Image-guided percutaneous cryotherapy for the management of gynecologic cancer metastases
Introduction
Cryotherapy has been used to treat cancer metastases as well as primary tumors since the 1960's. Though complication rates were unacceptable initially, recent advances in cryobiology and technology have allowed for the advancement of this therapy with minimally invasive methods and a safer approach.
In particular, using multiple smaller cryoprobes and image guidance allows the operator to sculpt the ice formation so it is tailored to each individual lesion [1], [2], [3]. The lower sedation requirements than heat-based ablations [e.g., radiofrequency (RF)] broadens options for patients of advanced age and/or co-morbidities. Cellular damage caused by cryotherapy is by direct injury due to ice crystal formation and cell microcirculatory failure [5]. In addition, some studies have shown that apoptosis is induced by the therapy particularly in the periphery of the treated zone which may impact a tumor's sensitivity to adjuvant therapy [5].
At our institution, cryotherapy has been used to manage recurrent painful metastases and isolated metastases in a variety of gynecologic cancers that were refractory to conventional therapy. We report our initial experience with image-guided percutaneous cryotherapy (IPC) for the palliative management of localized metastases in a series of patients with recurrent gynecologic malignancies.
Section snippets
Patients
Using the gynecologic oncology as well as the interventional radiology databases, gynecologic oncology patients treated with IPC between August 2003 and August 2007, were retrospectively identified. Clinical information was abstracted from cryotherapy procedure records and patients' electronic medical records. All cryotherapy procedures were performed and data collected under an Institutional Review Board (IRB) approved protocol and in compliance with the Health Insurance Portability and
Results
Twenty-eight ablation procedures were performed in 15 patients with gynecologic malignancies, covering the treatment of 41 metastatic foci. Repeat ablations were performed in 6 patients for developing multi-focal tumors that were different from the original ablated tumors. Three of these patients had primary ovarian tumors whereby 2 of these patients each had 5 ablation procedures for new abdominal foci while the third had 3 procedures for recurrent subcutaneous and skin metastases. Two other
Discussion
Patients who present with painful metastatic foci or with isolated metastases have a number of local treatment options, including surgical resection, radiofrequency ablation, radiation and cryotherapy. Surgical resection is associated with a 5-year survival of 38% in patients with colorectal cancer liver metastases, and is thus the current treatment of choice if the patient is an operative candidate. Success depends on margin status, the ability to leave enough normal tissue behind, the absence
Conflict of interest statement
PJL has served as a consultant and partial research sponsor of Endocare, Inc and as a cofounder of Cryodynamics, LLC. All other authors have no conflicts of interest to declare.
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