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Ma Y, Gao L, Tian Y, Chen P, Yang J, Zhang L. Advanced biomaterials in cell preservation: Hypothermic preservation and cryopreservation. Acta Biomater 2021; 131:97-116. [PMID: 34242810 DOI: 10.1016/j.actbio.2021.07.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 02/07/2023]
Abstract
Cell-based medicine has made great advances in clinical diagnosis and therapy for various refractory diseases, inducing a growing demand for cell preservation as support technology. However, the bottleneck problems in cell preservation include low efficiency and poor biocompatibility of traditional protectants. In this review, cell preservation technologies are categorized according to storage conditions: hypothermic preservation at 1 °C~35 °C to maintain short-term cell viability that is useful in cell diagnosis and transport, while cryopreservation at -196 °C~-80 °C to maintain long-term cell viability that provides opportunities for therapeutic cell product storage. Firstly, the background and developmental history of the protectants used in the two preservation technologies are briefly introduced. Secondly, the progress in different cellular protection mechanisms for advanced biomaterials are discussed in two preservation technologies. In hypothermic preservation, the hypothermia-induced and extracellular matrix-loss injuries to cells are comprehensively summarized, as well as the recent biomaterials dependent on regulation of cellular ATP level, stabilization of cellular membrane, balance of antioxidant defense system, and supply of mimetic ECM to prolong cell longevity are provided. In cryopreservation, cellular injuries and advanced biomaterials that can protect cells from osmotic or ice injury, and alleviate oxidative stress to allow cell survival are concluded. Last, an insight into the perspectives and challenges of this technology is provided. We envision advanced biocompatible materials for highly efficient cell preservation as critical in future developments and trends to support cell-based medicine. STATEMENT OF SIGNIFICANCE: Cell preservation technologies present a critical role in cell-based applications, and more efficient biocompatible protectants are highly required. This review categorizes cell preservation technologies into hypothermic preservation and cryopreservation according to their storage conditions, and comprehensively reviews the recently advanced biomaterials related. The background, development, and cellular protective mechanisms of these two preservation technologies are respectively introduced and summarized. Moreover, the differences, connections, individual demands of these two technologies are also provided and discussed.
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Affiliation(s)
- Yiming Ma
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Tianjin 300350, PR China; Frontier Technology Research Institute, Tianjin University, Tianjin 300350, PR China
| | - Lei Gao
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Tianjin 300350, PR China; Frontier Technology Research Institute, Tianjin University, Tianjin 300350, PR China
| | - Yunqing Tian
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Tianjin 300350, PR China; Frontier Technology Research Institute, Tianjin University, Tianjin 300350, PR China
| | - Pengguang Chen
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Tianjin 300350, PR China; Frontier Technology Research Institute, Tianjin University, Tianjin 300350, PR China
| | - Jing Yang
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Tianjin 300350, PR China; Frontier Technology Research Institute, Tianjin University, Tianjin 300350, PR China.
| | - Lei Zhang
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Tianjin 300350, PR China; Frontier Technology Research Institute, Tianjin University, Tianjin 300350, PR China.
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Fine RE, Gilmore RC, Dietz JR, Boolbol SK, Berry MP, Han LK, Kenler AS, Sabel M, Tomkovich KR, VanderWalde NA, Chen M, Columbus KS, Curcio LD, Feldman SM, Gold L, Hernandez L, Manahan ER, Seedman SA, Vaidya RP, Sevrukov AB, Aoun HD, Hicks RD, Simmons RM. Cryoablation Without Excision for Low-Risk Early-Stage Breast Cancer: 3-Year Interim Analysis of Ipsilateral Breast Tumor Recurrence in the ICE3 Trial. Ann Surg Oncol 2021; 28:5525-5534. [PMID: 34392462 DOI: 10.1245/s10434-021-10501-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/07/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The ICE3 trial is designed to evaluate the safety and efficacy of breast cryoablation, enabling women older than 60 years with low-risk early-stage breast cancers to benefit from a nonsurgical treatment and to avoid the associated surgical risks. METHODS The ICE3 trial is a prospective, multi-center, single-arm, non-randomized trial including women age 60 years or older with unifocal, ultrasound-visible invasive ductal carcinoma size 1.5 cm or smaller and classified as low to intermediate grade, hormone receptor (HR)-positive, and human epidermal growth factor receptor 2 (HER2)-negative. Ipsilateral breast tumor recurrence (IBTR) at 5 years was the primary outcome. A 3-year interim analysis of IBTR was performed, and the IBTR probability was estimated using the Kaplan-Meier method. RESULTS Full eligibility for the study was met by 194 patients, who received successful cryoablation per protocol. The mean age was 75 years (range, 55-94 years). The mean tumor length was 8.1 mm (range, 8-14.9 mm), and the mean tumor width was 7.4 mm (range, 2.8-14 mm). During a mean follow-up period of 34.83 months, the IBTR rate was 2.06% (4/194 patients). Device-related adverse events were reported as mild in 18.4% and moderate in 2.4% of the patients. No severe device-related adverse events were reported. More than 95% of the patients and 98% of the physicians reported satisfaction with the cosmetic results at the clinical follow-up evaluation. CONCLUSIONS Breast cryoablation presents a promising alternative to surgery while offering the benefits of a minimally invasive procedure with minimal risks. Further study within a clinical trial or registry is needed to confirm cryoablation as a viable alternative to surgical excision for appropriately selected low-risk patients.
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Affiliation(s)
- Richard E Fine
- Margaret West Comprehensive Breast Center, West Cancer Center and Research Institute, Germantown, TN, USA.
| | - Richard C Gilmore
- Margaret West Comprehensive Breast Center, West Cancer Center and Research Institute, Germantown, TN, USA
| | | | | | - Michael P Berry
- Margaret West Comprehensive Breast Center, West Cancer Center and Research Institute, Germantown, TN, USA
| | | | | | - Michael Sabel
- The University of Michigan Health System, Ann Arbor, MI, USA
| | | | - Noam A VanderWalde
- Margaret West Comprehensive Breast Center, West Cancer Center and Research Institute, Germantown, TN, USA
| | - Margaret Chen
- Columbia University Medical Center, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Rache M Simmons
- Weill Cornell Weill Medical College, Cornell University, New York, NY, USA
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Lugnani F, Zhao JG. Translation of Cryobiological Techniques to Socially Economically Deprived Populations—Part 2: Cryosurgery. J Med Device 2020. [DOI: 10.1115/1.4045836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AbstractCold and cryogenic temperatures are used for treating cancer and other pathological conditions in various fields of medicine. Cryosurgery, which resides at the interface of medicine and engineering, has attracted the interest of engineers, scientists, and medical doctors. Recently, particularly since the end of the 1980s, technological developments in cryotherapy equipment and enormous advances in imaging techniques, such as computed tomography and ultrasonography, have allowed surgeons and interventional radiologists to precisely guide cryogenic probes into tumors while avoiding damage to surrounding tissues. Extensive studies have allowed us to conclude that the use of cryogenics facilitates the successful treatment of solid tumors in various organs such as lung, liver, bones, kidneys, prostate, etc. Its simplicity of use, effectiveness, low cost, and limited demand on hospital infrastructure and personnel have made cryosurgery particularly suitable for the treatment of patients of socio-economically deprived populations.
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Affiliation(s)
- Franco Lugnani
- Hippocrates Doo, Brezec pri Divaci 9a, Divaca 6215, Slovenia
| | - John Guojiang Zhao
- Asia-Pacific Institute for Biomedical Research, 28 Connaught Road West, Hong Kong, China
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Abstract
OBJECTIVE Imaging plays a key role in the assessment of patients before, during, and after percutaneous cryoablation of hepatic tumors. Intra-procedural and early post-procedure imaging with CT and MRI is vital to the assessment of technical success including adequacy of ablation zone coverage. Recognition of the normal expected post-procedure findings of hepatic cryoablation such as ice ball formation, hydrodissection, and the normal appearance of the ablation zone is crucial to be able to differentiate from complications including vascular, biliary, or non-target organ injury. Delayed imaging is essential for determination of clinical effectiveness and detection of unexpected findings such as residual unablated tumor and local tumor progression. The purpose of this article is to review the spectrum of expected and unexpected imaging findings that may occur during or after percutaneous cryoablation of hepatic tumors. CONCLUSION Differentiating expected from unexpected findings during and after hepatic cryoablation helps radiologists identify residual or recurrent tumor and detect procedure-related complications.
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Goltsev AM, Bondarovych MO, Babenko NM, Gaevska YO, Dubrava TG, Ostankov MV. Effect of different cryopreservation regimens on Ehrlich carcinoma growth. Cell Tissue Bank 2019; 20:411-421. [DOI: 10.1007/s10561-019-09780-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/20/2019] [Indexed: 12/20/2022]
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Belozerov AG, Berezovsky YM, Zherdev AA, Korolev IA, Pushkarev AV, Agafonkina IV, Tsiganov DI. A Study of the Thermophysical Properties of Human Prostate Tumor Tissues in the Temperature Range from–160 to +40°C. Biophysics (Nagoya-shi) 2018. [DOI: 10.1134/s0006350918020057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Bloom JB, Gold SA, Hale GR, Rayn KN, Sabarwal VK, Bakhutashvili I, Valera V, Turkbey B, Pinto PA, Wood BJ. "Super-active surveillance": MRI ultrasound fusion biopsy and ablation for less invasive management of prostate cancer. Gland Surg 2018; 7:166-187. [PMID: 29770311 DOI: 10.21037/gs.2018.03.06] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Multiparametric magnetic resonance imaging (mpMRI) of the prostate has allowed clinicians to better visualize and target suspicious lesions during biopsy. Targeted prostate biopsies give a more accurate representation of the true cancer volume and stage so that appropriate treatment or active surveillance can be selected. Advances in technology have led to the development of MRI and ultrasound fusion platforms used for targeted biopsies, monitoring cancer progression, and more recently for the application of focal therapy. Lesions visualized on mpMRI can be targeted for ablation with a variety of energy sources employed under both local and general anesthesia. Focal ablation may offer an alternative option for treating prostate cancer as compared to the well-established interventions of whole-gland radiation or prostatectomy. Focal ablation may also be an option for patients on active surveillance who wish to be even more "active" in their surveillance. In this review, we describe the advancements and development of fusion biopsies, the rationale behind focal therapy, and introduce focal ablative techniques for indolent prostate cancers ("super-active surveillance"), including cryoablation and focal laser ablation (FLA) and the subsequent MRI/biopsy surveillance.
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Affiliation(s)
- Jonathan B Bloom
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Samuel A Gold
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Graham R Hale
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Kareem N Rayn
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Vikram K Sabarwal
- Department of Urology, George Washington University, Washington, DC, USA
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, National Cancer Institute, Bethesda, MD, USA
| | - Vladimir Valera
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, Bethesda, MD, USA
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Martin JW, Patel RM, Okhunov Z, Vyas A, Vajgrt D, Clayman RV. Multipoint Thermal Sensors Associated with Improved Oncologic Outcomes Following Cryoablation. J Endourol 2017; 31:355-360. [PMID: 28114787 DOI: 10.1089/end.2016.0864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Cryoablation (CA) is a minimally invasive modality for the management of small renal cortical neoplasms (RCN). Effective ablation is dependent on achieving target temperatures during CA that result in tumor cell death. We investigated long-term oncologic outcomes following CA using multipoint thermal sensors (MTS), which allow precise temperature determination at four points along the needle. METHODS We performed a retrospective review of 20 patients with <4 cm RCN who underwent de novo CA from 2005 to 2009. In 11 procedures, MTS needles were deployed with the goal of obtaining -20°C at the tumor margin, while 9 were done without MTS. Patient demographics, tumor characteristics, and CA procedure data were retrieved and analyzed. Follow-up CT or MRI was used to assess recurrence status. RESULTS With a mean follow-up of 45 months, none of the 11 patients experienced a recurrence in the MTS group, compared with 4 of 9 (44.4%) patients in the non-MTS group (p = 0.026). Of the biopsy-confirmed renal cancers, none of the 6 in the MTS group, compared with 3 of 6 (50%) in the non-MTS group, recurred (p = 0.182). Age, tumor size, surgical approach, tumor histopathology, grade, follow-up time, and skin-to-tumor distance were similar between the MTS and non-MTS groups. The MTS group was also associated with increased total length of freeze (p = 0.041), procedure time (p = 0.020), cryoprobe utilization (p = 0.049), and a greater ratio of cryoprobes used per cm diameter of tumor (p = 0.003). CONCLUSIONS In this small renal mass pilot study, the use of MTS needles to monitor temperature and guide cryoneedle deployment was associated with improved oncologic outcomes.
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Affiliation(s)
- Jeremy W Martin
- 1 Department of Urology, University of California , Irvine, Irvine, California
| | - Roshan M Patel
- 1 Department of Urology, University of California , Irvine, Irvine, California
| | - Zhamshid Okhunov
- 1 Department of Urology, University of California , Irvine, Irvine, California
| | - Aashay Vyas
- 1 Department of Urology, University of California , Irvine, Irvine, California
| | - Duane Vajgrt
- 2 Department of Radiology, University of California , Irvine, Irvine, California
| | - Ralph V Clayman
- 1 Department of Urology, University of California , Irvine, Irvine, California
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Parsi MA, Trindade AJ, Bhutani MS, Melson J, Navaneethan U, Thosani N, Trikudanathan G, Watson RR, Maple JT. Cryotherapy in gastrointestinal endoscopy. VideoGIE 2017; 2:89-95. [PMID: 29905303 PMCID: PMC5991494 DOI: 10.1016/j.vgie.2017.01.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Key Words
- AVM, arteriovenous malformation
- BE, Barrett’s esophagus
- CE-D, complete elimination of dysplasia
- CE-IM, complete elimination of intestinal metaplasia
- CPT, Current Procedural Terminology
- GAVE, gastric antral vascular ectasia
- HGD, high-grade dysplasia
- RFA, radiofrequency ablation
- RP, radiation proctopathy
- RVU, relative value unit
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Overduin CG, Fütterer JJ, Scheenen TW. 3D MR thermometry of frozen tissue: Feasibility and accuracy during cryoablation at 3T. J Magn Reson Imaging 2016; 44:1572-1579. [DOI: 10.1002/jmri.25301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/21/2016] [Accepted: 04/21/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Christiaan G. Overduin
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen the Netherlands
| | - Jurgen J. Fütterer
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen the Netherlands
- MIRA Institute for Biomedical Engineering and Technical Medicine; University of Twente; Enschede the Netherlands
| | - Tom W.J. Scheenen
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen the Netherlands
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Kasuya A, Ohta I, Tokura Y. Structural and immunological effects of skin cryoablation in a mouse model. PLoS One 2015; 10:e0123906. [PMID: 25821968 PMCID: PMC4379110 DOI: 10.1371/journal.pone.0123906] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 02/27/2015] [Indexed: 11/18/2022] Open
Abstract
Cryoablation is therapeutically applied for various disorders in several organs, and skin diseases are typical targets as this cryotherapy has been widely used for viral warts, benign tumors, and actinic keratosis. The main mechanisms of cryoablation consist of direct freezing effect on skin constituents, thrombosis formation in microcirculation, and subsequent immunological responses. Among them, however, the immunological mechanism remains unelucidated, and it is an issue how the direct freezing injury induces immunological consequences. We established a mouse cryoablation model with liquid nitrogen applied to the shaved back skin, and used this system to study the immunological excitement. After application of liquid nitrogen, the thermal decrease ratio was -25°C/sec or less and the lowest temperature was less than -100°C, which was sufficient to induce ulceration. Destruction of cornified layer and necrosis of epidermal cells were observed in transmission electron microscopy image, and increased transepidermal water loss and skin permeability were detected by the functional measurements. By flow cytometry, antigen-presenting dendritic cells (DCs), including PDCA1+B220+CD19- plasmacytoid DCs (pDCs) and CD11c+ myeloid DCs, as well as neutrophils and macrophages were increased in subcutaneous tissue. In parallel, the mRNA expressions of interferon α1 which are known as pDC-producing cytokines, was elevated. We also found marked degranulation of mast cells, providing a possibility that released histamine attracts pDCs. Finally, FITC migration assay revealed that pDCs and CD11c+ DCs emigrated from the cryoablated skin to the draining lymph nodes. Our study suggests that cryoablation induces destruction of the barrier/epidermis, accumulation of pDCs and CD11c+ DCs to the skin, and migration of DCs to regional lymph nodes. Viral elements or tumor cell lysates released from damaged keratinocytes may stimulate the DCs, thereby leading to antiviral or antitumor effect.
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Affiliation(s)
- Akira Kasuya
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Isao Ohta
- Ultrastructural Morphology Laboratory, Research Equipment Centre, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshiki Tokura
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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de Freitas RMC, Andrade CS, Caldas JGMP, Tsunemi MH, Ferreira LB, Arana-Chavez VE, Cury PM. Image-Guided Cryoablation of the Spine in a Swine Model: Clinical, Radiological, and Pathological Findings with Light and Electron Microscopy. Cardiovasc Intervent Radiol 2015; 38:1261-70. [DOI: 10.1007/s00270-014-1043-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/30/2014] [Indexed: 01/23/2023]
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Onik G, Barrie K, Miessau M, Bostwick D, Vaughan D, Brady J, Budd W. Long-Term Results of Optimized Focal Therapy for Prostate Cancer: Average 10-Year Follow-Up in 70 Patients. JOURNAL OF MEN'S HEALTH 2014. [DOI: 10.1089/jomh.2014.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rodríguez SA, Arias Fúnez F, Bueno Bravo C, Rodríguez-Patrón Rodríguez R, Sanz Mayayo E, Palacios VH, Burgos Revilla FJ. Cryotherapy for primary treatment of prostate cancer: intermediate term results of a prospective study from a single institution. Prostate Cancer 2014; 2014:571576. [PMID: 24693437 PMCID: PMC3945790 DOI: 10.1155/2014/571576] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/12/2013] [Accepted: 12/26/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose. Published data about cryotherapy for prostate cancer (PC) treatment are based on case series with a lack of clinical trials and the inexistence of a validated definition of biochemical failure. A prospective study with standardized followup protocol was conducted in our institution. Material and Methods. Prospective study of a series of cases including 108 patients diagnosed with localized PC at clinical stage T1c-T2c treated by primary cryoablation and median followup of 61 months. Criteria of biochemical recurrence were unified according to the American Society for Therapeutic Radiology and Oncology (ASTRO). End points were biochemical progression-free survival (BPFS), cancer-specific survival, and overall survival. Rate of complications was reported. Results. The BPFS for low-, medium-, and high-risk patients was 96.4%, 91.2%, and 62.2%, respectively. Cancer-specific survival was 98.1%. Overall survival reached 94.4%. Complications included incontinence in 5.6%, urinary tract obstruction in 1.9%, urethral sloughing in 5.6%, haematuria in 1.9%, perineal pain in 11.1%, and prostatorectal fistula in 0.9%. Erectile disfunction was found in 98.1%. Conclusions. Cryotherapy is an effective and minimally invasive treatment for primary PC in well-selected cases, with low surgical risk and good results in terms of BPFS, cancer-specific survival, and overall survival.
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Affiliation(s)
- S. Alvarez Rodríguez
- Urology Department, Ramón y Cajal Hospital, University of Alcalá de Henares, Colmenar km 9,100, 28034 Madrid, Spain
| | - F. Arias Fúnez
- Urology Department, Ramón y Cajal Hospital, University of Alcalá de Henares, Colmenar km 9,100, 28034 Madrid, Spain
| | - C. Bueno Bravo
- Urology Department, Ramón y Cajal Hospital, University of Alcalá de Henares, Colmenar km 9,100, 28034 Madrid, Spain
| | | | - E. Sanz Mayayo
- Urology Department, Ramón y Cajal Hospital, University of Alcalá de Henares, Colmenar km 9,100, 28034 Madrid, Spain
| | - V. Hevia Palacios
- Urology Department, Ramón y Cajal Hospital, University of Alcalá de Henares, Colmenar km 9,100, 28034 Madrid, Spain
| | - F. J. Burgos Revilla
- Urology Department, Ramón y Cajal Hospital, University of Alcalá de Henares, Colmenar km 9,100, 28034 Madrid, Spain
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Hashimoto K, Izumi Y, Yamauchi Y, Yashiro H, Inoue M, Nakatsuka S, Nomori H. Prediction of the critical thermal zone during pulmonary cryoablation on computed tomography from correlated experimental and clinical findings. J Thorac Cardiovasc Surg 2013; 145:832-8. [DOI: 10.1016/j.jtcvs.2012.03.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 03/04/2012] [Accepted: 03/16/2012] [Indexed: 11/30/2022]
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Baumunk D, Blana A, Ganzer R, Henkel T, Köllermann J, Roosen A, Machtens S, Salomon G, Sentker L, Witzsch U, Köhrmann K, Schostak M. Fokale Therapie des Prostatakarzinoms. Urologe A 2012; 52:549-56. [DOI: 10.1007/s00120-012-3002-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Daniels CS, Rubinsky B. Cryosurgery with pulsed electric fields. PLoS One 2011; 6:e26219. [PMID: 22087224 PMCID: PMC3210118 DOI: 10.1371/journal.pone.0026219] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 09/22/2011] [Indexed: 01/04/2023] Open
Abstract
This study explores the hypothesis that combining the minimally invasive surgical techniques of cryosurgery and pulsed electric fields will eliminate some of the major disadvantages of these techniques while retaining their advantages. Cryosurgery, tissue ablation by freezing, is a well-established minimally invasive surgical technique. One disadvantage of cryosurgery concerns the mechanism of cell death; cells at high subzero temperature on the outer rim of the frozen lesion can survive. Pulsed electric fields (PEF) are another minimally invasive surgical technique in which high strength and very rapid electric pulses are delivered across cells to permeabilize the cell membrane for applications such as gene delivery, electrochemotherapy and irreversible electroporation. The very short time scale of the electric pulses is disadvantageous because it does not facilitate real time control over the procedure. We hypothesize that applying the electric pulses during the cryosurgical procedure in such a way that the electric field vector is parallel to the heat flux vector will have the effect of confining the electric fields to the frozen/cold region of tissue, thereby ablating the cells that survive freezing while facilitating controlled use of the PEF in the cold confined region. A finite element analysis of the electric field and heat conduction equations during simultaneous tissue treatment with cryosurgery and PEF (cryosurgery/PEF) was used to study the effect of tissue freezing on electric fields. The study yielded motivating results. Because of decreased electrical conductivity in the frozen/cooled tissue, it experienced temperature induced magnified electric fields in comparison to PEF delivered to the unfrozen tissue control. This suggests that freezing/cooling confines and magnifies the electric fields to those regions; a targeting capability unattainable in traditional PEF. This analysis shows how temperature induced magnified and focused PEFs could be used to ablate cells in the high subzero freezing region of a cryosurgical lesion.
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Affiliation(s)
- Charlotte S Daniels
- Department of Mechanical Engineering, University of California, Berkeley, Berkeley, California, United States of America.
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Yang G, Zhang A, Xu LX. Intracellular ice formation and growth in MCF-7 cancer cells. Cryobiology 2011; 63:38-45. [PMID: 21536022 DOI: 10.1016/j.cryobiol.2011.04.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Revised: 03/15/2011] [Accepted: 04/13/2011] [Indexed: 12/11/2022]
Affiliation(s)
- Geer Yang
- School of Biomedical Engineering, Shanghai Jiao Tong University, PR China
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Preciado JA, Rubinsky B. Isochoric preservation: A novel characterization method. Cryobiology 2010; 60:23-9. [DOI: 10.1016/j.cryobiol.2009.06.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 06/18/2009] [Accepted: 06/19/2009] [Indexed: 11/16/2022]
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22
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Jankun M, Kelly TJ, Zaim A, Young K, Keck RW, Selman SH, Jankun J. Computer Model for Cryosurgery of the Prostate. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10929089909148173] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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23
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Hieronymi S, Witzsch U. Cryoablation for prostate cancer: an overview about background, procedure and nurses' responsibilities. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2009. [DOI: 10.1111/j.1749-771x.2009.01084.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Abstract
The European Association of Urology guidelines on prostate cancer state that cryotherapy is a true therapeutic alternative for patients with clinically localized prostate cancer. The aim of this paper is to establish a uniform practice for performing prostate cryoablation. A collaboration has been set up among five European centres with experience in almost 1000 prostate cancer patients on the use of cryotherapy. The present recommendations were developed through sharing of experience and thorough discussions within the group. This first paper from the group establishes the technical recommendations for use of prostate cryotherapy.
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25
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Josan S, Bouley DM, van den Bosch M, Daniel BL, Butts Pauly K. MRI-guided cryoablation: In vivo assessment of focal canine prostate cryolesions. J Magn Reson Imaging 2009; 30:169-76. [PMID: 19557805 DOI: 10.1002/jmri.21827] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To analyze the appearance of acute and chronic canine prostate cryolesions on T1-weighted (T1w) and T2-weighted (T2w) magnetic resonance imaging (MRI) and compare them with contrast-enhanced (CE) MRI and histology for a variety of freezing protocols. MATERIALS AND METHODS Three different freezing protocols were used in canine prostate cryoablation experiments. Six acute and seven chronic (survival times ranging between 4-53 days) experiments were performed. The change in T2w signal intensity was correlated with freezing protocol parameters. The lesion area on T2w MRI was compared to CE-MRI. Histopathologic evaluation of the cryolesions was performed and visually compared to the appearance on MRI. RESULTS The T2w signal increased from pre- to postfreeze at the site of the cryolesion, and the enhancement was higher for smaller freeze area and duration. The T2w lesion area was between the CE nonperfused area and the hyperenhancing CE rim. The appearance of the lesion on T1w and T2w imaging over time correlated with outcome on pathology. CONCLUSION T1w and T2w MRI can potentially be used to assess cryolesions and to monitor tissue response over time following cryoablation.
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Affiliation(s)
- Sonal Josan
- Department of Electrical Engineering, Stanford University, Stanford, California, USA.
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26
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Onik G, Narayan P, Brunelle R, Vaughn D, Dineen M, Brown T. Saline Injection into Denonvillier's Fascia during Prostate Cryosurgery. MINIM INVASIV THER 2009. [DOI: 10.3109/13645700009093718] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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27
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Abstract
Both benign and malignant conditions affecting prostate gland are very common in elderly men. However, the conventional treatment of these conditions can be associated with significant side effects and complications, and less invasive treatment alternative has been always searched for. Because of the anatomical location and easy accessibility of prostate, many newer treatment modalities using thermal ablation have been applied to the organ. These include not only heating of the pathological tissue but also freezing. Some of such treatment techniques have shown to be effective and safe and been clinically used widely. In this review article, various tissue ablation techniques using temperature change applied to prostate gland are covered. Each procedure's advantages and disadvantages are compared and discussed.
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Affiliation(s)
- K Shinohara
- Department of Urology, University of California, 1600 Divisadero St. A634, San Francisco, CA 94143-1695, USA.
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28
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[Cryoablation of localized prostate cancer. Current state]. Urologe A 2009; 48:719-28. [PMID: 19547948 DOI: 10.1007/s00120-009-1985-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Due to continuous technical developments for more than half a century followed by better clinical results with minimal side effects, cryoablation of the prostate for localized prostate cancer has evolved as a true alternative therapeutic option in selected cases. The current version of cryoablation has almost nothing in common with those versions established in the 1960s and 1970s and further developed in the 1980s and 1990s. The present version is minimally invasive and has a high efficacy for treatment of high risk carcinomas and failure of other therapeutic modalities. Cryoablation of the prostate is indicated if there are absolute or relative contraindications for radical surgery. In salvage cases cryoablation is the therapy of choice for localized prostate cancer. Standardization of the procedure, definition of freeze-thaw cycles and structured training programs have led to this status.
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29
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MR imaging-guided percutaneous cryoablation of the prostate in an animal model: in vivo imaging of cryoablation-induced tissue necrosis with immediate histopathologic correlation. J Vasc Interv Radiol 2008; 20:252-8. [PMID: 19091600 DOI: 10.1016/j.jvir.2008.10.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 10/23/2008] [Accepted: 10/23/2008] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the feasibility of magnetic resonance (MR) imaging-guided percutaneous cryoablation of normal canine prostates and to identify MR imaging features that accurately predict the area of tissue damage at a microscopic level. MATERIALS AND METHODS Six adult male mixed-breed dogs were anesthetized, intubated, and placed in a 0.5-T open MR imaging system. A receive-only endorectal coil was placed, and prostate location and depth were determined on T1-weighted fast spin-echo (FSE) MR imaging. After placement of cryoprobes and temperature sensors, three freezing protocols were used to ablate prostate tissue. Ice ball formation was monitored with T1-weighted FSE imaging. Tissue necrosis area was assessed with contrast-enhanced weighted MR imaging and compared with histopathologic findings. RESULTS A total of 12 cryolesions (mean size, 1.2 cm) were bilaterally created in six prostates. Ice ball formation was oval and signal-free on T1-weighted FSE sequences in all cases. Postprocedural contrast-enhanced MR imaging typically showed a nonenhancing area of low signal intensity centrally located within the frozen area, surrounded by a bright enhancing rim in all cases. On histopathologic examination, two distinct zones were identified within cryolesions. Centrally, a necrotic zone with complete cellular destruction and hemorrhage was found. Between this necrotic zone and normal glandular tissue, a zone of fragmented and intact glands, interstitial edema, and rare acute inflammatory cells was seen. Correlation between nonenhancement on contrast-enhanced weighted MR images and tissue necrosis on pathologic examination was consistent within all six dogs. CONCLUSIONS MR imaging-guided cryoablation of the prostate is technically feasible. The nonenhancing area on postablation contrast-enhanced weighted MR imaging accurately predicts the area of cryoablation-induced tissue necrosis on pathologic analysis.
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30
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Gonzalgo ML, Patil N, Su LM, Patel VR. Minimally invasive surgical approaches and management of prostate cancer. Urol Clin North Am 2008; 35:489-504, ix. [PMID: 18761202 DOI: 10.1016/j.ucl.2008.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
For clinically localized prostate cancer, radical prostatectomy remains the "gold standard" treatment. New forms of minimally invasive therapies are sought out by patients, however, because of the potential morbidity associated with open surgery. With quality-of-life aspects influencing patient decision making, minimally invasive therapeutic modalities have generated great interest among patients. Laparoscopic radical prostatectomy, robotic-assisted laparoscopic prostatectomy, brachytherapy, cryotherapy, and high-intensity focused ultrasound are all considered to be minimally invasive treatment options for the management of clinically localized prostate cancer.
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Affiliation(s)
- Mark L Gonzalgo
- Department of Urology, James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Marburg 145, Baltimore, MD 21287, USA
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31
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32
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33
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Ismail M, Hardev P, Davies J. Salvage cryotherapy for recurrent prostate cancer after radiation failure: current status and future perspectives. ACTA ACUST UNITED AC 2008. [DOI: 10.2217/14750708.5.1.37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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34
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35
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Pontones Moreno JL, Morera Martínez JF, Vera Donoso CD, Jiménez Cruz JF. [Cryosurgery in the management of prostate cancer]. Actas Urol Esp 2007; 31:211-32. [PMID: 17658150 DOI: 10.1016/s0210-4806(07)73627-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article reviews the current status of the prostatic cryosurgery in the management of patients with prostate cancer. Recent advances in cryoablative technology have allowed to treat these patients successfully with decreased morbidity. Using transrectal high-resolution ultrasound imaging, prostate cryotherapy is delivered with multiple ultrathin (17-gauge) cryo-needles, via percutaneous transperineal approach. The extent of freezing can be precisely controlled and monitored with thermic devices, tissue destruction is monitored with real-time visualization of the prostate and surrounding structures, and urethral warming is used to avoid urethral sloughing. However, the results with the second and third-generation cryosurgical equipment will have to be confirmed by means of prospective and randomized trials, because up to now we only have data based on retrospective analyses, which are very heterogeneous. The ability of prostate-specific antigen (PSA) to predict long-term outcome after cryotherapy for localized prostate cancer is not well known because experience with this treatment modality is still limited; however, it seems that a PSA value of 0.5 ng/ml or less after 6 months or longer after cryotherapy would be associated with a high probability (greater than 95%) of negative post-treatment biopsy. Cryosurgery could also be an option of treatment for men with recurrent local disease who have undergone radiotherapy or radical prostatectomy. We have to keep in mind possible complications (incontinence, impotency, urethrorectal fistula or bladder outlet obstruction. The favorable side effect profile and preliminary oncologic and funtional results could suggest that cryosurgery will have a role in the minimally invasive management of selected patients with prostate cancer.
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36
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Gage AA, Baust JG. Cryosurgery for tumors. J Am Coll Surg 2007; 205:342-56. [PMID: 17660083 DOI: 10.1016/j.jamcollsurg.2007.03.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 03/07/2007] [Indexed: 02/02/2023]
Affiliation(s)
- Andrew A Gage
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY, USA
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37
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Onik G. Percutaneous Image-Guided Prostate Cancer Treatment: Cryoablation as a Successful Example. Tech Vasc Interv Radiol 2007; 10:149-58. [DOI: 10.1053/j.tvir.2007.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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38
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Ross PL, Meng MV, Kane CJ. Laparoscopic approaches to renal malignancies. Curr Probl Cancer 2006; 30:168-93. [PMID: 16860165 DOI: 10.1016/j.currproblcancer.2006.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Philip L Ross
- Department of Urology, The UCSF Comprehensive Cancer Center Urology Section, University of California-San Francisco, San Francisco, CA, USA
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39
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Ho SSC. Cryosurgery for prostate cancer: How I do it. SURGICAL PRACTICE 2006. [DOI: 10.1111/j.1744-1633.2006.00296.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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40
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Devireddy RV, Smith DJ, Bischof JC. Mass transfer during freezing in rat prostate tumor tissue. AIChE J 2006. [DOI: 10.1002/aic.690450321] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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41
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Har-Shai Y, Sabo E, Rohde E, Hyams M, Assaf C, Zouboulis CC. Intralesional cryosurgery enhances the involution of recalcitrant auricular keloids: a new clinical approach supported by experimental studies. Wound Repair Regen 2006. [DOI: 10.1111/j.1524-475x.2005.00084.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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42
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Han B, Grassl ED, Barocas VH, Coad JE, Bischof JC. A Cryoinjury Model Using Engineered Tissue Equivalents for Cryosurgical Applications. Ann Biomed Eng 2005; 33:972-82. [PMID: 16060538 DOI: 10.1007/s10439-005-3478-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cryosurgery is emerging as a promising treatment modality for various cancers, but there are still challenges to be addressed to improve its efficacy. Two primary challenges are determining thermal injury thresholds for various types of cell/tissue, and understanding of the mechanisms of freezing induced cell/tissue injury within a cryolesion. To address these challenges, various model systems ranging from cell suspensions to three-dimensional in vivo tissues have been developed and used. However, these models are either oversimplifications of in vivo tissues or difficult to control and extract precise experimental conditions from. Therefore, a more readily controllable model system with tissue-like characteristics is needed. In this study, a cryoinjury model was developed using tissue engineering technology, and the capabilities of the model were demonstrated. Engineered tissue equivalents (TEs) were constructed by seeding and culturing cells in a type I collagen matrix. Two different cell lines were used in this study, AT-1 rat prostate tumor cells and LNCaP human prostate cancer cells. The constructed TEs underwent a freeze/thaw cycle imitating in vivo cryosurgery. Thermal conditions within TEs during freeze/thaw cycles were characterized, and the responses of TEs to these thermal conditions including freezing induced cellular injury and extracellular matrix damage were investigated at three different time points. The results illustrate the feasibility to establish thermal thresholds of cryoinjury for different cell/tissue types using the presently developed model, and its potential capabilities to study cell death mechanisms, cell proliferation or migration, and extracellular matrix structural damage after a freeze/thaw cycle.
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Affiliation(s)
- Bumsoo Han
- Department of Mechanical Engineering, University of Minnesota, 111 Church Street SE, Minneapolis, MN 55455, USA
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43
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Merrick GS, Wallner KE, Butler WM. Prostate cryotherapy: More questions than answers. Urology 2005; 66:9-15. [PMID: 15992870 DOI: 10.1016/j.urology.2004.12.039] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Revised: 11/22/2004] [Accepted: 12/15/2004] [Indexed: 11/28/2022]
Affiliation(s)
- Gregory S Merrick
- Schiffler Cancer Center, Wheeling Hospital, Wheeling, West Virginia 26003-6300, USA.
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44
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Rubinsky B, Perez PA, Carlson ME. The thermodynamic principles of isochoric cryopreservation. Cryobiology 2005; 50:121-38. [PMID: 15843002 DOI: 10.1016/j.cryobiol.2004.12.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2004] [Revised: 10/11/2004] [Accepted: 12/13/2004] [Indexed: 11/30/2022]
Abstract
The goal of this study is to introduce the fundamental thermodynamic principles of isochoric (constant volume) cryopreservation for low temperature preservation of biological materials. Traditionally, cryopreservation is performed in an isobaric process (constant pressure) at 1 atm, because this is our natural environment and it is most convenient experimentally. More than half a century of studies on cryopreservation shows that the major mechanism of damage during isobaric cryopreservation is the increase in intracellular ionic concentration during freezing, which presumably causes chemical damage to the components of cells. Cryoprotectants as well as hyperbaric pressures have been developed as methods to reduce the extent of chemical damage during freezing. The theoretical studies in this paper show that in isochoric cryopreservation, the increase in solution concentration during freezing is lower at each temperature by almost an order of magnitude from that in isobaric cryopreservation. This suggests that isochoric cryopreservation could be a preferential alternative to isobaric cryopreservation. The technology for isochoric cryopreservation is very simple; freezing in a constant volume chamber. Using a simple isochoric cryopreservation device, we confirm the theoretical thermodynamic predictions.
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Affiliation(s)
- Boris Rubinsky
- Department of Mechanical Engineering, University of California at Berkeley, Berkeley, CA 94720, USA.
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45
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Richter S, Pistorius G, Seidel R, Feifel G, Schilling MK, Vollmar B, Menger MD. Arteriolovenular Shunting Critically Determines Shutdown of Microcirculation Upon Cryotherapy in Tumor-Bearing Rat Liver. Ann Surg Oncol 2005; 12:303-12. [PMID: 15827680 DOI: 10.1245/aso.2005.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2004] [Accepted: 11/29/2004] [Indexed: 11/18/2022]
Abstract
BACKGROUND Tissue destruction by cryosurgery not only is mediated by direct cell damage, but also involves secondary mechanisms, such as ischemia due to shutdown of the microcirculation. Clinicians favor repetitive cryoapplication, although there is no proven evidence for a more effective tumor eradication. METHODS The aims of this study were (1) to establish a rat liver tumor model that allows for intravital microscopic analysis of hepatic tumor microcirculation and (2) to elucidate critical determinants of shutdown of microvascular perfusion after single and repetitive cryotherapy. In WAG-Rji rats (n = 14), syngeneic colon carcinoma cells (CC531) were implanted into the left liver lobe. Hepatic and tumor microcirculation were studied by intravital microscopy. RESULTS Two weeks after implantation, the tumors had developed a microvasculature with a capillary density markedly (P < .05) lower compared with the sinusoidal density of normal liver. However, at the tumor margin, venule diameters were significantly enlarged (P < .05), with high red blood cell velocities and arteriolovenular shunts. Both freeze procedures (temperature at the tumor margin: -32.4 degrees C +/- 1.6 degrees C and -36.4 degrees C +/- 2.0 degrees C) resulted in a complete shutdown of intratumoral and peritumoral capillary and hepatic sinusoidal perfusion. In contrast, some large venules showed maintenance of blood flow initially after freezing (15 minutes); however, this was abolished during the subsequent 2-hour observation period. CONCLUSIONS Enlarged high-flow venules at the tumor margin, which participate in arteriolovenular shunting, critically determine the shutdown of the microcirculation upon cryotherapy. Repetitive freezing is not more effective than a single-freeze procedure to achieve complete tumor microcirculatory stasis.
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Affiliation(s)
- Sven Richter
- Department for General, Visceral, and Vascular Surgery, University of Saarland, D-66421, Homburg/Saar, Germany
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46
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Ahmed S, Lindsey B, Davies J. Salvage cryosurgery for locally recurrent prostate cancer following radiotherapy. Prostate Cancer Prostatic Dis 2004; 8:31-5. [PMID: 15583704 DOI: 10.1038/sj.pcan.4500774] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The popularity of radiotherapy as a minimally invasive treatment for prostate cancer is increasing. Despite advancements in radiation delivery, a number of patients will fail treatment. Salvage radical prostatectomy has been the main therapeutic option for locally recurrent radiation failure prostate cancer with curative intent. The operation is technically difficult to perform and associated with significant comorbidities. Salvage cryotherapy has emerged as a minimally invasive alternative option. In this article, we review the role of cryotherapy in recurrent prostate cancer and compare its outcome with salvage radical prostatectomy.
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Affiliation(s)
- S Ahmed
- The Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 5XX, UK.
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47
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Maiwand MO, Evans JM, Beeson JE. The application of cryosurgery in the treatment of lung cancer. Cryobiology 2004; 48:55-61. [PMID: 14969682 DOI: 10.1016/j.cryobiol.2003.12.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2003] [Accepted: 12/11/2003] [Indexed: 10/26/2022]
Abstract
Lung cancer is the commonest cause of cancer death, with a very poor survival rate. By the time of diagnosis, most cases are at an advanced stage and about 30% present with symptoms caused by central endobronchial obstruction. Endobronchial cryosurgery is an effective technique, which can be used to relieve tracheobronchial obstruction caused by lung cancer. This report describes the technique, using a nitrous oxide cooled cryoprobe, inserted through a bronchoscope, to remove the obstruction and reopen the airway. In this study, 476 consecutive patients (mean age 68.3 years, M:F ratio 1.9:1) with obstructive tracheobronchial tumours underwent a mean of 2.4 cryosurgical treatments. Their TNM staging was, stage II 6.7%, IIIa 21.0%, IIIb 23.9%, IV 48.4%. Improvement in symptom quantification was found with 76.4, 69.0, 59.2, and 42.6% of symptomatic patients for haemoptysis, cough, dyspnoea, and chest pain, respectively. Mean values for respiratory function improved from 1.38 to 1.41 litres for FEV1 and 1.91 to 2.04 litres for FVC (p </= 0.0001). Mean performance status improved from 59.6 to 75.2 for Karnofsky scale and 3.04 to 2.20 for the WHO scale and the complication rate was 3.5% of treatments. The Kaplan-Meier median survival was 8.2 months and 1- and 2-year survival 38.4 and 15.9%, respectively. Survival analysis suggested a possible survival advantage over alternative palliative techniques. Endobronchial cryosurgery provides a safe and effective method for the palliation of otherwise inoperable lung cancer. It has advantages over other methods in terms of safety, cost, and a low complication rate. Cryosurgery can be repeated as often as required.
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Affiliation(s)
- M O Maiwand
- Department of Thoracic Surgery, Harefield Hospital, Harefield, Middlesex UB9 6JH, UK.
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48
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Zhang J, Sandison GA, Murthy JY, Xu LX. Numerical Simulation for Heat Transfer in Prostate Cancer Cryosurgery. J Biomech Eng 2004; 127:279-94. [PMID: 15971706 DOI: 10.1115/1.1865193] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A comprehensive computational framework to simulate heat transfer during the freezing process in prostate cancer cryosurgery is presented. Tissues are treated as nonideal materials wherein phase transition occurs over a temperature range, thermophysical properties are temperature dependent and heating due to blood flow and metabolism are included. Boundary conditions were determined at the surfaces of the commercially available cryoprobes and urethral warmer by experimental study of temperature combined with a mathematical optimization process. For simulations, a suitable computational geometry was designed based on MRI imaging data of a real prostate. An enthalpy formulation-based numerical solution was performed for a prescribed surgical protocol to mimic a clinical freezing process. This computational framework allows for the individual planning of cryosurgical procedures and objective assessment of the effectiveness of prostate cryosurgery.
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Affiliation(s)
- Jiayao Zhang
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA
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49
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Abstract
An increasing number of small asymptomatic renal cell carcinomas (RCCs) are being detected by cross-sectional imaging. Because of the nonaggressive biologic behavior of many of these tumors, there is increasing interest in minimally invasive treatment modalities,particularly for the elderly, infirm, and patients with comorbid conditions. Radiofrequency(RF) ablation, cryoablation, microwave ablation, and laser ablation have all shown promise for the treatment of RCC, with high local control and low complication rates for RF ablation and cryoablation. However, the clinical trial data remain early, and survival data are not yet available for a definitive comparison with conventional surgical techniques for removal of RCC.
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Affiliation(s)
- J Louis Hinshaw
- Department of Radiology, University of Wisconsin, E3/311 CSC, 600 Highland Avenue, Madison, WI 53711, USA
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50
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Chao BH, He X, Bischof JC. Pre-treatment inflammation induced by TNF-α augments cryosurgical injury on human prostate cancer. Cryobiology 2004; 49:10-27. [PMID: 15265713 DOI: 10.1016/j.cryobiol.2004.04.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2003] [Accepted: 04/07/2004] [Indexed: 11/22/2022]
Abstract
Vascular injury is a major mechanism of cryosurgical destruction. The extent of vascular injury may be affected by the addition of molecular adjuvants. This study, in addition to determining the injury mechanism in the LNCaP Pro 5 human prostate cancer subline grown in a nude mouse, examined the effect of cytokine TNF-alpha on cryosurgery of an in vivo microvascular preparation (Dorsal Skin Flap Chamber). A comparison of injury data to a thermal model indicated that the minimum temperature after moderate cooling, thawing, and hold time required for causing necrosis was 3.5+/-6.9 degrees C in TNF-alpha-treated LNCaP Pro 5 tumor tissue (n=4) and -9.8+/-5.8 degrees C in TNF-alpha-treated normal skin of the nude mouse (n=4). Compared to tissues without TNF-alpha treatment, where the minimum temperature required for causing necrosis was -16.5+/-4.3 degrees C in LNCaP Pro 5 tumor tissue (n=8) and -24.4+/-7.0 degrees C in normal skin of the nude mouse (n=9), the results indicate the local use of TNF-alpha can dramatically increase the threshold temperature of cryo-destruction by more than 10 degrees C (p <0.01). These findings were consistent with the hypothesis that vascular-mediated injury is responsible for defining the edge of the cryolesion in microvascular-perfused tissue, and therefore pre-induced inflammation can augment cryoinjury. The local use of TNF-alpha to pre-inflame prostate cancer promises to increase both the ability of freezing to destroy cancer as well as improve the ability of ultrasound or other iceball-monitoring techniques to predict the outcome of the treatment.
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Affiliation(s)
- Bo H Chao
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
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