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PubMed1999

Cryosurgery in the treatment of giant cell tumor. A long-term followup study.

Between 1983 and 1993, 102 patients with giant cell tumor of bone were treated at three institutions. Sixteen patients (15.9%) presented with already having had local recurrence. All patients were treated with thorough curettage of the tumor, burr drilling of the tumor inner walls, and cryotherapy by direct pour technique using liquid nitrogen. The average followup was 6.5 years (range, 4-15 years). The rate of local recurrence in the 86 patients treated primarily with cryosurgery was 2.3% (two patients), and the overall recurrence rate was 7.9% (eight patients). Six of these patients were cured by cryosurgery and two underwent resection. Overall, 100 of 102 patients were cured with cryosurgery. Complications associated with cryosurgery included six (5.9%) pathologic fractures, three (2.9%) cases of partial skin necrosis, and two (1.9%) significant degenerative changes. Overall function was good to excellent in 94 patients (92.2%), moderate in seven patients (6.9%), and poor in one patient (0.9%). Cryosurgery has the advantages of joint preservation, excellent functional outcome, and low recurrence rate when compared with other joint preservation procedures. For these reasons, it is recommended as an adjuvant to curettage for most giant cell tumors of bone.

Adolescent↗
PubMed2003

Laparoscopic renal cryosurgery: the Northwestern experience.

PURPOSE: Laparoscopic renal cryosurgery provides a minimally invasive alternative for the treatment of small renal lesions of undefined malignant potential. We report on our series of patients treated with laparoscopic renal cryosurgery. MATERIALS AND METHODS: Fifteen patients underwent laparoscopic renal cryoablation of peripheral, exophytic unifocal renal lesions. Patients were managed with a 4-port transperitoneal approach for anteromedial tumors and 3 to 4-port retroperitoneal approach for posterolateral tumors. All lesions were biopsied and sent to pathology for permanent section. A 4.8 mm cryoprobe (CMS cryoprobe, 4.8 mm x 2 cm x 40 cm, Cryomedical Sciences Inc., Ewing, New Jersey) was placed into the tumor using visual and ultrasonographic guidance, and a double freeze-passive thaw cycle was performed. The iceball was extended at least 1 cm beyond the tumor margin under ultrasound guidance. Followup biopsies were performed on all consenting patients with renal cell carcinoma at least 3 months after cryosurgery was performed. RESULTS: Laparoscopic renal cryosurgery was successfully performed on all 15 patients (6 male and 9 female). Of the 15 patients 10 had renal cell carcinoma. Mean age was 68.5 years (range 49 to 86). Mean tumor size was 2.15 cm (range 1.2 to 3.2) and mean estimated blood loss was 67 cc (range 15 to 125). There were 2 perioperative complications. Mean hospital stay was 3.5 days (range 1 to 11). Patients returned to work after 16.5 days (range 7 to 28). Radiographic followup revealed stable cryoablative lesions in all patients. Mean radiographic followup was 453 days (range 147 to 816). Mean preoperative creatinine was 1.25 mg/dl (range 0.8 to 4.3) and mean postoperative creatinine obtained 1 month postoperatively was 1.36 (range 0.8 to 4.8). There was 1 treatment failure, although another patient had a positive biopsy outside the ablated area. The failure occurred in the largest tumor treated (3.2 cm) and was due to incomplete treatment of the periphery of the lesion. The other patient had a successfully treated tumor but a positive followup biopsy due to multifocal papillary renal cell carcinoma and required nephrectomy. CONCLUSIONS: Laparoscopic renal cryosurgery appears to be a safe and effective minimally invasive alternative for the treatment of small renal masses. Careful selection of patients with lesions that are less than 3.0 cm and close monitoring of the iceball is necessary to treat these patients successfully.

Aged↗
PubMed1997

Cryosurgery for cutaneous malignancy. An update.

BACKGROUND: Cryosurgery is a successful modality for destruction of basal and squamous cell carcinomas. There is a trend toward more aggressive freezing of lesions and treatment of selected difficult tumors. OBJECTIVE: The indications and advantages for cryosurgery, recent treatment techniques, tissue response, complications, and results merit description. METHOD: The standard method of treatment is used with aggressive freezing of the lesion, including a greater lateral spread of freeze and attainment of lower tissue temperatures. RESULTS: The cure rate of cryosurgery is high and the cosmetic results are good to excellent. CONCLUSION: The results of cryosurgery are comparable with other modalities. It may be preferable or advantageous for some patients because of the quickness and safety of the procedure and its low cost. With changes in health care spending due to law or regulation, and within the environment of a managed care system, dermatologists may choose cryosurgery on the basis of outcome and cost.

Basal Cell Carcinoma↗
PubMed2005

Analysis of thermal stress in cryosurgery of kidneys.

In this study, the thermal stress distribution in cryosurgery of kidney was investigated using a multiphysics finite element model developed in ANSYS (V8.1). The thermal portion of the model was verified using experimental data and the mechanics portion of the model (elastic) was verified using classic analytical solutions. Temperature dependent thermal and mechanical properties were used in the model. Moreover, the model accounts for thermal expansion due to both thermal expansion in single phase and volumetric expansion associated with phase change of tissue water to ice. For a clinical cylindrical cryoprobe inserted into the renal cortex from the top-middle renal capsule, it was found that the thermal stress distributions along the radial position are very different at different depths from the top renal capsule. The thermal stress is much higher at both ends than in the middle of the cryoprobe surface. It was found that there might be more tissue next to the top renal capsule than other region undergoing microcrack formation or plastic deformation. Furthermore, it was found that macrocrack formation is more likely to occur in tissue adjacent to the cryoprobe surface (especially on the sharp point tip) and during the thawing phase of cryosurgery. It was further found that the volumetric expansion associated with phase change induced much higher thermal stress than thermal expansion in a single phase and might therefore be the main cause of the frequently observed crack formation shortly after initiation of thawing in cryosurgery. Because the thermal stress adjacent to the cryoprobe is much higher than the yield stress of frozen renal tissue, a plastic stress model is required for better modeling of the thermal stress distribution in cryosurgery of kidney in future. However the computational effort will then be drastically increased due to the strong nonlinear nature of the plastic model and more experimental studies are indispensable for better understanding of the mechanical behavior of frozen tissue in cryosurgery.

Animals↗
PubMed2000

Cryosurgery.

Cryosurgery is a surgical technique that employs freezing to destroy undesirable tissue. Developed first in the middle of the nineteenth century it has recently incorporated new imaging technologies and is a fast growing minimally invasive surgical technique. A historical review of the field of cryosurgery is presented, showing how technological advances have affected the development of the field. This is followed by a more in-depth survey of two important topics in cryosurgery: (a) the biochemical and biophysical mechanisms of tissue destruction during cryosurgery and (b) monitoring and imaging techniques for cryosurgery.

Animals↗
PubMed1996

Prostate carcinoma: MR imaging findings after cryosurgery.

PURPOSE: To determine the morphologic changes in the prostate gland after cryosurgery and to assess the value of magnetic resonance (MR) imaging in detecting residual tumor. MATERIALS AND METHODS: Twenty-seven patients with prostate carcinoma underwent endorectal MR imaging after cryosurgery. Eighteen patients also underwent MR imaging before cryosurgery. MR findings were correlated with posttreatment clinical data, prostate-specific antigen level, and biopsy results. RESULTS: Mean prostate volume had decreased by 52% in patients examined 8 weeks or more after cryosurgery. Zonal differentiation was lost in 22 of 27 patients (81%). Areas of intraprostatic necrosis were identified in 14 of 27 patients (52%). A thick capsule enveloped the gland and neurovascular bundles in 24 of 27 patients (89%). Osteonecrosis of the symphysis pubis was seen in six of 27 patients (22%). Positive and negative predictive values for MR assessment of recurrent tumor were 44% and 73%, respectively. CONCLUSION: Cryosurgery-induced changes in the prostate gland preclude reliable detection of residual prostate carcinoma at MR imaging.

Aged↗
PubMed2005

The outcome after cryosurgery and intralesional steroid injection in vulvar lichen sclerosus corresponds to preoperative histopathological findings.

BACKGROUND: Vulvar lichen sclerosus (LS) still presents a therapeutic challenge. QUESTIONS: The aim of the present study was to investigate whether there is a correlation between preoperative histopathological findings in female LS and long-term results after cryosurgery and intralesional steroid injections. MATERIAL AND METHODS: 22 females with LS, mean age 65.3 +/- 10.5 years, were treated with cryosurgery (-186 degrees C) using the contact method with 1 freeze-thaw cycle per lesion and intralesional triamcinolone acetonide injection. The time between surgery and follow-up examination was 27.8 +/- 14.6 months. We compared the clinical outcome and the thickness of the epidermis, the zone of sclerosis and the inflammatory infiltrate in biopsy specimens taken before treatment. RESULTS: In 14 of 22 patients, a relapse after cryosurgery occurred (median after 7.5 months). Patients would 'moderately' recommend cryosurgery for LS (2.2 +/- 0.9; minimum: 0, optimum: 4). Pruritus was significantly reduced (visual analog scale: preoperative 7.1 +/- 2.6 vs. postoperative 2.0 +/- 2.4; p = 0.001) even in patients with relapse (preoperative 7.6 +/- 2.4 vs. postoperative 3.1 +/- 2.28; p = 0.001). Women with relapse showed a significantly higher composed thickness of epidermis, sclerosis and inflammatory infiltrate (430 +/- 139.0 microm) than those without relapse (314 +/- 41.2 microm; p = 0.046). CONCLUSION: In our patients, cryosurgery and intralesional steroid injections were efficient in the treatment of LS. Patients showing relapse had a thicker epidermis and a stronger inflammatory infiltrate. Therefore a treatment of LS should be performed at an early stage of the disease.

Adult↗
PubMed1980

Treatment of cervical intraepithelial neoplasia with local excisional biopsy and cryosurgery.

One hundred and ninety-eight patients with abnormal cytologic smears had extensive diagnostic biopsy of the portio combined with endocervical curettage. Severe dysplasia or cancer in situ was found in 57 per cent of the patients. During a period of observation of 6--42 months (average 18 months) the cervical intraepithelial neoplasia (CIN) regressed in 54 per cent. Cryosurgery was used to treat 93 patients with persistent CIN after biopsy. Treatment was successful in almost 70 per cent after one single application of cryosurgery. The complications were negligible. Treatment was less successful with increasing histological severity as well as with increasing age of the patients; this applies both to biopsy and cryosurgery. Cryosurgery is significantly less effective when the CIN is of both ecto- and endocervical origin. Extensive multiple biopsies of the portio in combination with endocervical curettage performed under general anaesthesia, followed by cryosurgery with persistent cytological abnormalities, are indicated as an alternative to conization, especially in younger patients with ectocervical CIN.

Biopsy↗
PubMed2000

Healing experiences after cervical cryosurgery.

BACKGROUND: Treatment for cervical intraepithelial neoplasia with cryosurgery is uncomfortable for many women. The subsequent healing process is also thought to bring discomfort. The purpose of our study was to describe women's experiences after cryosurgery, and how obesity, age, and gravidity affected, the healing process. METHODS: We developed a survey from focus group results to measure the unpleasantness of hydrorrhea (watery discharge) from cryosurgery, the pad protection required, and the odor associated with the hydrorrhea. The cryosurgical experiences were compared with normal menses for the use and frequency of pad protection, medications used, and any activity restrictions. RESULTS: Cryosurgical experiences were unpleasant for 78.3% of the women because of the pain and cramping of the procedure and the resulting hydrorrhea, odor, and necessity of wearing pads for protection. These experiences after cryosurgery caused 38.6% to restrict their activities and 67.1% to take medications, a significantly greater proportion than the 16.9% whose activities were restricted normal menses and the 26.8% who took medications for normal menses (P=-.004, P <.001, respectively). In addition to these experiences, obese, multigravid, and older women were more bothered by the duration of wearing pads than their counterparts (P=.0246, =.0061, and P=.0159, respectively). CONCLUSIONS: Our study showed that the cryosurgical healing process was not pleasant, and was least tolerable for obese, multigravid, and older women. As many as 50% of women undergoing cryosurgery will perceive the hydrorrhea, its odor, and the wearing of pads to be worse than normal menses, especially if their menses are usually light.

Adolescent↗
PubMedDate not supplied

Cryosurgery treatment of plantar warts.

Plantar warts are common, painful and contagious. Because of their dept of penetration, self treatment with topical creams and gels is often very slow and commonly unsuccessful. Surgical excision or cautery are very painful, can leave permanent tender scars and often lead to relapse because of the Koebner phenomenon. 100 consecutive patients with plantar warts treated by one General Practitioner over a sixteen month period were analysed. Patients were followed up to assess success and relapse rates and the development of any complications. The number, type, size and position of plantar warts were also recorded and analysed. A total of 514 plantar warts presented for treatment. 505 Plantar Warts in 96 patients were considered suitable for treatment using liquid nitrogen cryosurgery via a Byrmill cryogun. Patients were treated by the open spray technique after debulking the plantar wart using a surgical blade. 421 plantar warts (83.5%) cleared completely with one single treatment of cryosurgery. A further 30 (6%) cleared with two treatments and another 15 (3%) cleared with three treatments. In total, 467 plantar warts (92.5%) cleared completely using cryosurgery and 90% of these cleared with one treatment. Of the remaining 38 plantar warts, 23 (4.5%) were lost to follow up and 12 (2.4%) were managed using other techniques after initially being treated with cryosurgery. Only 3 (0.6%) plantar warts failed to clear. However, all three were smaller and less painful after treatment. No patient had to be referred to hospital for treatment of their plantar warts. There were no serious complications of treatment. This study highlights the advantages of cryosurgery for treating plantar warts in general practice. This technique is quick, safe, highly successful, has a low relapse rate and leaves little or no scars.

Adolescent↗
PubMed2000

[Role of transrectal ultrasonography in the follow-up of patients treated with prostatic cryosurgery].

Cryosurgery of prostate is a minimally invasive treatment for localized cancer. Imaging techniques (transrectal ultrasound (TRUS) or magnetic resonance) have been proposed to evaluate tumor persistence/recurrence after cryosurgical treatment other than serum PSA and prostate biopsies. Actually, criteria to identify cancer after cryosurgical ablation are not well assessed. Aim of this study is to evaluate the clinical significance and role of TRUS in detecting tumor within the former prostate gland after cryoablation. We evaluated ultrasound (US) features and imaging, serum PSA and biopsies in 20 patients treated by cryosurgery at our Hospital with a mean follow-up of 18 months. Twenty patients (mean age 70 years, PSA 25.9 ng/ml, clinical stage: 10 T2 N0M0 and 10 T3 N0M0) were followed up for a mean of 16 months. Ultrasound findings (gland volume, capsule, hypoechoic area, post-voided urine volume, seminal vesicles) were correlated to PSA levels (every 3 months) and prostate biopsies (6, 12 and 24 months). All cases were evaluated by the same ultrasound scanner (Eidos, Hitachi-5-6.5 MHz) and by two operators. Prostate capsule was interrupted by hypo-hyperechoic areas in all cases. Transition zone was no more recognizable. Ultrasound findings showed in all cases hypoechoic areas, but US did not identified tumor recurrence in 2 patients. During follow-up, PSA below 0.5 ng/ml was recorded in 75% of cases. We detected tumor in 2 cases, respectively 12 and 18 months after cryosurgery: in the first case few residual cancer cells within fibrous tissue were found in 1 out of 6 biopsies at 6 months (PSA 0.58 ng/ml), in the second one, tumor with viable normal prostatic glands was found in one biopsy of the apex at 18 months (PSA 4.0 ng/ml). TRUS showed several anaechoic foci with necrotic tissue and coalescence of liquid areas in 2 patients (one developed acute urinary retention). Actually, serum PSA is the best marker in order to detect clinically significant tumor after cryosurgery. Hypoechoic areas and capsule interruptions observed by ultrasound imaging of prostate gland after cryosurgery are not correlated with tumor recurrence or tumor persistence. TRUS is only indicated for ultrasound-guided biopsies during follow-up and to confirm urologic complications.

Aged↗
PubMedDate not supplied

Cryosurgery as a means to improve surgical treatment of patients with multiple unresectable liver metastases.

BACKGROUND: The aim of the study was to evaluate the results of cryosurgery in patients with multiple (five or more), heavily pretreated, unresectable liver metastases. MATERIALS AND METHODS: Nineteen patients with multiple unresectable liver metastases were entered into a prospective nonrandomized trial. The liver tumours were treated during surgery under ultrasound guidance. All the patients were followed-up to assess complications, treatment response and sites of recurrence. RESULTS: 140 metastases were identified in 19 patients (mean, 7; range, 5-25) and 13 patients had a synchronous liver resection. Cryosurgery was used to treat 90 metastases (mean diameter, 30 mm; range, 10-135). There were no treatment-related deaths and the overall rate of complications was 21%. During a mean follow-up of 28 months (range, 5-60), tumours recurred at the site of cryosurgery in two patients (10%), in the remaining liver in nine patients (47%) and elsewhere in five patients (26%). Three patients had no evidence of disease 48, 50 and 60 months after liver cryosurgery, respectively. CONCLUSION: Cryosurgery may be effective in the treatment of patients with multiple unresectable liver metastases and should be investigated in multimodality treatment programmes.

Adenocarcinoma↗
PubMedDate not supplied

Cryosurgery as treatment modality for colorectal liver metastases.

Liver metastases occur in more than 40% of the patients with colorectal cancer. The best prospect of cure is achieved by resection of the metastases. Only 10-15% of the patients with colorectal metastases are candidates for resection. When resection is impossible, other treatment options are limited. Response rates to chemotherapy are around 40%, but survival benefit is generally limited to a few months. Recently, cryosurgery has provided a new therapeutic approach for unresectable colorectal liver metastases. The metastases are localized by ultrasonography and are subsequently frozen with the aid of cryosurgical equipment. The treatment results in necrosis of the tumor and is characterized by low mortality and acceptable morbidity. Experience with cryosurgery is limited, but the results are promising. Various studies report a 1-year survival of more than 70% and a 2-year survival of > 50%. Disease-free survival after 2 years varies between 20-29%. Recurrences in the liver are usually other lesions than those treated with cryosurgery. Cryosurgery in combination with resection or as sole treatment, can result in radical treatment for patients formerly considered unresectable. Resection of liver metastases, however, remains the gold standard in the treatment of liver metastases. The main indication for cryosurgery may be as a complement to hepatic resection in those patients in whom liver resection can not achieve complete tumor clearance.

Colorectal Neoplasms↗
PubMed2001

[Therapeutic effect of multimodal therapy, such as cryosurgery, locoregional immunotherapy and systemic chemotherapy against far advanced breast cancer].

A total of 6 breast cancer patients, 5 with local recurrent tumors on their anterior chest wall and 1 with far advanced primary breast tumor, underwent multimodal therapy in which cryosurgery was performed in combination with local injection of the non-specific immunopotentiator OK-432. This multimodal therapy was repeated as many times as possible. In addition, 3 patients whose general condition was relatively good were treated with mild chemotherapy. In every patient who underwent cryosurgery combined with locoregional immunotherapy, eradication or reduction of tumor was observed for several months. Of 3 patients who underwent cryosurgery, locoregional immunotherapy and systemic chemotherapy, the tumor burden decreased markedly in 2 patients and rapid tumor growth was suppressed in 1 patient, even though the diameter of tumor was over 5 cm in all cases. There were no side effects caused by either cryosurgery or locoregional immunotherapy. Little toxicity was observed throughout the mild chemotherapy. These results indicated that cryosurgery in combination with local injection of OK-432 should be a feasible modality against unresectable breast cancer on the chest wall, and that this therapeutic effect might be augmented by mild chemotherapy.

Aged↗
PubMed1999

Cryosurgery for recurrent prostate cancer following radiation therapy.

Patients with prostate cancer are commonly treated medically or undergo radical prostatectomy and/or radiation therapy. Radiation therapy is usually selected for patients with local or regional disease and patients for whom traditional surgery has failed. The local recurrence of cancer in patients treated with radiation therapy presents a difficult challenge regarding the selection of further treatment options. A commonly applied treatment is salvage prostatectomy, but it can be difficult and complicated, with positive surgical margins occurring in as many as 50 percent of patients and with significant postoperative morbidity. Hormonal therapy, which is not curative, has served as an alternative to surgery in patients who have failed to respond to radiation therapy. Cryosurgery, the destruction of diseased tissue by freezing, is increasingly used both as a first-line therapy and as a second-line therapy (salvage therapy) in patients for whom radiation therapy has failed. Recent reports suggest that cryosurgery may be a useful alternative procedure for treating some of these patients with recurrent cancers. Outcomes of cryosurgery are improving through better instrumentation, surgical technique, and experience. The available data suggest that some patients with radioresistant cancer appear to benefit from the use of cryosurgery as a salvage therapy. Use of this technique has resulted in biochemical disease-free survival for varying periods of some patients who had recurrent prostate carcinoma following radiation therapy; however, morbidity remains high and relatively few patients have had adequate followup. Salvage cryosurgery prospective clinical trials are warranted and would help determine long-term survival benefits and make possible the comparison of cryotherapy patient survival rates with those of untreated biopsy-positive patients.

Cryosurgery↗
PubMed2005

[Treatment of recurrent odontogenic keratocyst with enucleation and cryosurgery: a retrospective study of 10 cases].

PURPOSE: To evaluate the clinical outcomes of treatment of recurrent odontogenic keratocyst with enucleation and cryosurgery in 10 consecutive cases. METHODS: 10 patients with recurrent odontogenic keratocyst of the jaw were treated with enucleation and liquid nitrogen cryosurgery between 1994 and 2000. After enucleation of the cystic lining, liquid nitrogen (-196 degrees C) was applied to the bony walls via cotton rolls for cryosurgery. The time for cryosurgery was between 3 to 5 minutes with 3 cycles of freeze and thaw. All the patients were followed up for 5 to 10 years after treatment with regular clinical and radiographic examinations. Postoperative complications and the final outcomes were evaluated. RESULTS: No recurrence was noted within the follow-up period after combined treatment of enucleation and cryosurgery. Secondary wound healing developed in 1 patient due to accidental freezing of the adjacent tissues, and pathologic fracture of the mandible occurred in 1 patient. The fracture healed secondarily with intermaxillary fixation. CONCLUSION: Based on these results, the combination of enucleation and liquid nitrogen cryotherapy offers patients improved therapy in the management of recurrent odontogenic keratocysts of the jaw, with lower recurrence and avoidance of ostectomy, which is likely to be accepted by the patients.

Cryosurgery↗
PubMed1991

Natural killer cell activity following cryosurgery of normal and tumour bearing liver in an animal model.

Cryosurgery is a useful tool to treat unresectable liver carcinoma. In addition to the local effects of freezing, cryosurgery is thought to affect host immune response. We tested this by measuring natural killer (NK) cell cytotoxicity following cryosurgery of normal liver and an implanted liver tumour in the rat. Controls underwent sham cryosurgery. NK cytotoxicity was enhanced following cryosurgery of normal liver and liver tumour.

Animals↗
PubMed1990

[Changes in immunoparameters following cryosurgery in prostate cancer].

To determine the effect on immunoparameters of cryosurgery in cases of stage B prostatic cancer and to determine whether such changes were specifically related to the cryosurgery technique, immunoparameters were measured and compared with cases of prostatic hyperplasia treated by transurethral resection (TUR-P). A decrease in immunoparameters was recognized in the cryosurgery group at 1-3 days postoperatively (increase in IAP, decrease in NK cell activity, decrease in lymphocyte blastogenesis reaction to PHA). The protein histograms, immunoglobulin and IAP changed similarly after the two above procedures. These changes were thought to be due to the invasive nature of the procedures. However, some difference was seen between the cryosurgery group and the TUR-P group in terms of rate of lymphocyte blastogenesis reaction to PHA and Con A, IgG, complement and NK cell activity which might indicate a specific effect of cryosurgery different from TUR-P.

Aged↗