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Mokbel K, Kodresko A, Ghazal H, Mokbel R, Trembley J, Jouhara H. The Evolving Role of Cryosurgery in Breast Cancer Management: A Comprehensive Review. Cancers (Basel) 2023; 15:4272. [PMID: 37686548 PMCID: PMC10486449 DOI: 10.3390/cancers15174272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Breast cancer is the most commonly diagnosed type of cancer, accounting for approximately one in eight cancer diagnoses worldwide. In 2020, there were approximately 2.3 million new cases of breast cancer globally, resulting in around 685,000 deaths. Consequently, there is an ongoing need to develop innovative therapeutic approaches that can improve both clinical outcomes and patient quality of life. The use of ultra-low cryogenic temperatures, facilitated by cryogenic media such as liquid nitrogen, has revolutionized the biomedical field and opened up new possibilities for advanced clinical treatments, including cryosurgery. Cryosurgery has demonstrated its feasibility as a minimally invasive technique for destroying breast tumors and eliciting a significant antitumor immune response in the host. This feature sets cryosurgery apart from other ablative techniques. It has been shown to be well tolerated and effective, offering several advantages such as simplicity, the avoidance of general anesthesia, minimal pain, low morbidity, short recovery time, cost-effectiveness, and notably, improved aesthetic outcomes. The reviewed studies indicate that cryosurgery holds promise in the management of early-stage breast cancer and metastatic disease, especially in triple-negative and Her2-positive molecular subtypes in conjunction with checkpoint inhibitors and anti-Her2 antibodies, respectively. Furthermore, the effectiveness of cryosurgery in the management of ductal carcinoma in situ should be investigated as an alternative modality to surgery or surveillance. The minimally invasive nature of cryosurgery has the potential to significantly enhance the quality of life for patients.
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Affiliation(s)
- Kefah Mokbel
- The London Breast Institute, Princess Grace Hospital, London W1U 5NY, UK
| | - Alevtina Kodresko
- Heat Pipe and Thermal Management Research Group, College of Engineering, Design and Physical Sciences, Brunel University, London UB8 3PH, UK
| | - Heba Ghazal
- School of Pharmacy and Chemistry, Kingston University, Kingston Upon Thames KT1 2EE, UK
| | - Ramia Mokbel
- The Princess Grace Hospital, Part of HCA Healthcare UK, London W1U 5NY, UK
| | - Jon Trembley
- Air Products PLC, Hersham Place Technology Park, Molesey Road, Surrey KT12 4RZ, UK
| | - Hussam Jouhara
- Heat Pipe and Thermal Management Research Group, College of Engineering, Design and Physical Sciences, Brunel University, London UB8 3PH, UK
- Vytautas Magnus University, Studentu Street 11, LT-53362 Akademija, Kaunas District, Lithuania
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Li C, Wu Q, Chang D, Liang H, Ding X, Lao C, Huang Z. State-of-the-art of minimally invasive treatments of bone metastases. J Bone Oncol 2022; 34:100425. [PMID: 35391944 PMCID: PMC8980625 DOI: 10.1016/j.jbo.2022.100425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 10/29/2022] Open
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Colak C, Forney MC, Simpfendorfer CS, Mesko NW, Ilaslan H. Preoperative cryoablation of a hypervascular bone metastasis: A case of effective devascularization before preoperative embolization. Clin Imaging 2021; 79:148-153. [PMID: 33951570 DOI: 10.1016/j.clinimag.2021.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/25/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
Image-guided cryoablation has become a common approach for the palliative treatment of painful metastatic bone lesions, and indications for this procedure have expanded to include local control of bone metastases. We report a case in which cryoablation was performed on a large hypervascular renal cell carcinoma bone metastasis before surgical fixation of an impending fracture. In this case, cryoablation reduced the patient's pain but also appeared to result in devascularization of the tumor, thus obviating the need for preoperative embolization. This case raises the possibility that image-guided cryoablation may represent an alternative to preoperative embolization for vascular tumors while also serving a palliative function.
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Affiliation(s)
- Ceylan Colak
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, A21, Cleveland, OH 44195, USA.
| | - Michael C Forney
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, A21, Cleveland, OH 44195, USA.
| | - Claus S Simpfendorfer
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, A21, Cleveland, OH 44195, USA.
| | - Nathan W Mesko
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Ave, A41, Cleveland, OH 44195, USA.
| | - Hakan Ilaslan
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, A21, Cleveland, OH 44195, USA.
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Percutaneous image-guided cryoablation of painful bone metastases: A single institution experience. Orthop Traumatol Surg Res 2019; 105:369-374. [PMID: 30858041 DOI: 10.1016/j.otsr.2019.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 07/16/2018] [Accepted: 01/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Bone metastases are frequently painful and may lead to various complications that can affect quality of life. While external beam radiation therapy is the standard first-line treatment, 20-30% of patients do not experience sufficient pain relief. Cryoablation is increasingly being used for the treatment of musculoskeletal metastases. The purpose of our retrospective study was to analyze pain relief and local disease control after percutaneous image-guided cryoablation (PCA) therapy of painful bone metastases. MATERIALS AND METHODS Sixteen patients treated with PCA for painful bone metastases (n=18) over a 5-year period (from June 2011 to June 2016) were retrospectively reviewed. Five patients also benefited from long bone fixation because of an impending fracture. We analyzed the impact of treatment on pain relief, using a numerical rating scale (NRS), and local disease control. RESULTS The mean follow-up period was 12 months (range, 1.5-39 months). At last oncological outpatient consultation, 75% (12/16) of patients had good pain relief, while 63% (10/16) had locally stable disease or no local recurrence of the treated bone metastases. The mean NRS score decreased significantly from 3.3 to 1.2 after PCA (p=0.0024). The five patients with concomitant long bone fixation all had satisfactory pain relief at the last follow-up visit. CONCLUSION PCA is a safe and valid treatment option for pain and local disease control in cases of painful bone metastases after failed standard first-line therapy. This technique can also be effectively associated to prophylactic long bone fixation and may allow for easier rehabilitation protocols when treating weight-bearing bones. LEVEL OF EVIDENCE IV, Retrospective case series.
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Ferrer-Mileo L, Luque Blanco AI, González-Barboteo J. Efficacy of Cryoablation to Control Cancer Pain: A Systematic Review. Pain Pract 2018; 18:1083-1098. [DOI: 10.1111/papr.12707] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/22/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Laura Ferrer-Mileo
- Department of Medical Oncology; Catalan Institute of Oncology-Hospitalet; Barcelona Spain
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McArthur TA, Narducci CA, Lander PH, Lopez-Ben R. Percutane Image-Guided Cryoablation of Painful Osseous Metastases: A Retrospective Single-Center Review. Curr Probl Diagn Radiol 2017; 46:282-287. [DOI: 10.1067/j.cpradiol.2016.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/24/2016] [Accepted: 11/08/2016] [Indexed: 11/22/2022]
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Wu B, Xiao YY, Zhang X, Zhao L, Carrino JA. CT-guided percutaneous cryoablation of osteoid osteoma in children: an initial study. Skeletal Radiol 2011; 40:1303-10. [PMID: 21311882 DOI: 10.1007/s00256-011-1119-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 01/22/2011] [Accepted: 01/25/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the safety and efficacy of CT-guided percutaneous cryoablation for osteoid osteoma in children. MATERIALS AND METHODS This study was approved by the institutional ethics committee. From January 2007 to July 2008, six children (four boys, two girls, mean age 12.6 years old) with osteoid osteoma were treated with CT-guided percutaneous cryoablation. The procedures were carried out under conscious sedation and local anesthesia. CT guidance was used for procedural planning, instrument guidance, and monitoring. An argon-based cryoablation system was used. Each cryoablation included two freezing-thawing cycles. Follow-up was performed to assess technical and clinical outcome for a minimum of 12 months. A visual analog scale (VAS) was used to assess severity of pain pre- and post-procedure, and mean VAS for the group was compared pre- and post-procedure with a t-test. The mean clinical follow-up period was 28.7 months (ranging from 18 to 36 months). RESULTS Cryoablation was technically and clinically successful for all patients. No major immediate or delayed complications were observed. Significant pain relief (P <0.05) was observed in all patients after operation. Mean VAS were 6.57 ± 0.55 pre-procedure and 0.57 ± 0.10 1 month post-procedure. Patients were allowed to fully bear their weight and function without limitation within 3 days after the procedure. Pain recurrence was not observed in any patient. CONCLUSION Percutaneous cryoablation is safe and effective for the treatment of osteoid osteomas in children. Notably, this procedure can be accomplished without general anesthesia.
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Affiliation(s)
- Bin Wu
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing 100853, China.
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Palliation of painful metastatic disease involving bone with imaging-guided treatment: comparison of patients' immediate response to radiofrequency ablation and cryoablation. AJR Am J Roentgenol 2011; 197:510-5. [PMID: 21785102 DOI: 10.2214/ajr.10.6029] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The purpose of this article was to compare periprocedural analgesic requirements and hospital length of stay for treatment of patients with painful metastatic tumors involving bone using either percutaneous radiofrequency ablation (RFA) or cryoablation. MATERIALS AND METHODS A retrospective review was conducted of patients who underwent either imaging-guided cryoablation or imaging-guided RFA for painful metastatic tumors involving bone. The total analgesic usage for 24 hours after the procedure was expressed as a standard morphine-equivalent dose. Analgesic usage at admission served as a baseline for comparison. Total hospital stay was used as an additional measurement of procedure-related morbidity. RESULTS Fifty-eight patients underwent either cryoablation (n = 36) or RFA (n = 22) for painful metastatic tumors involving bone. Twenty-two primary tumors were treated. The most common treatment site was the pelvis (n = 31). There was no significant difference between the two groups with regard to tumor histologic type (p = 0.52) and location (p = 0.72). The median tumor diameter was 4.4 cm for the cryoablation group and 5.0 cm for the RFA group (p = 0.63). Pretreatment pain scores, measured on a scale of 0 to 10, were not significantly different between the two groups: 6.5 for cryoablation and 6.0 for RFA (p = 0.78). Analgesic use in the 24 hours immediately after the procedure decreased significantly by 24 morphine-equivalent doses after cryoablation, whereas it increased by a median of 22 morphine-equivalent doses after RFA (p = 0.03). Total hospital length of stay for patients undergoing cryoablation was a median of 2.5 days less than that for patients receiving RFA (p = 0.003). CONCLUSION The use of cryoablation compared with RFA is associated with a greater reduction in analgesic dose and shorter hospital stays after the procedure in the perioperative time frame.
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Abstract
Interventional radiology plays a major role in the management of bone tumors. Many different percutaneous techniques are available. Some aim to treat pain and consolidate a pathological bone (cementoplasty); others aim to ablate tumor or reduce its volume (sclerotherapy, thermal ablation). In this article, image-guided techniques of primary and secondary bone tumors with vertebroplasty, ethanol injection, radiofrequency ablation, laser photocoagulation, cryoablation, and radiofrequency ionization (coblation) will be reviewed. For each modality, the principles, the indications, and the results will be presented. The technical choice depends on the therapeutic intent-curative or palliative-and the need for consolidation, but also on the general status of the patient and the other therapeutic options. For the most complex cases, combined treatments can be required. However, the less disabling technique should always be considered first.
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Affiliation(s)
- Afshin Gangi
- Department of Radiology B, University Hospital of Strasbourg, Strasbourg, France
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Sabharwal T, Katsanos K, Buy X, Gangi A. Image-guided ablation therapy of bone tumors. Semin Ultrasound CT MR 2009; 30:78-90. [PMID: 19358439 DOI: 10.1053/j.sult.2008.12.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
A wide range of thermal and cryoablation methods is currently available for the curative eradication or palliative treatment of a variety of bone and soft-tissue tumors. Radiofrequency ablation has been developed as a multipurpose tool for the skeletal system. Cryoablation has the added advantages of direct computed tomography or magnetic resonance visualization and monitoring of treatment outcome with less peri- and postoperative pain. Use of appropriate thermo-sensors and insulation techniques, like carbon dioxide insufflation, results in enhanced safety and efficacy. Ablation of weight-bearing bones has to be supplemented with cement consolidation. The authors present an overview of the current status of percutaneous image-guided ablation therapy of bone and soft-tissue tumors, analyze the merits and limitations of the various systems available, and discuss possible new applications for the future.
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Affiliation(s)
- Tarun Sabharwal
- Department of Interventional Radiology, Guy's and St. Thomas' Hospital, 1st Floor, Lambeth Wing, Lambeth Palace Road, London SE1 7EH, UK
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Reply. AJR Am J Roentgenol 2008. [DOI: 10.2214/ajr.08.1567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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