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Baust JG, Bischof JC, Jiang-Hughes S, Polascik TJ, Rukstalis DB, Gage AA, Baust JM. Re-purposing cryoablation: a combinatorial 'therapy' for the destruction of tissue. Prostate Cancer Prostatic Dis 2015; 18:87-95. [PMID: 25622539 DOI: 10.1038/pcan.2014.54] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/18/2014] [Accepted: 12/10/2014] [Indexed: 11/09/2022]
Abstract
It is now recognized that the tumor microenvironment creates a protective neo-tissue that isolates the tumor from the various defense strategies of the body. Evidence demonstrates that, with successive therapeutic attempts, cancer cells acquire resistance to individual treatment modalities. For example, exposure to cytotoxic drugs results in the survival of approximately 20-30% of the cancer cells as only dividing cells succumb to each toxic exposure. With follow-up treatments, each additional dose results in tumor-associated fibroblasts secreting surface-protective proteins, which enhance cancer cell resistance. Similar outcomes are reported following radiotherapy. These defensive strategies are indicative of evolved capabilities of cancer to assure successful tumor growth through well-established anti-tumor-protective adaptations. As such, successful cancer management requires the activation of multiple cellular 'kill switches' to prevent initiation of diverse protective adaptations. Thermal therapies are unique treatment modalities typically applied as monotherapies (without repetition) thereby denying cancer cells the opportunity to express defensive mutations. Further, the destructive mechanisms of action involved with cryoablation (CA) include both physical and molecular insults resulting in the disruption of multiple defensive strategies that are not cell cycle dependent and adds a damaging structural (physical) element. This review discusses the application and clinical outcomes of CA with an emphasis on the mechanisms of cell death induced by structural, metabolic, vascular and immune processes. The induction of diverse cell death cascades, resulting in the activation of apoptosis and necrosis, allows CA to be characterized as a combinatorial treatment modality. Our understanding of these mechanisms now supports adjunctive therapies that can augment cell death pathways.
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Affiliation(s)
- J G Baust
- 1] Institute of Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA [2] Department of Biological Sciences, Binghamton University, Binghamton, NY, USA
| | - J C Bischof
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - S Jiang-Hughes
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - T J Polascik
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - D B Rukstalis
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - A A Gage
- Department of Surgery, State University of New York at Buffalo, Medical School, Buffalo, NY, USA
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