Cryoablation
Cryoablation, also known as cryosurgery or targeted cryoablation therapy, is a minimally invasive technique used to treat tumors and precancerous tissues by applying extremely low temperatures to destroy cancer cells in a localized area. This procedure typically involves the use of liquid nitrogen, alcohol, or argon gas delivered through probes inserted through small incisions, effectively freezing the targeted tissue. Cryoablation is particularly beneficial for tumors that are difficult to reach or inoperable due to their location or advanced stage, and it can serve as both a primary treatment and a palliative option for various cancers, including prostate, kidney, and breast cancer.
Preparation for cryoablation is minimal, requiring an intravenous line for sedation and basic blood work. The procedure, guided by imaging technologies such as CT or ultrasound, can last from thirty minutes to two hours. Most patients undergo the procedure with local anesthesia and can often return to normal activities within a couple of days. While generally safe, cryoablation does carry some risks, including potential damage to surrounding organs and complications specific to certain cancers. The advantages of cryoablation include lower complication rates, reduced hospital stays, and faster recovery times, making it a valuable option for patients seeking effective cancer treatment with less invasive methods.
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Cryoablation
ALSO KNOWN AS: Cryosurgery, targeted cryoablation therapy, ablation therapy
DEFINITION: Cryoablation is a minimally invasive method of treating tumors or other affected tissue using extremely cold temperatures to destroy cancer cells or precancerous cells in a localized area. Cryoablation uses liquid nitrogen, alcohol, or an argon gas-based system delivered through probes that are inserted through a small incision in the skin to freeze a particular area of the tumor and kill the cancerous tissue.
Cancers diagnosed or treated: Prostate, kidney, skin, liver, lung, bone, soft-tissue, pelvic cancers, and breast cancer; also used for some heart rhythm disturbances
Why performed: Cryoablation is often used when a tumor is not operable or removable because of the late stage of the cancer or its difficult location near major blood vessels or other organs not affected by the cancer. It may be used as a primary treatment for some cancers such as prostate cancer or as a palliative treatment for liver or other cancers to relieve pain and control cancer-related symptoms. Progress has been made in treating kidney cancers with cryoablation. Sometimes, cryoablation is added to other traditional treatments (radiation therapy or chemotherapy) for cancer. Cryoablation is also used to remove precancerous lesions, such as precancerous moles.
Patient preparation: Minimal preparation is needed for cryoablation. An intravenous (IV) line is started in the patient for sedation, and the patient’s blood work is checked. Some physicians may also prescribe an antibiotic as a preventive measure.
Steps of the procedure: The procedure may take as little as thrity minutes and as long as one to two hours. If the patient has cryoablation during an operation as an added treatment for the tumor, general anesthesia will be used and a hospital stay will be required. Most cryoablation procedures, however, can be done under local anesthesia and require little extended care.
An interventional radiologist performs cryoablation using image guidance. A computed tomography (CT) scan, ultrasound, or magnetic resonance imaging (MRI) helps the interventional radiologist guide the probe (usually multiple probes) into the tumor and avoid damage to any healthy tissue surrounding the tumor. A local anesthetic is given in the area overlying the tumor where the probe enters. The agent used (liquid nitrogen, alcohol, or argon gas) is delivered through the probe to freeze the tissue.
During freezing, an ice ball or crystals form inside and outside the cell spaces of the tumor tissue. The ice that forms inside the cell space leads to cell death by injury to the cell membrane, structures within the cell, or both. Ice that forms outside the cell space, where freezing is slower, causes cell death by creating a rush of the fluid moving in the space outside the cell. This causes the cell to burst and results in cell death by a deprivation of oxygen to the cell and the cell membrane.
After the procedure: Most cryoablations are outpatient procedures. The patient is monitored for a few hours. However, in some instances, the patient may have to stay overnight in the hospital. Drugs such as ibuprofen may be given to relieve a patient’s discomfort from having to remain in one position during the procedure.
Although there may be a few restrictions suggested by the physician, most patients can resume their daily activities within one or two days.
Risks: Depending on the type of tumor, side effects from cryoablation vary. The most common minor side effects are pain or bruising at the site, fever, nausea, local infection, fatigue, and temporary low platelet count not requiring transfusion. Most resolve within a week.
Major risks include freezing injury to organs near the tumor, fluid collection within the organ being treated, and puncture of the colon or other organs near the tumor that can result in major bleeding or infection.
For prostate cancer, impotence and loss of bladder control can be a major complication. A more recent cryoablation procedure for prostate cancer, called nerve-sparing cryoablation and focal prostate cryoablation, is being used to reduce the possibility of impotence and urinary incontinence.
Results: The advantages of cryoablation are low complication rates, ability to destroy local tumor tissue with minimal discomfort to the patient, reduction in hospital stay, shortened patient recovery time, less scarring, and lower cost (compared to surgery). It is an especially useful treatment for cancers that are otherwise untreatable and can enhance an individual’s quality of life through better symptom control.
For some cancers, such as lung and bone cancer, cryoablation is considered investigational, and health insurance companies may not cover the procedure.
Bibliography
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Bahn, Duke, et al. “Focal Prostate Cryoablation: Initial Results Show Cancer Control and Potency Preservation.” Journal of Endourology 20.9 (2006): 688–92. Print.
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Chung, Leland. Prostate Cancer: Biology, Genetics, and New Therapeutics. Totowa: Humana, 2001. Print.
Galati, Francesca, et al. “Cryoablation for the Treatment of Breast Cancer: Immunological Implications and Future Perspectives. Utopia or Reality?” La Radiologia Medica 129.2 (2024): 222-228. doi:10.1007/s11547-024-01769-z. Accessed 9 July 2024.
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