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PubMed1982

Immunological aspects of cryosurgery in general surgery.

Existence and verification of the cryoimmunologic reaction are established in basic experiments and clinical studies. However, the most effective condition in which to elicit cryoimmunologic reaction is still unknown. Evidence suggests the necessity to intensify cryoimmune reaction, if we intend to use this as one of the specific immunotherapies clinically. Establishment of criteria to select patients receiving cryosurgery is another pending question. It is important to assess the patient's immunity or immunological competence prior to cryosurgery, thereby preventing immunologically induced aggravation after cryosurgery. Twelve years of clinical experience in cryosurgery was presented and analyzed. Overall 3-year survival in the primary cancer patients was 33.3%, and 5-year survival was 17.7%. It is our aim to achieve the most beneficial effects of cryosurgery for the patients with malignancies which would otherwise be difficult to treat by conventional means.

Adjuvants, Immunologic↗
PubMed1992

Progress in cryosurgery.

The Workshop on Cryosurgery at the 28th Annual Meeting of the Society for Cryobiology contained a diversity of papers which fairly represented the present state of cryosurgery in medical practice and which identified directions for future research. Emphasis was clearly on the development of visceral cryosurgery, which appears likely to become of increased clinical importance as a result of combination with ultrasound imaging techniques. This report reviews in brief the important new developments in cryosurgery and focuses on those presentations which were of special interest from the viewpoint of research in cryosurgery.

Cryosurgery↗
PubMedDate not supplied

PSA elevation during prostate cryosurgery and subsequent decline.

PURPOSE: To determine the immediate effect of prostate cryosurgery on PSA and the subsequent decline. METHODS AND MATERIALS: PSA level was measured in 14 patients who underwent cryosurgery for prostate cancer. Blood samples were taken immediately before and after cryosurgery and 1, 2, 4, 6 weeks and 3 months postoperatively. A confidence interval for the elevation from baseline to maximal PSA was calculated. PSA decline was assessed in patients with a nadir PSA < or =0.5 ng/mL. Patients with a postoperative nadir PSA >0.5 ng/mL were considered to harbor viable cancer and were excluded from the decline analysis. The observed PSA levels during the postoperative period were compared with the expected levels that were calculated according to the maximal PSA level and a serum half-life of 2.5 days. Student t-test was used to compare expected and observed PSA levels. RESULTS: PSA increased from an average of 9.23 ng/mL preoperatively to a maximum average of 155 ng/mL (maximal PSA ranges: 18.9-490.5 ng/mL). The 95% CI for the increase in PSA from baseline level was 63.4 to 224.14. PSA nadir < or =0.5 ng/mL was achieved in 10 patients. The observed PSA decline course was slower than expected according to its half-life. Average observed and expected PSA levels at 2,4 and 6 weeks after cryosurgery were 10.4 versus 3.57 ng/mL (P = 0.005), 0.65 versus 0.07 (P = 0.007) and 0.09 versus 0.001 (P = 0.03), respectively. CONCLUSION: PSA levels increase steeply following cryosurgery, and decline slower than expected according to the serum half-life.

Adenocarcinoma↗
PubMed1997

Cytoablative therapy with combined resection and cryosurgery for limited bilobar hepatic colorectal metastases.

BACKGROUND: Cryosurgery can be employed in patients with unresectable hepatic metastases when the tumor size and the number of metastases are limited. However, local recurrence can result from incomplete ablation. We proposed a trial of complete cytoablation with a combined approach of cryosurgery and hepatic resection for patients with bilobar hepatic metastases. METHODS: Seven patients underwent cryosurgery alone (CRYO). Seven additional patients underwent combined resection and cryosurgery (CRYO+RES) for bilobar metastases. RESULTS: In the CRYO group, 5 of 7 patients had at least one centrally located tumor. All 5 of these patients had early recurrence at the site of ablation. In the CRYO+RES group complete ablation was achieved in 7 of 7. Two (28.6%) of these patients developed local recurrence. CONCLUSION: Cytoablation of hepatic metastases can be safely achieved with combined hepatic resection and cryosurgery in selected patients. Long-term survival data are necessary before advocating widespread application of this approach.

Aged↗
PubMed1985

Treatment of cervical ectropion by cryosurgery: effect on cervical mucus characteristics.

Eighteen women with cervical ectropion and 12 women with ectropion and vaginal discharge were treated by cryosurgery. Evaluation of the cervical mucus characteristics by cervical score and in vitro penetration test was performed before treatment and 2 months later. In the group with ectropion only (group A) the total cervical score was 5.7 +/- 0.4 and 11.9 +/- 0.06 (P less than 0.001) (mean +/- standard error) before treatment and 2 months later, respectively. In the group with ectropion and vaginal discharge (group B) the total cervical score before and after cryosurgery was 3.8 +/- 0.4 and 11.8 +/- 0.1 (P less than 0.001), respectively. In vitro penetration tests in group A before and after treatment were 0.72 +/- 0.1 and 2.9 +/- 0.08 (P less than 0.001), respectively. In group B, in vitro penetration tests before and after cryosurgery were 0.25 +/- 0.1 and 2.8 +/- 0.1 (P less than 0.001), respectively. It appears that cryosurgery improves the cervical mucus characteristics. It is recommended that infertile patients with hostile cervical mucus and ectropion will be treated by cryosurgery.

Adult↗
PubMed2002

Focal "nerve-sparing" cryosurgery for treatment of primary prostate cancer: a new approach to preserving potency.

OBJECTIVES: To present a pilot study in which 9 patients treated with focal, unilateral nerve-sparing cryosurgery were followed for up to 6 years. Cryosurgery, in which the whole gland is frozen, has a high rate of impotence, similar to non-nerve-sparing radical prostatectomy. METHODS: Before focal nerve-sparing cryosurgery, all patients underwent repeated biopsy on the side opposite the previous positive biopsy. One neurovascular bundle was spared on the side opposite the positive biopsy. Just before the start of freezing, a 22-gauge spinal needle was placed into Denonvilliers fascia using a transperineal route, and saline was injected to separate the rectum from the prostate. Combined hormone therapy was stopped in all patients postoperatively. The prostate-specific antigen (PSA) level was obtained every 3 months for the first 2 years and then every 6 months thereafter. Patients were considered to have a stable PSA if they had two consecutive PSA measurements without a rise. All patients were strongly encouraged to undergo routine biopsies despite a stable PSA level. RESULTS: Between June 1995 and November 2000, 9 patients underwent focal, nerve-sparing cryosurgery. The follow-up ranged from 6 to 72 months (mean 36). All patients had stable PSA levels at last follow-up. Six patients routinely biopsied had negative biopsies. Potency (defined as an erection sufficient to complete intercourse to the satisfaction of the patient) was maintained in 7 of 9 patients. CONCLUSIONS: Focal nerve-sparing cryosurgery, in which one neurovascular bundle is spared, appears to preserve potency in most patients without compromising cancer control. These preliminary results warrant further study.

Aged↗
PubMed2002

Future directions for cryosurgery computer treatment planning.

Computer treatment planning for cryosurgery is an area of research and development that will greatly assist the practicing physician and will promote improved quality assurance for clinical procedures. Good planning and precision image-guided treatment delivery are complementary in achieving an optimal treatment outcome. State-of-the-art cryosurgery treatment planning systems are at an early stage of development in comparison with radiation treatment planning systems for external beams. Using 30 years of progress in the area of radiation treatment planning as a guide, this article presents a summary of the avenues for research and development in cryosurgery treatment planning that are likely to accelerate the practical application of precision cryosurgery to a broad spectrum of anatomical sites. Emphasis is placed on prostate cryosurgery, imaging techniques, and recommendations for manufacturers of these systems. Optimization of the clinical procedure in the planning stage using mathematical algorithms to define the positioning and operation of cryoprobes is discussed.

Algorithms↗
PubMed2000

In vivo interstitial temperature mapping of the human prostate during cryosurgery with correlation to histopathologic outcomes.

OBJECTIVES: To determine the critical temperatures below which human prostatic tissue can be cryoablated in situ and the comparative cryoablative efficacy of single versus double-freeze cryosurgery. METHODS: Six patients with prostate cancer previously scheduled for prostatectomy underwent unilateral or bilateral cryosurgery using a single cryosurgery probe per hemiprostate. Intraprocedural interstitial prostatic temperatures were measured by thermocouple junctions placed at various radial distances from the probe. After subsequent prostatectomy, whole-mount sections of the prostate gland were subjected to histopathologic evaluation. RESULTS: Uniform coagulative necrosis was observed in proximity to the cryosurgery probe. The percentage of the prostate volume falling within the zone of necrosis produced by a single probe was significantly greater (P = 0.048) after a double freeze (median 13%; range 8% to 20%) than a single freeze (median 4%; range 0% to 12%). The critical temperature for cryoablation with a double freeze was -41.4 degrees C (95% confidence interval -49.9 degrees to -33.0 degrees C) compared with -61.7 degrees C (95% confidence interval -74.5 degrees to -48.9 degrees C) for a single freeze (P <0.0005). CONCLUSIONS: Uniform coagulative necrosis of human prostatic tissue in vivo can be accomplished throughout a significantly larger zone with a double freeze than with a single freeze. A double freeze at temperatures below approximately -40 degrees C results in necrosis. These findings provide a basis for more optimal use of temperature monitoring during cryosurgery, which is essential to ensure effective treatment of the entire prostate gland with minimum risk of damage to adjacent tissues such as the rectum and external sphincter.

Aged↗
PubMed2001

Serum response of hepatocyte growth factor, insulin-like growth factor-I, interleukin-6, and acute phase proteins in patients with colorectal liver metastases treated with partial hepatectomy or cryosurgery.

BACKGROUND/AIMS: The aim of the study was to compare the serum response of regeneration factors and acute phase proteins in patients treated with partial hepatectomy or cryosurgery. METHODS: The responses of serum hepatocyte growth factor (HGF), insulin-like growth factor-I (IGF-I) (free and total), interleukin-6 (IL-6) and the acute phase proteins, C-reactive protein (CRP) and serum amyloid A (SAA) were examined in patients with colorectal liver metastases treated with partial hepatectomy (n = 14) or cryosurgery (n = 10). RESULTS: In both groups, IL-6 peak levels at the end of the operation were followed by peak levels at day 1 for HGF and CRP. SAA peak levels occurred on day 1 (hepatectomy group) and on day 4 (cryo group). The total HGF, IGF-I, and IL-6 responses were comparable in both groups. CRP and SAA responses were higher in the patients treated with cryosurgery than in patients after hepatectomy. Free IGF-I trough levels were lower in partial hepatectomy patients than in cryosurgery patients. CONCLUSIONS: In patients with colorectal liver metastases the responses of the regenerating factors HGF, IGF-I, and IL-6 are comparable to those in patients treated with partial hepatectomy. Upregulation of acute phase protein production is higher in patients after cryosurgery than in patients after partial hepatectomy.

Acute-Phase Proteins↗
PubMed1979

Six years' experience with cryosurgery in the oral cavity.

Ninety selected patients with a benign or malignant lesion in the oral cavity were treated by cryosurgery. A clinical study was carried out during a 6-year period to investigate the value of cryosurgery as supplemental or substitute therapy. Good results have been obtained in the treatment of small to moderate, superficially situated angiomas. Cryotherapy has also been found to be satisfactory in the treatment of papillary hyperplasia of the palate. As symptomatic treatment we employed the freezing procedure to painful erosive lichen planus. Until now, a casual treatment has not been possible because of an unknown etiology. Used as symtomatic therapy, cryosurgery may be of some use in these cases, especially to relieve pain. Good results have been obtained in the treatment of oral leukoplakia. The pathologically changed mucous membranes could be completely eliminated in most of the cases without severe scar formation or impairment to functions. Cryosurgery for palliation was employed in 11 incurable tumors. Results have been disappointing. Twenty-one localized malignant neoplasms were treated by cryosurgery to cure. The tumor was completely destroyed in 67% of the cases.

Adolescent↗
PubMed2001

Salvage external beam radiotherapy for clinical failure after cryosurgery for prostate cancer.

PURPOSE: To investigate the role of external beam radiotherapy (EBRT) as salvage treatment of prostate cancer after cryosurgery failure. METHODS AND MATERIALS: Between 1993 and 1998, 6 patients underwent EBRT with curative intent for local recurrence of prostate cancer after cryosurgery. All 6 patients had biopsy-proven recurrence and palpable disease on digital rectal examination at the time of EBRT. The median follow-up was 34 months (range 8-46). The median prostate-specific antigen level was 2.3 ng/mL (range 0.8-4.1). No patient had evidence of metastatic disease. Two patients received hormonal therapy before beginning EBRT. No patient received hormonal therapy after EBRT completion. The median elapsed time between cryosurgery and EBRT was 3 years (range 1.5-4). The median delivered dose was 66 Gy (range 62-70.2) using a 10-MeV photon beam. An in-house-developed three-dimensional treatment planning system was used to plan delivery of the prescribed dose with conformal radiotherapy techniques. RESULTS: After EBRT, all patients had complete resolution of palpable disease. Four patients (66%) were disease free at the time of the last follow-up. Two patients developed biochemical failure as defined by the American Society for Therapeutic Radiology and Oncology consensus definition. One of these patients had a prostate-specific antigen level of 97 ng/mL before cryosurgery. No patient developed distant metastasis during follow-up. Two patients (33%) developed proctitis; 1 case resolved with Rowasa suppositories and 1 required blood transfusion. CONCLUSIONS: Our preliminary results suggest that EBRT can render a significant number of patients biochemically free of disease and can cause complete resolution of clinically palpable disease after initial cryosurgery. The results also showed that EBRT can be given without excessive morbidity. EBRT should be considered as a treatment option in these potentially curable cases.

Aged↗
PubMed2000

The use of view angle tilting to reduce distortions in magnetic resonance imaging of cryosurgery.

Susceptibility artifacts from magnetic resonance (MR)-compatible cryoprobes can distort MR images of iceballs. In this work, we investigate the ability of view angle tilting (VAT) to correct susceptibility induced distortions in MR images of cryosurgery. The efficacy of VAT was tested in an ex vivo bovine liver model of cryosurgery using MR-compatible cryoprobes. Artifacts on high bandwidth fast spin echo images of freezing obtained with and without VAT were compared with photographs of the actual iceball shape and size. In vivo imaging with VAT was demonstrated during percutaneous MR-guided cryosurgery of pig liver and brain. VAT was most successful in reducing probe and iceball distortions when the imaging plane was normal to the cryoprobe, and the cryoprobe was perpendicular to the main magnetic field of the scanner. VAT had the greatest benefit when used to correct MR images of freezing when the surface of the iceball was relatively near to the cryoprobe. For large iceballs, the artifact was small so the VAT correction was less important. We conclude that VAT significantly reduced distortions in the shape of the signal void corresponding to the extent of freezing visualized during MR-guided cryosurgery. This improved ability to visualize the exact location of the cryoprobe, as well as the precise shape of the iceball, particularly during initial freezing when the iceball is small, has potential to significantly improve the accuracy of MR-guided cryosurgery of small lesions, and the accuracy of MR-assisted temperature calculations that are based on precise imaging of the probe location, and boundary geometry of the iceball.

Animals↗
PubMed2005

Cryosurgery in aggressive, benign, and low-grade malignant bone tumours.

Cryosurgery is a method of treatment for various tumours that induces tissue necrosis with ablative intent. It is used in benign, aggressive, and low-grade malignant bone tumours such as chondrosarcoma grade 1. We describe the history of the technique and the issues associated with cryobiology, as well as the indications, technique, complications, and results of cryosurgery. At the University Medical Centre Nijmegen, Netherlands, 302 tumours have been treated by use of cryosurgery with at least 2 years' follow-up. 96-100% of patients were cured-the response depended on tumour type. Comparison of functional results with data from studies shows that these results concur with other studies on cryosurgery, and are at least equal to results of marginal excision and mostly better than those of wide excisions of grade 1 chondrosarcomas. Thus from an oncological point of view, cryosurgery combined with intralesional excision is equal to marginal excision.

Bone Neoplasms↗
PubMed2001

Photodynamic therapy vs. cryosurgery of basal cell carcinomas: results of a phase III clinical trial.

BACKGROUND: A previously reported randomized clinical trial showed treatment of Bowen's disease using photodynamic therapy (PDT) with topically applied delta-aminolaevulinic acid (ALA) to be at least as effective as cryosurgery and to be associated with fewer adverse effects. OBJECTIVES: To compare ALA-PDT and cryotherapy in the treatment of histopathologically verified basal cell carcinomas (BCCs) in a non-blinded, prospective phase III clinical trial. METHODS: One lesion from each of 88 patients was included. The BCCs were divided into superficial and nodular lesions. The follow-up period was restricted to 1 year with close follow-up for the first 3 months. Efficacy was assessed as the recurrence rate 12 months after the first treatment session, verified by histopathology. Tolerability was evaluated as the time of healing, pain and discomfort during and after the treatment, and final cosmetic outcome. RESULTS: Histopathologically verified recurrence rates in the two groups were statistically comparable and were 25% (11 of 44) for ALA-PDT and 15% (six of 39) for cryosurgery. However, clinical recurrence rates were only 5% (two of 44) for PDT and 13% (five of 39) for cryosurgery. Additional treatments, usually one, had to be performed in 30% of the lesions in the PDT group. The healing time was considerably shorter and the cosmetic outcome significantly better with PDT. Pain and discomfort during the treatment session and in the following week were low, and were equivalent with the two treatment modalities. CONCLUSIONS: In terms of efficacy, ALA-PDT is comparable with cryosurgery as a treatment modality for BCCs. Retreatments are more often required with PDT than with cryosurgery. This can easily be performed due to the shorter healing time, less scarring and better cosmetic outcome that follows ALA-PDT.

Adult↗
PubMed1997

Treatment of chromoblastomycosis with itraconazole, cryosurgery, and a combination of both.

BACKGROUND: Chromoblastomycosis is a subcutaneous mycosis, seen frequently in tropical areas, and caused by dematiaceous fungi. It produces nodulo-verrucous lesions in the arms and legs. There is no treatment of choice for this disease and sometimes a combination of chemotherapy and physical therapy is necessary. METHODS: The study included 12 patients diagnosed with chromoblastomycosis by means of fungal and histopathologic tests. The patients were assigned to three treatment groups: patients with small lesions, not greater than 15 cm2 in area, were assigned to Group 1, in which the treatment consisted of itraconazole 300 mg/day, or to Group 2, in which the treatment consisted of one or more sessions of open-spray cryosurgery. Patients with large lesions were assigned to Group 3 and started treatment with itraconazole 300 mg/day, until a maximal reduction of lesions occurred, and then underwent one or several cryosurgery sessions. Clinical, fungal, and laboratory tests were performed in each group before, during, and at the completion of treatment. RESULTS: Positive cultures of Fonsecaea pedrosoi were obtained in 11 out of 12 patients. Two out of four patients in Groups 1 and 3 had a clinical and fungal cure and the remaining patients experienced significant improvement. All four patients included in Group 2 achieved a cure. No important side-effects were seen among the patients included in any of the two itraconazole groups, and only two out of eight patients reported gastric discomfort. The cryosurgery group reported only normal complications of the process, such as edema and pain; two out of eight patients had a superimposed infection. CONCLUSIONS: The results of itraconazole and cryosurgery were good in cases with small lesions; antifungal therapy being more appropriate for flexion areas. The combination of itraconazole, to reduce the size of the lesions, with subsequent treatment of the remaining lesions with cryosurgery, represents a new alternative in the treatment of patients with large lesions. Both types of therapy are considered safe, with few side-effects.

Administration, Oral↗
PubMed2001

Intralesional cryosurgery using lumbar puncture and/or hypodermic needles for large, bulky, recalcitrant keloids.

BACKGROUND: Keloids are notoriously difficult to treat. A variety of treatment modalities are currently in use, indicating that none is totally satisfactory. Surface cryosurgery is effective for smaller keloids, but not for larger ones. It often results in widespread depigmentation over the surface of the keloids, which may not be desirable, especially in patients with dark skin. OBJECTIVES: To determine the efficacy of intralesional (IL) cryosurgery in large, bulky keloids unresponsive to IL steroids, and to observe the extent of depigmentation and other complications produced by the technique. METHODS: Twelve patients with large, bulky, symptomatic keloids unresponsive to at least five injections of IL triamcinolone acetonide were included in the study. The age of the patients and the duration of the keloids were in the range 19-50 years and 1-12 years, respectively. The IL cryosurgery device was assembled using a small liquid nitrogen Dewar cylinder, a rubber and a plastic tube taken from a drip-set, adhesive tape, and hypodermic and lumbar puncture needles. The lumbar puncture or injection needle was introduced through the lesion until it appeared at the other side. Liquid nitrogen was then passed through the needle. The freezing time was between 20 and 30 s. The procedure was repeated for a second freeze-thaw cycle in the same session. RESULTS: The patients underwent a minimum of five up to a maximum of 10 sessions of IL cryosurgery. Seven out of 12 patients showed > 75% flattening. Depigmentation was observed along the tracks of the needles in all the patients, which improved during follow-up due to pigment spread from the normally pigmented areas in between. At the end of follow-up, 1-25% of the area remained hypo- or depigmented in four patients, 26-50% in six patients, and 51-75% in the remaining two patients. CONCLUSIONS: IL cryosurgery should be the preferred mode of therapy for large, bulky keloids, which are unresponsive to IL steroids.

Adult↗
PubMed2003

Histologic cure of basal cell carcinoma treated with cryosurgery.

BACKGROUND: Cryosurgery is a method of treatment for basal cell carcinoma (BCC). Despite numerous studies reporting excellent cure rates with cryosurgery, there are no studies in the literature that have shown a histologic cure of BCC. OBJECTIVE: We sought to show histologically that cryosurgery is an effective cure for well-defined, noduloulcerative BCC of the trunk and upper extremities. METHODS: Twelve noduloulcerative BCCs of the trunk and proximal upper extremities less than 1 cm were treated with single freeze-thaw cryosurgery using a cryoprobe apparatus with liquid nitrogen. A thermocouple needle measured temperature, with the goal to reach between -50 degrees C and -60 degrees C. One to 2 months later, the site was excised and examined with horizontal step sections throughout the entire tissue. RESULTS: No tissue specimens had histologic evidence of tumor. CONCLUSION: Single freeze-thaw cryosurgery provides a histologic cure of well-defined, noduloulcerative BCCs of the trunk and extremities less than or equal to 1 cm.

Biopsy, Needle↗
PubMed1997

Place of cryosurgery in the treatment of malignant liver tumors.

OBJECTIVE: The authors evaluate the results of cryosurgery in malignant liver tumors. SUMMARY BACKGROUND DATA: The outcome of primary or secondary liver tumors is poor when resection can not be achieved. Encouraging results of cryosurgery have been reported in unresectable liver tumors, but this treatment needs further evaluation of its efficacy in homogeneous groups of patients. METHODS: From 63 patients with malignant liver tumors with various histology treated by cryosurgery in a 2.5-year period, the authors evaluated the results of 34 patients with nonresectable hepatocellular carcinoma (9 patients) or nonresectable metastases from colorectal cancer (25 patients). Cryosurgery was used either as a single treatment (4 hepatocellular carcinomas, 5 metastases) or in association with liver resection (5 hepatocellular carcinomas, 20 metastases). Systemic chemotherapy was used routinely before surgery and after surgery. RESULTS: There was no intraoperative mortality. Mortality within 2 months was 3% and was unrelated to the procedure. Postoperative morbidity consisted of one sterile fluid collection and one biliary fistula (8%). At a mean follow-up of 16 months, (range, 2-27) local recurrence rate was 0% for hepatocellular carcinoma and 44% for metastases. Cumulative survival at 24 months was 63% and 52%, respectively, with 6 patients (67%) and 5 patients (20%) currently disease free. In the group of patients with metastases, survival was related to the size of the treated tumor (p = 0.06) and the absence of residual disease (p = 0.03). CONCLUSIONS: Cryosurgery is safe and increases the number of patients with unresectable liver malignancies in whom surgery can aim at eradicating the tumor. Local recurrence is observed more frequently for metastases than for hepatocellular carcinoma. The benefit in survival is related to the complete treatment of the tumoral disease.

Adult↗