruction, which can potentially initiate or amplify antitumor immunity through the release of tumor-associated antigens. However, clinically efficacious immunity is lacking and regional recurrences are a limiting factor relative to surgical excision. To understand the mechanism of immune activation by cryoablation, comprehensive analyses of innate immunity and HER2/neu humoral and cellular immunity following cryoablation with or without peritumoral CpG injection were conducted using two HER2/neu(+) tumor systems in wild-type (WT), neu-tolerant, and SCID mice. Cryoablation of neu(+) TUBO tumor in BALB/c mice resulted in systemic immune priming, but not in neu-tolerant BALB NeuT mice. Cryoablation of human HER2(+) D2F2/E2 tumor enabled the functionality of tumor-induced immunity, but secondary tumors were refractory to antitumor immunity if rechallenge occurred during the resolution phase of the cryoablated tumor. A step-wise increase in local recurrence was observed in WT, neu-tolerant, and SCID mice, indicating a role of adaptive immunity in controlling residual tumor foci. Importantly, local recurrences were eliminated or greatly reduced in WT, neu tolerant, and SCID mice when CpG was incorporated in the cryoablation regimen, showing significant local control by innate immunity. For long-term protection, however, adaptive immunity was required because most SCID mice eventually succumbed to local tumor recurrence even with combined cryoablation and CpG treatment. This improved understanding of the mechanisms by which cryoablation affects innate and adaptive immunity will help guide appropriate combination of therapeutic interventions to improve treatment outcomes.
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Affiliation(s)
- Jesse J Veenstra
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | | | | | | | - Michael L Cher
- Karmanos Cancer Institute, Detroit, Michigan. Department of Urologic Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Akira Takashima
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine, Toledo, Ohio
| | - Wei-Zen Wei
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan. Karmanos Cancer Institute, Detroit, Michigan.
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21
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Bozkaya S, Köklü HK, Uğar D, Hocaoğlu T, Bariş E. Simple and Effective Cryosurgical Treatment of Various Oral Lesions. EUR J INFLAMM 2014. [DOI: 10.1177/1721727x1401200208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to evaluate the efficacy of cryosurgery on 134 different benign oral lesions in 90 patients. All lesions were treated every 2 weeks until complete regression of the lesion had been achieved. Patients were examined at 2, 7, and 10 days, 2 and 4 weeks, and 3 and 6 months after the cryosurgery. The relationship between the number of cryosurgery applications to achieve complete regression and the type of lesions was assessed for statistical significance by one-way analysis of variance and with the Scheffé test. The mean application number of the cryosurgery was 1.82±0.49 for fibroma, 2.35±1.44 for vascular lesions, 1.50±0.70 for mucocele, 2.65±1.18 for lichen planus lesions. The difference between the type of the lesion and number of application was statistically significant for all groups (p< 0.05). Our data prove that a significantly fewer number of cryosurgery treatments are required to achieve complete regression for fibroma and mucocele lesions compared to lichen planus lesions. During the follow-up period, only 7 lichen planus lesions of 76 lesions recurred.
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Affiliation(s)
- S. Bozkaya
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - H.A. Kutluay Köklü
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - D. Uğar
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - T.P. Hocaoğlu
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cumhuriyet University, Sivas, Turkey
| | - E. Bariş
- Department of Oral Pathology, Faculty of Dentistry, Gazi University, Ankara, Turkey
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22
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23
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Sprenkle PC, Mirabile G, Durak E, Edelstein A, Gupta M, Hruby GW, Okhunov Z, Landman J. The Effect of Argon Gas Pressure on Ice Ball Size and Rate of Formation. J Endourol 2010; 24:1503-7. [DOI: 10.1089/end.2009.0587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Preston C. Sprenkle
- Department of Urology, Columbia University Medical Center, New York, New York
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Gabriella Mirabile
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Evren Durak
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Andrew Edelstein
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Mantu Gupta
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Gregory W. Hruby
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Zhamshid Okhunov
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Jaime Landman
- Department of Urology, Columbia University Medical Center, New York, New York
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24
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Dominique-Jean Larrey: the effects of therapeutic hypothermia and the first ambulance. Resuscitation 2009; 81:268-71. [PMID: 20036046 DOI: 10.1016/j.resuscitation.2009.11.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Revised: 10/15/2009] [Accepted: 11/05/2009] [Indexed: 11/21/2022]
Abstract
The fields of emergency medicine and resuscitation are indebted to the Baron Dominique-Jean Larrey (1766-1842) for significant advances in patient care. Larrey was a great surgeon who served in the French army during Napoleon's rule. He developed one of the first ambulance services, utilized positive pressure ventilation, and introduced hypothermia as a form of therapy. He dedicated his professional life to improving the care of wounded soldiers on the battlefield. Larrey coined the term "Triage" to allocate resources to those most in need of emergent care. Today, many of his techniques still prevail in modern medicine.
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25
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Goel R, Anderson K, Slaton J, Schmidlin F, Vercellotti G, Belcher J, Bischof JC. Adjuvant approaches to enhance cryosurgery. J Biomech Eng 2009; 131:074003. [PMID: 19640135 DOI: 10.1115/1.3156804] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Molecular adjuvants can be used to enhance the natural destructive mechanisms of freezing within tissue. This review discusses their use in the growing field of combinatorial or adjuvant enhanced cryosurgery for a variety of disease conditions. Two important motivations for adjuvant use are: (1) increased control of the local disease in the area of freezing (i.e., reduced local recurrence of disease) and (2) reduced complications due to over-freezing into adjacent tissues (i.e., reduced normal functional tissue destruction near the treatment site). This review starts with a brief overview of cryosurgical technology including probes and cryogens and major mechanisms of cellular, vascular injury and possible immunological effects due to freeze-thaw treatment in vivo. The review then focuses on adjuvants to each of these mechanisms that make the tissue more sensitive to freeze-thaw injury. Four broad classes of adjuvants are discussed including: thermophysical agents (eutectic forming salts and amino acids), chemotherapuetics, vascular agents and immunomodulators. The key issues of selection, timing, dose and delivery of these adjuvants are then elaborated. Finally, work with a particularly promising vascular adjuvant, TNF-alpha, that shows the ability to destroy all cancer within a cryosurgical iceball is highlighted.
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Affiliation(s)
- Raghav Goel
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
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26
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Sidana A, Chowdhury WH, Fuchs EJ, Rodriguez R. Cryoimmunotherapy in urologic oncology. Urology 2009; 75:1009-14. [PMID: 19758686 DOI: 10.1016/j.urology.2009.06.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 06/02/2009] [Accepted: 06/10/2009] [Indexed: 01/30/2023]
Abstract
Cryoablation is gaining acceptance as a primary treatment of localized as well as a salvage therapy of metastatic urologic malignancies. Anecdotal clinical reports suggest cryoablation can induce a systemic anti-tumor immune response; this phenomenon has been confirmed in animal models. To capitalize on this stimulatory effect of cryotherapy for control of advanced malignancies, it must be further intensified. This article reviews the existing evidence regarding cryoimmunology and discusses the mechanisms for generation of an anti-tumor immune response. Several immunotherapy approaches that can be combined with cryoablation to devise a cryoimmunotherapeutic strategy with potential to affect the progression of metastatic disease are described.
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Affiliation(s)
- Abhinav Sidana
- James Buchanan Brady Urology Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287-2101, USA
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27
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28
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Levy MY, Sidana A, Chowdhury WH, Solomon SB, Drake CG, Rodriguez R, Fuchs EJ. Cyclophosphamide unmasks an antimetastatic effect of local tumor cryoablation. J Pharmacol Exp Ther 2009; 330:596-601. [PMID: 19407102 DOI: 10.1124/jpet.109.152603] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cryoablation of a solitary tumor mass releases intact tumor antigens and can induce protective antitumor immunity but has limited efficacy in the treatment of established metastatic cancer. Cyclophosphamide (Cy), an anticancer drug, selectively depletes regulatory T cells (T(reg)s) and attenuates suppression of antitumor immunity. We used a BALB/c mouse model of metastatic colon cancer to investigate the systemic antitumor effects of in situ cryotherapy alone or in combination with 200 mg/kg i.p. Cy. When combined with Cy, cryoablation was significantly more effective than either surgical excision or cautery at inducing systemic antitumor immunity, resulting in the cure of a fraction of animals with established metastatic disease and resistance to tumor rechallenge. Lymphocytes from cured animals contained an expanded population of tumor-specific, interferon-gamma producing T cells and transferred antitumor immunity to naive recipients. Depletion of CD8(+) cells significantly impaired the adoptive transfer of antitumor immunity. Furthermore, treatment with Cy and cryoablation was associated with a significant decrease in the ratio of regulatory to effector CD4(+) T cells. The combination of tumor cryoablation and Cy induces potent, systemic antitumor immunity in animals with established metastatic disease.
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Affiliation(s)
- Moshe Yair Levy
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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29
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Affiliation(s)
- Abhinav Sidana
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Ronald Rodriguez
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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30
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Sabel MS. Cryo-immunology: a review of the literature and proposed mechanisms for stimulatory versus suppressive immune responses. Cryobiology 2008; 58:1-11. [PMID: 19007768 DOI: 10.1016/j.cryobiol.2008.10.126] [Citation(s) in RCA: 213] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 09/30/2008] [Accepted: 10/02/2008] [Indexed: 12/24/2022]
Abstract
The use of cryosurgery to ablate tumors is expanding, primarily due to its technical ease and minimal morbidity. A potential secondary advantage to the in situ freezing of malignant disease is the cryo-immunologic response, the generation of an anti-tumor immune response triggered by the natural absorption of the malignant tissue. While initially proposed based on clinical observations of distant disease regressing after cryoablation of a primary tumor, results from preclinical studies have been mixed and the existence of a cryo-immunologic response has been controversial. Recent studies have shed light on the potential mechanism by which cryoablation may modulate the immune system, also reveals that both immunostimulatory and immunosuppressive responses may be triggered. This article reviews the existing evidence regarding tumor cryo-immunology and puts forward hypotheses regarding patient, tumor and technical factors that may influence the resultant immune response and warrant further investigation.
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Affiliation(s)
- Michael S Sabel
- Division of Surgical Oncology, University of Michigan Comprehensive Cancer Center, Department of Surgery, 3304 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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31
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Korpan NN. Cryosurgery: early ultrastructural changes in liver tissue in vivo. J Surg Res 2008; 153:54-65. [PMID: 18486151 DOI: 10.1016/j.jss.2008.02.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2007] [Revised: 02/21/2008] [Accepted: 02/23/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Experimental observations with regard to freezing in vitro cell lines and fluid systems led to the application of low temperatures to in vivo biological systems. For the first time, this report describes the cryosurgical response of liver parenchyma and the early ultrastructural cellular changes in liver tissue, i.e., cryosurgery, in vivo. MATERIALS AND METHODS Forty-eight animals were used for the experiment. The dogs were divided into four groups. In group A, the liver tissue was frozen to -80 degrees C and in group B, to -180 degrees C. Temperatures of -80 degrees C and -180 degrees C in contact with liver tissue was selected for cryosurgical exposure. For transmission electron microscopy, the specimens were taken immediately and 1 h after the finishing of the freeze-thaw cycles intraoperatively. Further, the next specimens were taken in 24 h, this time also intraoperatively. RESULTS The electronic microscopic analysis showed that, after local cryodestruction at temperatures of -80 degrees C and -180 degrees C, similar processes occurred within the liver tissue in the early postcryosurgical phase-immediately and 1 h after cryosurgical session. The hepatocytes in the center of the cryozone changed upon thawing. Ultrastructural changes in the hepatic cells, where the first signs of dystrophic processes had been noticed, were increased. CONCLUSIONS Our new insights prove on the cell level that suddenly and progressively damaged liver cells in the postcryosurgical zone lead to aseptic cryoaponecrosis and then to aseptic cryoapoptosis of vital normal tissue. The vascular capillary changes and circulatory stagnation demonstrate together with cryoaponecrosis and cryoapoptosis the anti-angiogenesis mechanisms, which are some of the main mechanisms of biological tissue injury following the low temperature exposure.
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Affiliation(s)
- Nikolai N Korpan
- International Institute for Cryosurgery, Department of Surgery, Rudolfinerhaus, Vienna, Austria.
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