开放式磁共振引导肝癌的冷冻消融治疗疗效分析

目的 探讨在开放式磁共振(MRI)监视下、采用经皮穿刺方法 进行肝癌的冷冻消融治疗的疗效.方法 对60例HCC的肝肿瘤进行了冷冻消融治疗.采用新奥博为0.3-T开放式MRI系统,冷冻探针通过实时监视被置于消融病灶中.评估其临床体征、症状和实验室检验结果 ,并对冷冻消融治疗的疗效进行分析.结果 MRI引导下经皮穿刺冷冻消融治疗能精确到达肿瘤、彻底消融的目的 ,有血清肝酶水平临床上的改变,没有引起严重的并发症.结论 MRI引导下经皮穿刺的肝脏肿瘤冷冻消融治疗是可行和安全的.MRI能够在手术期间引导冷冻消融治疗,以及用于评估冷冻消融治疗的效果.     

开放式磁共振导航下经皮穿刺肝癌的冷冻消融治疗

目的:探讨在开放式磁共振(MRI)监视下、采用经皮穿刺方法进行肝癌冷冻消融治疗的可行性、疗效和安全性.方法:采用新奥博为0.3-T 开放式MRI系统对20例病人中的22个肝肿瘤进行冷冻消融治疗.冷冻探针通过实时监视被置于消融病灶中,冷冻消融术采取氩氦刀(Cryo-Hit),对临床体征、症状、实验室检验和影像学结果进行评估,并术后随访.结果:在MRI引导下经皮穿刺冷冻探针均成功置于病灶内,共对20例病人22个肝肿瘤进行了冷冻消融治疗(共24次治疗),手术期间MRI显示冰球扩展并包裹整个肿瘤,包裹肿瘤的冰球在MRI图像中呈现边缘清晰的信号暗区.使用一个冷冻探针形成最大的冰球为 5.0cm×2.5cm×2.5cm、使用4个冷冻探针形成的冰球最大为7.6cm×5.5cm×5.0cm.冷冻消融治疗有血清肝酶水平临床上的改变,没有引起严重的并发症.术后随访1-6月,肿瘤经影像检查体积缩小者5例,增大3例,无变化12例.手术切除肿瘤1例,病情进展死亡2例,死于消化道出血.结论:MRI引导下经皮穿刺的肝脏肿瘤冷冻消融治疗是可行和安全的.MRI能够在手术期间引导冷冻消融治疗,以及用于评估冷冻消融治疗的效果.     

氩氦刀冷冻消融辅助治疗骨巨细胞瘤三例早期临床报道

目的 探讨氩氦刀冷冻消融技术在治疗骨巨细胞瘤中的应用价值.方法 3例骨巨细胞瘤患者行肿瘤刮除植骨、内固定术,术中氩氦刀冷冻消融辅助灭活瘤体及瘤腔.比较冷冻消融前后肿瘤的病理组织学变化,观察术后皮肤、神经、血管等软组织并发症,评价早期关节功能.结果 术后无软组织损伤并发症,随访4个月,关节功能良好,无软骨退变,骨修复正常.结论氩氦刀冷冻消融技术辅助治疗骨巨细胞瘤安全有效.     

开放式磁共振导航下经皮穿刺肝癌的冷冻消融治疗

目的：探讨在开放式磁共振（MRI）监视下、采用经皮穿刺方法进行肝癌冷冻消融治疗的可行性、疗效和安全性。方法：采用新奥博为0．3-T开放式MRI系统对20例病人中的22个肝肿瘤进行冷冻消融治疗。冷冻探针通过实时监视被置于消融病灶中,冷冻消融术采取氩氦刀（Cryo—Hit）,对临床体征、症状、实验室检验和影像学结果进行评估,并术后随访。结果：在MRI引导下经皮穿刺冷冻探针均成功置于病灶内,共对20例病人22个肝肿瘤进行了冷冻消融治疗（共24次治疗）,手术期间MRI显示冰球扩展并包裹整个肿瘤,包裹肿瘤的冰球在MRI图像中呈现边缘清晰的信号暗区。使用一个冷冻探针形成最大的冰球为5．0cm×2．5cm×2．5cm、使用4个冷冻探针形成的冰球最大为7．6cm×5．5cm×5．0cm。冷冻消融治疗有血清肝酶水平临床上的改变,没有引起严重的并发症。术后随访1—6月,肿瘤经影像检查体积缩小者5例,增大3例,无变化12例。手术切除肿瘤1例,病情进展死亡2例,死于消化道出血。结论：MRI引导下经皮穿刺的肝脏肿瘤冷冻消融治疗是可行和安全的。MRI能够在手术期间引导冷冻消融治疗,以及用于评估冷冻消融治疗的效果。     

氩氦刀冷冻消融治疗肺癌的研究进展

肺癌的治疗方法包括传统外科手术、微创手术、分子靶向药物治疗、化学治疗、放疗等,其中氩氦刀冷冻消融治疗属于微创手术,是一种较为安全、有效的瞬时局部治疗肿瘤的方法,其消融范围可控、可监测,对周围正常组织损伤较小,具有降低肿瘤负荷、缓解肿瘤压迫或直接侵犯引起的疼痛、改善患者生活质量的作用.本文对肺癌的发病状况和常见治疗方法及氩氦刀冷冻消融治疗肺癌的研究进展作一综述.     

氩氦刀冷冻消融治疗脑胶质瘤的现状与展望

胶质瘤是中枢神经系统难治性肿瘤，冷冻消融治疗作为一种新兴的肿瘤治疗技术在胶质瘤治疗中的价值正逐渐被重视。本文回顾了大量文献，从病理及分子生物学角度总结了冷冻消融治疗胶质瘤的机制；通过众多临床病例分析了冷冻疗法的适用范围、临床疗效和存在的问题；基于国内外前瞻性研究展望了冷冻治疗胶质瘤的发展方向及前景。冷冻消融可以通过直接导致坏死和凋亡、改变局部微循环和调节抗肿瘤免疫等机制摧毁肿瘤细胞；在影像学技术实时监控下冷冻可以成为很好的手术辅助手段，现已取得了满意的临床效果；另外冷冻技术与化疗、放疗、免疫治疗等方法联合应用可更有利于发挥其治疗作用。随着冷冻设备的改进和冷冻技术的完善，冷冻消融将在胶质瘤治疗中占有重要的地位。      

肝脏恶性肿瘤的微创治疗

肝癌的微创治疗是指相对于传统肝切除术而言具有低创特征的治疗,应用于无肝切除指征或考虑切除疗效欠佳的小肝癌.目前微创治疗主要包括经皮穿刺射频消融治疗、经皮穿刺微波消融治疗、经皮穿刺冷冻消融治疗和经皮穿刺无水乙醇瘤内注射等.对于较大和多发肿瘤可与肝动脉介入治疗的联合应用提高疗效.通过肿瘤血清学指标和影像学检查来评价疗效.     

早期非小细胞肺癌局部消融联合免疫检查点抑制剂的研究进展

对于不适合手术的早期非小细胞肺癌患者,立体定向消融放射治疗是首选的治疗手段.近年来,射频消融、微波消融和冷冻消融等热消融治疗也渐见有报道.尽管局部消融治疗展现了良好的局部控制,但总体区域及远处转移率仍较高,因此,结合有效的全身治疗是探索的方向.立体定向消融放射治疗和热消融参与"癌症-免疫周期",可以促进肿瘤抗原释放、提...     

冷冻消融免疫效应的研究进展

冷冻消融术是一种肿瘤微创治疗，具有局部消瘤作用确切、不良反应小、安全性高等优势，并能激发体液免疫和细胞免疫，甚至诱导远处病灶消失即远位效应，因此具有局部和全身双重治疗效应。然而，冷冻消融引起的免疫效应可能出现免疫增强、免疫无应答或免疫抑制，这与癌症类型、坏死/凋亡比例、冷冻范围、冷冻速率、冷冻数量等密切相关。冷冻消融可增大坏死/凋亡比例，联合细胞过继疗法、粒细胞-巨噬细胞集落刺激因子、免疫检查点抑制剂、Toll样受体激动剂能够增强全身性免疫效应。然而，如何利用、加强冷冻消融的远位效应仍然是治疗肿瘤，尤其是晚期肿瘤的关键。      

胰腺癌冷冻治疗及冷冻免疫

胰腺癌是预后极差的肿瘤, 当前各种治疗手段效果均不佳。冷冻在各种实体瘤的治疗中已取得较好效果, 但在胰腺癌治疗中的作用报道甚少。体内外实验表明冷冻可毁损肿瘤细胞, 安全性好。临床研究显示: 冷冻为主综合治疗中晚期胰腺癌, 中位生存期达13.4~16个月, 1年生存率57.5%~63.6%;安全性好, 主要并发症为: 胃排空障碍的发生率为0~40.9%;胰漏发生率为0~6.8%;胆漏的发生率为0~6.8%。更为重要的是, 肿瘤冷冻消融后, 以坏死肿瘤细胞和细胞碎片的形式, 释放大量肿瘤抗原, 诱导冷冻后免疫, 可抑制肿瘤的生长和转移。将局部冷冻消融治疗与全身免疫治疗相结合, 可为中晚期肿瘤综合治疗提供新的治疗技术与方法。      

18F-脱氧葡萄糖-正电子发射型计算机断层显像与CT同机融合图像对氩氦刀治疗肺癌近期疗效的

 【摘要】　目的　观察肺癌经氩氦刀治疗后18F-脱氧葡萄糖-正电子发射型计算机断层显像与CT同机融合图像（18F-FDG PET-CT）显像的变化,寻找氩氦刀治疗后近期疗效评价的方法。方法　对15例肺癌患者19个病灶进行氩氦刀治疗,在治疗后1～6个月内完成18F-FDG PET-CT检查。其中7例患者治疗前后进行了18F-FDG PET-CT检查,8例仅治疗后进行了18F-FDG PET-CT检查,但可自身比较。冷冻治疗组织和对照组织最大标准化摄取值（SUVmax）的比较采用配对资料的t检验,冷冻治疗后PET-CT时间间隔与SUVmax检测采用重复测量方差分析。结果　术后18F-FDG PET-CT检查显示19个氩氦刀冷冻病灶,13个未见放射性核素的浓聚,在随访过程中未见肿瘤生长。2例纵隔型肺癌周边残留,表现为边界清楚的“梨形”放射性缺损,随访4个月左右发现肿瘤开始向周围扩展;4例冷冻的肿瘤组织内表现为放射性核素浓聚,均在半年内复发。肺内单发肿瘤氩氦刀治疗前后SUVmax定性和定量检测结果显示,差异有统计学意义（t＝3.784,P＜0.05）;但是对于冷冻治疗与PET-CT检查间隔时间对SUVmax变化的影响差异无统计学意义（F＝0.106,P＞0.05）。结论　18F-FDG PET-CT图像真实地反映了氩氦刀冷冻治疗的范围及效果,是氩氦刀冷冻治疗后近期效果评价较理想的方法。     

Review of primary and salvage cryoablation for prostate cancer.

BACKGROUND: Cryosurgery has gained popularity as a minimally invasive treatment option for primary and recurrent prostate cancer. Herein we present a review and summary reports on primary cryoablation for prostate cancer and salvage cryoablation following radiation failure. METHODS: We reviewed the current published literature in the English language on these topics, along with some historic articles dating back to the 1960s for background and development of the procedure. The material is supplemented by some commentary based on our own 13-year experience with cryoablation for prostate cancer. The review is divided into two sections: primary and salvage cryoablation. RESULTS: For primary cryoablation, success rates are proportional to the risk categories of the primary cancers. A pretreatment prostate-specific antigen (PSA) 10 ng/mL and post-cryoablation nadir PSA > 1 ng/mL for salvage procedures. Side effects are more prevalent and serious than with primary cryoablation but for carefully selected patients, the long-term results are favorable. CONCLUSIONS: Patient selection is the key to success with cryoablation, in both the primary and salvage setting. The modality can offer long-term cancer control in carefully selected patient with properly executed techniques.     

Cryoablation as a Replacement for Surgical Resection in Early Stage Breast Cancer

With improvements in technology, freezing malignant tissue (cryoablation) as an alternative to surgery has been used to treat cancers of the skin, prostate, liver, lung, and bone. There is significant interest in cryoablation of breast cancer. Potential advantages over lumpectomy include the minimally invasive nature of the treatment, improved cosmetic results, patient comfort, decreased costs, and the possible immune response to the ablated tissue. Several pre-clinical and clinical studies have demonstrated both the feasibility of breast cancer cryoablation and the generation of an anti-tumor immune response, and clinical experience with cryoablation of benign breast tumors is growing. The ongoing American College of Surgeons Oncology Group Trial Z1072, a phase II trial examining the success of breast cancer cryoablation, is an important first step in possibly replacing lumpectomy with cryoablation for a subset of breast cancer patients. This article reviews the breast cryoablation literature to date and discusses the directions the field needs to move in to realize that goal.     

A randomized trial of external beam radiotherapy versus cryoablation in patients with localized prostate cancer

BACKGROUND:

A recent randomized trial to compare external beam radiation therapy (EBRT) to cryoablation for localized disease showed cryoablation to be noninferior to external beam EBRT in disease progression and overall and disease‐specific survival. We report on the quality of life (QOL) outcomes for this trial.

METHODS:

From December 1997 through February 2003, 244 men with newly diagnosed localized prostate cancer were randomly assigned to cryoablation or EBRT (median dose 68 Gy). All patients received neoadjuvant antiandrogen therapy. Patients completed the EORTC QLQ C30 and the Prostate Cancer Index (PCI) before treatment and at 1.5, 3, 6, 12, 18, 24, and 36 months post‐treatment.

RESULTS:

Regardless of treatment arm, participants reported high levels of QOL with few exceptions. cryoablation was associated with more acute urinary dysfunction (mean PCI urinary function cryoablation = 69.4; mean EBRT = 90.7; P < .001), which resolved over time. No late arising QOL issues were observed. Both EBRT and cryoablation participants reported decreases in sexual function at 3 months with the cryoablation patients reporting poorer functioning (mean cryoablation = 7.2: mean EBRT = 32.9; P < .001). Mean sexual function score was 15 points lower at 3 years for the cryoablation group and 13% more of the cryoablation men said that sexuality was a moderate or big problem.

CONCLUSIONS:

In this randomized trial, no long‐term QOL advantage for either treatment was apparent with the exception of poorer sexual function reported by those treated with cryoablation. Men who wish to increase their odds of retaining sexual function might be counseled to choose EBRT over cryoablation. Cancer 2009. © 2009 American Cancer Society.     

博莱霉素冷冻消融增效作用的试验研究

[目的]通过体内试验探讨博莱霉素的冷冻消融增效作用。[方法]12只杂种家犬B超引导氩氦刀冷冻消融肝脏，然后静脉注射低剂量和常规剂量^131Ⅰ标记的博莱霉素，测定博莱霉素在肝脏不同部位的分布情况，研究比较各组动物肝脏消融灶大小和病理变化。[结果]术后3h单纯冷冻组（A组）、冷冻＋低剂量博莱霉素组（B组）和冷冻＋常规剂量博莱霉素组（C组）肝脏消融灶体积差异不显著（P〉0．05）。而术后第1d、3d、5d观察，均发现后两组肝脏消融灶体积均显著大于单纯冷冻组（P〈0．01），5d后三组消融体积分别为：13．44±0．7cm^3，18．84±1．5cm^3和19．78±2．2cm^3（B、C组与A组比较，P〈0．01；B组与C组比较，P〉0．05）。[结论]冷冻治疗可增加博莱霉素的细胞渗透率，冷冻术后较低浓度博莱霉素即有细胞毒性作用，冷冻联合博莱霉素具有增效作用。     

氩氦刀冷冻治疗荷瘤兔肝脏肿瘤的CT表现及病理分析

[目的]探讨冷冻治疗荷瘤兔肝脏肿瘤的CT与病理表现。[方法]两组试验兔行氩氦刀冷冻治疗，其中荷瘤冷冻治疗组（A组）17只，正常肝冷冻对照组（B组）12只。分别在术前、术后1周、2周、3周、4周行CT平扫和增强检查，将影像学表现与相应时期标本病理进行比较分析。[结果]A、B两组在术后1周、2周、3周均表现为消融区低密度、无强化，消融区边缘呈环形强化，但其强化的形态有所不同。术后4周，两组消融区平扫均表现为低密度区；强化扫描时，B组边缘强化环消失，而A组部分边缘未见强化，部分边缘仍见强化，且强化环较前明显扩大，病理提示强化部分有残瘤形成。[结论]治疗后4周的影像学特点是评价肝脏肿瘤冷冻消融治疗效果的重要依据。     

氩氦刀冷冻消融治疗原发性肝癌术后常见并发症及防治

目的探讨氩氦刀冷冻消融治疗肝硬化性、原发性肝癌并发症的防治。方法60例不宜手术切除的中晚期原发性肝癌患者,在超声引导下行氩氦刀冷冻消融治疗,观察术后并发症的发生并总结预防及治疗经验。结果肝硬化原发性肝癌氩氦刀冷冻消融治疗可出现多系统、多器官的并发症,经积极干预,并发症明显减少,部分可恢复。本组研究中胸腔积液比例明显高于文献,未出现致命性并发症。结论氩氦刀冷冻消融治疗肝硬化基础上的原发性肝癌是一种创伤小、疗效显著且安全的方法,其并发症是可防可控的。     

Immunological Aspects of Cryoablation of Non–Small Cell Lung Cancer: A Comprehensive Review

In cryoimmunotherapy, target tumors are treated with cryoablation to generate antitumor immune responses. Because immune checkpoint inhibitors have demonstrated that lung cancer can be an immunotherapy-responsive disease, there has been renewed interest in the immunological aspects of cryoablation of lung cancer. Herein, we review preclinical and clinical trials of cryoablation of primary lung tumors. We examine the magnitude of cryoablation-induced antitumor immune responses and the synergy between cryoablation and either other immunotherapies or molecular targeted therapies to improve treatment responses in advanced lung cancer. We further discuss a rationale for the addition of cryoablation to immune checkpoint inhibitors for the treatment of advanced lung cancer, which is currently under clinical investigation.     

Cryoablation of Small Renal Tumors

ObjectivesTo review the worldwide experience with cryoablation of small renal tumors.MethodsA systematic review was made of all English language publications on cryoablation of renal tumors as well as partial nephrectomy, radiofrequency ablation and high intensity focused ultrasound published prior to September 2006. The literature was reviewed and the findings analyzed.ResultsData from basic science and clinical trials supports renal cryoablation as a safe and effective method for treatment of small renal tumors. Clinical studies document less peri- and post-operative morbidity than laparoscopic partial nephrectomy. Basic science and clinical studies suggest superior efficacy with cryoablation as compared to radiofrequency ablation. Longer follow-up is needed before its true efficacy can be established.ConclusionLaparoscopic renal cryoablation, though evolving, appears to be a reasonable alternative for the treatment of small renal tumors in selected patients. Meticulous long-term clinical and radiologic follow-up will be critical for determining local recurrence and cancer-free survival rates, to establish the ultimate role of renal cryoablation in the management of small renal tumors.     

Cryosurgical ablation of renal cell carcinoma.

BACKGROUND: Small renal masses are being commonly diagnosed incidentally in older patients. A partial nephrectomy is the first-line nephron sparing treatment option for these lesions. However, probe ablative therapy such as cryoablation is emerging as an alternative option for select patients requiring nephron sparing surgery. METHODS: The current literature regarding the management of small renal lesions with cryoablation was retrospectively reviewed. We selected six of the largest published series of renal cryoablation with a total of 320 patients. The diagnosis, staging, treatment options, mechanism, efficacy and morbidity associated with renal cryoablation were evaluated. RESULTS: Renal cryoablation for localized small renal masses is well tolerated and associated with a low complication rate. The range of mean tumor size in our literature review series (320 patients) was 2.3 to 2.6 cm. After a range of mean follow-up of 5.9 to 72 months, including a series with a minimum of 5 years of follow-up, the cancer specific survival was 97% to 100% and overall patient survival was 82% to 90.2%. CONCLUSIONS: Renal cryoablation, based on available clinical reports, appears to be a curative option for patients with small localized renal cell carcinomas (RCCs) who are unwilling or unable to undergo a partial nephrectomy. With encouraging intermediate oncological follow-up available, longer-term follow-up is needed to validate the use of cryoablation as a primary treatment option.