Meta-analysis of transarterial chemoembolization combined with cryoablation vs transarterial chemoembolization alone for≥5 cm hepatocellular carcinoma

BACKGROUND Hepatocellular carcinoma(HCC)ranks sixth globally in cancer incidence and third in mortality rates.Unfortunately,over 70% of HCC patients forego the opportunity for curative surgery or liver transplantation due to inadequate physical examinations,poor physical condition,and limited organ availability upon diagnosis.Clinical guidelines endorse transarterial chemoembolization(TACE)as the frontline treatment for intermediate to advanced-stage HCC.Cryoablation(CRA)is an emerging local ablative therapy increasingly used in HCC management.Recent studies suggest that combining CRA with TACE offers complementary and synergistic effects,potentially improving long-term survival rates.However,the superiority of combined TACE+CRA therapy over TACE alone for HCC lesions equal to or exceeding 5 cm requires further investigation.AIM To compare the efficacy and safety of TACE combined with CRA vs TACE alone in the treatment of HCC with a diameter of≥5 cm.METHODS PubMed,EMBASE,Cochrane Library,CNKI,Wanfang,and VIP databases were searched to retrieve all relevant studies on TACE and CRA up to July 2022.Meta-analysis was performed using RevMan 5.3 software.RESULTS After screening according to the inclusion and exclusion criteria,6 articles were included,including 2 randomized controlled trials and 4 nonrandomized controlled trials,with a total of 575 patients included in the meta-analysis.The results showed that the objective response rate[odds ratio(OR)=2.56,95%confidence interval(CI):1.66-3.96,P<0.0001],disease control rate(OR=3.03,95%CI:1.88-4.89,P<0.00001),1-year survival rate(OR=3.79,95%CI:2.50-5.76,P<0.00001),2-year survival rate(OR=2.34,95%CI:1.43-3.85,P=0.0008),and 3-year survival rate(OR=3.34,95%CI:1.61-6.94,P=0.001)were all superior to those of the control group;the postoperative decrease in alpha-fetoprotein value(OR=295.53,95%CI:250.22-340.85,P<0.0001),the postoperative increase in CD4 value(OR=10.59,95%CI:8.78-12.40,P<0.00001),and the postoperative decrease in CD8 value(OR=6.47,95%CI:4.44-8.50,P<0.00001)were also significantly higher than those in the TACE-alone treatment group.CONCLUSION Compared with TACE-alone treatment,TACE+CRA combined treatment not only improves the immune function of HCC patients with a diameter of≥5 cm,but also enhances the therapeutic efficacy and long-term survival rate,without increasing the risk of complications.Therefore,TACE+CRA combined treatment may be a more recommended treatment for patients with HCC with a diameter of≥5 cm.

Cryoablation of osteoid osteomas:Is it a valid treatment option?

BACKGROUND Osteoid osteoma is a benign bone tumor with characteristic clinical symptomatology.The selected method for its treatment is percutaneous radiofrequency ablation.However,percutaneous cryoablation is an alternative method with certain advantages.AIM To evaluate percutaneous computed tomography(CT)-guided cryoablation for the treatment of osteoid osteoma in young patients and adults.METHODS A total of 25 patients were treated with percutaneous CT-guided cryoablation for osteoid osteomas between October 2020 and March 2023 at a single institution.All patients were above 14-years-old(mean age,24-years-old),and all procedures were performed under local anesthesia.Of the 25 patients,8 were female and 17 were male.Tumor sites included the femur(n=9),medial malleolus(n=4),sacral ala(n=4),facets(n=4),humerus(n=3),and tibia(n=1).One cryoprobe was used in each procedure and,when possible,the lesion was covered by the ice-ball using an extraosseous position without penetrating the nidus.All necessary thermal protective techniques were used depending on the anatomical structure at risk.RESULTS All patients treated had complete response(100%clinical success rate)starting on the day of the procedure.Technical success was achieved in all cases.Visual analog scale(VAS)scores at 1 year were 0,compared to a mean VAS score of 8.5±1(SD)before the procedure.No recurrences were reported at the 1-year follow-up and no complications were observed.In 11/25 cases,an extraosseous position of the cryoprobe was used with less procedural time achieving technical and clinical success and no complications with less patient discomfort.All patients were discharged from the hospital on the same day as the procedure.CONCLUSION Cryoablation of osteoid osteomas is an efficacious and safe procedure with durable clinical results.Its greatest advantage is that the procedure can be performed under local anesthesia using an extraosseous position of the cryoprobe when possible.

Cryoablation techniques in bladder cancer: A review

Bladder cancer(BC)ranks as the tenth most common cancer globally.Histopathologically,BC is broadly categorized into urothelial and non-urothelial BC.Urothelial carcinoma represents over 90%of BC in most regions worldwide.The standard treatment procedure for diagnosing and treating non-muscle-invasive bladder cancer(NMIBC)is transurethral resection of bladder tumors(TURBT).Currently,the standard of care for muscle-invasive bladder cancer(MIBC)is neoadjuvant chemotherapy followed by radical cystectomy.Cryoablation therapy is a medical technique that uses extremely low temperatures to destroy diseased tissue.This treatment serves as a therapeutic tool for both benign and malignant diseases in organs such as the kidney,prostate gland,lung,liver,and breast,and is particularly effective for unresectable tumors,offering less trauma,quick recovery,good tolerability,and symptom control.However,cryoablation has its limitations.Over the past few years,cryoablation therapy has emerged as a new method for treating early BC.This treatment is minimally invasive,precise,and offers quick recovery,providing patients with a new treatment option.Although randomized studies are still limited,increasing evidence suggests its potential application in bladder cancer combined with transurethral resection(TURBT)or medication.Cryoablation is not standard therapy for bladder cancer.Treatment decisions should be discussed by a multidisciplinary team of urologists,oncologists,and interventional physicians and require more randomized controlled trials to define patient selection criteria and treatment approaches.

Cryoablation for intrapulmonary bronchial cyst:A case report

BACKGROUND Bronchial cysts are congenital malformations usually located in the mediastinum,and intrapulmonary localization is very rare.Cryoablation is a novel therapeutic approach that promotes tumor necrosis and stimulates anti-tumor immune responses.CASE SUMMARY This article reports a case of a 68-year-old male patient who was diagnosed with an intrapulmonary bronchogenic cyst by computed tomography examination and pathology,and the patient subsequently underwent cryoablation therapy and achieved complete response with after 3 months of follow-up.CONCLUSION Intrapulmonary bronchogenic cysts are very rare,cryoablation therapy is feasible,safe,and effective for intrapulmonary bronchial cysts.

Argon-helium cryoablation treatment of undifferentiated pleomorphic sarcoma of the thyroid:A case report and literature review

Undifferentiated pleomorphic sarcoma is an extremely rare malignant thyroid tumor.Thyroid sarcoma differs from common malignant thyroid tumors,such as thyroid follicular cell carcinoma.It is usually highly malignant,progresses rapidly,and is prone to remote metastasis.Currently,there is no standard protocol for the treatment of thyroid sarcomas,and most treatment effects are unsatisfactory.Argon-helium cryoablation is an important method of local treatment that is widely used in patients with unresectable advanced tumors.However,owing to the low incidence of thyroid sarcomas,there are no relevant literature reports on the treatment of thyroid sarcomas using cryoablation in China.This study reports the case of a patient with undifferentiated pleomorphic sarcoma of the thyroid gland who was treated with argon-helium cryoablation,and the immediate outcome was good.Based on a review of relevant literature,we discussed the effectiveness and safety of argon-helium cryoablation treatment,to provide clinical guidance and references for the treatment of patients with thyroid sarcoma.

Prostate cryoablation:A mini review

In recent years,cryotherapy has gained increasing acceptance as a treatment for prostate cancer,offering complementary therapeutic benefits when combined with radical surgery and radiotherapy.Despite the potential for surgical complications,it stands as a safe and viable therapeutic modality.Cryotherapy provides an efficient approach for elderly patients,especially those with compromised physical conditions and individuals experiencing recurrence after initial treatment.It has shown promise in extending survival periods and improving the overall quality of life for these patients.This article aims to comprehensively examine the developmental trajectory,surgical techniques,indications,therapeutic outcomes,and potential complications associated within prostate cancer treatment.

Combination treatment with comprehensive cryoablation and immunotherapy in metastatic hepatocellular cancer

AIM: To retrospectively assess the effect of comprehensive cryosurgery (ablation of intraand extra-hepatic tumors) plus dendritic cell-cytokine-induced killer cell immunotherapy in metastatic hepatocellular cancer. METHODS: We divided 45 patients into cryo-immunotherapy (21 patients), cryotherapy (n = 12), immunotherapy (n = 5) and untreated (n = 7) groups. Overall survival (OS) after diagnosis of metastatic hepatocellular cancer was assessed after an 8-year follow-up. RESULTS: Median OS was higher following cryo-immu-notherapy (32 mo) or cryotherapy (17.5 mo; P < 0.05) than in the untreated group (3 mo) and was higher in the cryo-immunotherapy group than in the cryotherapy group (P < 0.05). In the cryo-immunotherapy group, median OS was higher after multiple treatments (36.5 mo) than after a single treatment (21 mo; P < 0.05). CONCLUSION: Cryotherapy and, especially, cryoimmunotherapy significantly increased OS in metastatic hepatocellular cancer patients. Multiple cryo-immunotherapy was associated with a better prognosis than single cryo-immunotherapy.

Observation of the effect of targeted therapy of 64-slice spiral CT combined with cryoablation for liver cancer

AIM to observe the effect of targeted therapy with 64-slice spiral computed tomography (CT) combined with cryoablation for liver cancer. METHODS A total of 124 patients ( 142 tumors) were enrolled into this study. According to the use of dual-slice spiral CT or 64-slice spiral CT as a guide technology, patients were divided into two groups: dual-slice group (n = 56, 65 tumors) and 64-slice group (n = 8, 77 tumors). All patients were accepted and received targeted therapy by an argon-helium superconducting surgery system. The guided scan times of the two groups was recorded and compared. In the two groups, the lesion ice coverage in diameter of >= 3 cm and < 3 cm were recorded, and freezing effective rate was compared. Hepatic perfusion values [ hepatic artery perfusion (HAP), portal vein perfusion (PVP), and the hepatic arterial perfusion index (HAPI)] of tumor tissues, adjacent tissues and normal liver tissues at preoperative and postoperative four weeks in the two groups were compared. Local tumor changes were recorded and efficiency was compared at four weeks post-operation. Adverse events were recorded and compared between the two groups, including fever, pain, frostbite, nausea, vomiting, pleural effusion and abdominal bleeding. RESULTS Guided scan times in the dual-slice group was longer than that in the 64-slice group (t = 11.445, P = 0.000). The freezing effective rate for tumors < 3 cm in diameter in the dual-slice group (81.58%) was lower than that in the 64-slice group (92.86%) (chi(2) = 5.707, P = 0.017). The HAP and HAPI of tumor tissues were lower at four weeks post-treatment than at pretreatment in both groups (all P < 0.05), and those in the 64-slice group were lower than that in the dual-slice group ( all P < 0.05). HAP and PVP were lower and HAPI was higher in tumor adjacent tissues at post-treatment than at pre-treatment ( all P < 0.05). Furthermore, the treatment effect and therapeutic efficacy in the dual-slice group were lower than the 64-slice group at four weeks post-treatment (all P < 0.05). Moreover, pleural effusion and intraperitoneal hemorrhage occurred in patients in the dual-slice group, while no complications occurred in the 64-slice group (all P < 0.05). CONCLUSION 64-slice spiral CT applied with cryoablation in targeted therapy for liver cancer can achieve a safe and effective freezing treatment, so it is worth being used.

Advances in cryoablation for pancreatic cancer

Pancreatic carcinoma is a common cancer of the digestive system with a poor prognosis. It is characterized by insidious onset, rapid progression, a high degree of malignancy and early metastasis. Atpresent, radical surgery is considered the only curative option for treatment, however, the majority of patients with pancreatic cancer are diagnosed too late to undergo surgery. The sensitivity of pancreatic cancer to chemotherapy or radiotherapy is also poor. As a result, there is no standard treatment for patients with advanced pancreatic cancer. Cryoablation is generally considered to be an effective palliative treatment for pancreatic cancer. It has the advantages of minimal invasion and improved targeting, and is potentially safe with less pain to the patients. It is especially suitable in patients with unresectable pancreatic cancer. However, our initial findings suggest that cryotherapy combined with 125-iodine seed implantation, immunotherapy or various other treatments for advanced pancreatic cancer can improve survival in patients with unresectable or metastatic pancreatic cancer. Although these findings require further in-depth study, the initial results are encouraging. This paper reviews the safety and efficacy of cryoablation, including combined approaches, in the treatment of pancreatic cancer.

Tumour seeding after percutaneous cryoablation for hepatocellular carcinoma

AIM:To assess the rate and risk factors for tumour seeding in a large cohort of patients.METHODS:Over an 8-year period,1436 hepatocellular carcinoma(HCC) patients with 2423 tumour nodules underwent 3015 image-guided percutaneous cryoablation sessions [1215 guided by ultrasonography and 221 by spiral computed tomography(CT)].Follow-up CT or magnetic resonance imaging was performed every 3 mo.The detailed clinical data were recorded to analyse the risk factors for seeding.RESULTS:The median follow-up time was 18(range 1-90) mo.Seeding was detected in 11 patients(0.76%) at 1-24(median 6.0) mo after cryoablation.Seeding occurred along the needle tract in 10 patients and at a distant location in 1 patient.Seeded tumours usually showed similar imaging and histopathological features to the primary HCCs.Univariate analyses identified subcapsular tumour location and direct subcapsular needle insertion as risk factors for seeding.Multivariate analysis showed that only direct subcapsular needle insertion was an independent risk factor for seeding(P = 0.017;odds ratio 2.57;95%CI:1.47-3.65).Seeding after cryoablation occurred earlier in patients with poorly differentiated HCC than those with well or moderately differentiated HCC [1.33 ± 0.577 mo vs 11.12 ± 6.896 mo;P = 0.042;95%CI:(-19.115)-(-0.468)].CONCLUSION:The risk of seeding after cryoablation for HCC is small.Direct puncture of subcapsular tumours should be avoided to minimise seeding.

Sorafenib Combined with Cryoablation to Treat Unresectable Hepatocellular Carcinoma

Objective：To evaluate the efficacy and tolerability of sorafenib combined with cryoablation in treating unresectable hepatocellular carcinoma （HCC）.Methods：Patients with unresectable advanced HCC received cryoablation and sorafenib at a dose of 400 mg twice daily in 4-week cycles on the same day of the cryoablation.Tumor response,median overall survival and the median time to radiological progression were calculated and the toxicity was evaluated.Results：Seventy-eight patients with unresectable HCC were involved in this study.The median age was 52 years （range,22-81 years）.The Eastern Cooperative Oncology Group （ECOG） performance status scores were 0 （39.7%）,1 （55.1%）,and 2 （5.1%）.Nine （11.5%） patients were at Barcelona clinic liver cancer （BCLC） stage A,twenty-four （30.8%） patients were at stage B and 45 （57.7%） patients were at stage C.Five （6.4%） achieved partial responses,and 34 （43.6%） achieved stable disease.The median time to progression （TTP） for all enrolled patients was 6.6 months and the median overall survival （OS） was 12.2 months.Conclusion：Cryoablation combined with sorafenib demonstrates good efficacy and acceptable tolerability in treating unresectable advanced HCC patients.

The biochemical efficacy of primary cryoablation combined with prolonged total androgen suppression compared with radiotherapy on high-risk prostate cancer： a 3-year pilot study

To gain beneficial effects in the management of high-risk prostate cancer, an integrated approach that combines local therapy and androgen deprivation therapy （ADT） was used. We compared biochemical responses between primary cryosurgical ablation of the prostate （CSAP） combined with prolonged ADT and radiation combined with ADT, which is the established modality in high-risk disease. A total of 33 high-risk patients received CSAP combined with ADT for 3 months before and up to 24 months after treatment. This patient group was matched with another 33 patients who had undergone three-dimensional conformal radiation therapy （3D-CRT） with the same protocol for ADT. Biochemical recurrence （BCR） was assessed by the American Society for Therapeutic Radiation Oncology （ASTRO） definition, the Phoenix definition and a prostate-specific antigen （PSA） cutoff of 0.5 ng mL^-1. Median follow-up was 61.0 ± 11.9 months for the CSAP ＋ ADT group and 86.0±15.8 months for the 3D-CRT ＋ ADT group. In the CSAP group, major complications including rectourethral fistula and incontinence were not noted. In the CSAP ＋ ADT group, 57.0% had BCR using the ASTRO definition, 21.2% using the Phoenix definition and 54.5% using a PSA cutoff of 0.5 ng mL^-1. In the 3D-CRT ＋ ADT group, 54.5%, 21.2% and 54.5% had BCR using the ASTRO, Phoenix and PSA definition, respectively. In the CSAP ＋ ADT group, the BCR-free survival （BRFS） was 54 ± 10 months using the ASTRO definition, 65 ± 5 months using the Phoenix definition and 51 ± 4 months using a PSA cutoff of 0.5 ng mL-1. In the 3D-CRT ＋ ADT group, the BRFS was 68 ± 12, 93 ± 19 and 70 ± 18 months using the ASTRO, Phoenix and PSA definition, respectively. By the log-rank test, the BRFS values for each group were not statistically different. This intermediate-term result indicated that primary CSAP combined with prolonged ADT offers a parallel biochemical response compared with radiotherapy in high-risk prostate cancer.

Catheter ablation of atrial fibrillation: Radiofrequency catheter ablation for redo procedures after cryoablation

AIM: To evaluate the effectiveness of two different strategies using radiofrequency catheter ablation for redo procedures after cryoablation of atrial fibrillation.METHODS: Thirty patients(paroxysmal atrial fibrillation: 22 patients,persistent atrial fibrillation: 8 patients) had to undergo a redo procedure after initially successful circumferential pulmonary vein(PV) isolation with the cryoballoon technique(Arctic Front Balloon,CryoCath Technologies/Medtronic).The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy(CARTO;Biosense Webster) depending on the intra-procedural findings.After discharge,patients were scheduled for repeated visits at the arrhythmia clinic.A 7-day Holter monitoring was performed at 3,12 and 24 mo after the ablation procedure.RESULTS: During the redo procedure,a mean number of 2.9 re-conducting pulmonary veins(SD ± 1.0 PVs) were detected(using a circular mapping catheter).In 20 patients,a segmental approach was sufficient to eliminate the residual pulmonary vein conduction because there were only a few recovered pulmonary vein fibres.In the remaining 10 patients,a circumferential ablation strategy was used because of a complete recovery of the PV-LA conduction.All recovered pulmonary veins could be isolated successfully again.At 2-year follow-up,73.3% of all patients were free from an arrhythmia recurrence(22/30).There were no major complications.CONCLUSION: In patients with an initial circumferential pulmonary vein isolation using the cryoballoon technique,a repeat ablation procedure can be performed safely and effectively using radiofrequency catheter ablation.

Image-guidedcryoablation in unresectable or recurrent advanced colorectal cancer:a retrospective study

Purpose: The present study retrospectively analyzed thesafety and efficacy of computed tomography(CT)-guided cryoablationin the treatment ofunresectable or recurrent advanced colorectal cancer, which did not respond well to or experienced progression with radiotherapy or chemotherapy. Materials and Methods: From January 2013 to April 2015, 31 lesions in 27 patients(16 males, 11 females; mean age of 57.2 years) with pelvic unresectableadvanced or recurrent colorectal cancer were included in the study.The tumor diameter was approximately 3.37 ±1.41 cm. The primary tumor included 25 rectal cancers, 1 sigmoid colon adenocarcinoma, and 1 ileocecal mucinous adenocarcinoma. Cryoablation was performed with 17-gauge cryoprobes and monitored by 64-slice spiral CT. Follow-up was carried out by contrast-enhanced magnetic resonance imaging(MRI). The treatment efficacy was evaluated by symptom palliation, decreased carcinoembryonic antigen(CEA) serum level, and tumor response. Results: The cryoablation procedure was well-tolerated in all patients without major complications or procedure-related mortality. Long-term complications included abscess formation(1 patient), skin frostbite and post-sacrum antrum formation(1 patient). Pain relief was satisfactory in patients with perineal pain(P<0.001), and the median time of pain relief was 3.0 months. Complete ablations were obtained in 22 lesions of 18 patients, while 9 lesions in 9 patients underwent incomplete ablation. The median time to local recurrence for lesions with complete ablations was 15.0 months, and that to the progression of tumors with incomplete ablation was 4.0 months. Conclusion: CT-guided cryoablation is a minimally invasive, safe, and effective therapeutic option for unresectableadvanced or recurrent colorectal cancer. The treatment is well-tolerated by patients, and pain relief is achieved rapidly.

Expressions of MVD, VEGF, Ki67 in Residual Prostate Cancer after Cryoablation

OBJECTIVE To analyze the effects of cryoablation on the mice bearing Rm-I prostate cancer through detecting tumor angiogenesis and cancer cell proliferation in the mice after cryoablation, and to explore the effects of cryoablation on vascular endothelium growth factor （VEGF）, Ki67 protein expression and microvessel density （MVD） in the mice bearing prostate cancer. METHODS Sixty Rm-1 mouse models of prostate cancer were established. Experimental mice were randomized into 2 groups： the cryoablation group （n = 30） and the control group （n = 30）. After file therap）4 tumor tissues of the mice in group A and B were obtained at day 0 （without cryoablation）, 1st, 3rd, 5th, 7th, 14th day, respectivelj6 after cryoablation, and the expressions of MVD, VEGF and Ki67 proteins were detected at the same time points. RESULTS The expressions of MVD, VEGF and Ki67 proteins in group A were decreased. The lowest values of the factors were detected on the 3rd day after cryoablation, and increased slowly after that. The expressions of MVD, VEGF and Ki67 proteins in the control group were not changed. Significant changes of the expressions of MVD, VEGF and Ki67 proteins in the group A were found at different time points. Correlation analysis suggested a positive correlation between the expressions of VEGF and MVD proteins （r = 0.8793）, a positive correlation between the expressions of Ki67 and MVD proteins （r = 0.7614）, and a positive correlation between the expressions of VEGF and ki67 proteins （r = 0.6921）. CONCLUSION After argon-helium cryoablation treatment for the mice bearing prostate cancer, the expressions of MVD, VEGF and Ki67 proteins in local tumor were reduced on the 1st day. The lowest values of the factors were detected on the 3rd day after cryoablation, and then increased after that. Cryoablation combined with other modalities of treatment may effectively improve the treatment effects of cryoablation for prostate cancer.

Cryoablation combined with radiotherapy for hepatic malignancy:Five case reports

BACKGROUND The survival of patients treated with monotherapy for hepatic malignancies is not ideal.A comprehensive program of cryoablation combined with radiotherapy for the treatment of hepatic malignancies results in less trauma to the patients.It may provide an option for the treatment of patients with advanced hepatic malignancies.CASE SUMMARY We reported 5 cases of advanced-stage hepatic malignancies treated in our hospital from 2017-2018,including 3 cases of primary hepatocellular carcinoma and 2 cases of metastatic hepatic carcinoma.They first received cryoablation therapy on their liver lesions.The procedure consisted of 2 freeze-thaw cycles,and for each session,the duration of freezing was 13-15 min,and the natural rewarming period was 2-8 min.Depending on the tumor size,the appropriate cryoprobes were selected to achieve complete tumor ablation to the greatest extent possible.After cryoablation surgery,intensity-modulated radiotherapy(IMRT)for liver lesions was performed,and the radiotherapy regimen was 5400 cGy/18f and 300 cGy/f.None of the 5 patients had adverse events above grade II,and their quality of life was significantly improved.Among them,4 patients were free of disease progression in the liver lesions under local control,and their survival was prolonged;3 patients are still alive.CONCLUSION Our clinical practice demonstrated that cryoablation combined with IMRT could be implemented safely.The definitive efficacy for hepatic malignancies needs to be confirmed in larger-size sample prospective studies.

Feasibility of CT-CT fusion imaging for evaluation of the cryoablation margins in visible hepatocellular carcinoma on unenhanced CT images:Initial experience

Objective:To demonstrate the feasibility of CT-CT fusion imaging for assessment of the cryoablation margins in visible hepatocellular carcinoma(HCC)on unenhanced CT images.Methods:This retrospective study analyzed 14 patients with 14 HCC lesions treated with CT-guided cryoablation.Nine lesions in nine patients who developed local tumor progression(LTP)during the follow-up period of at least8 months were reviewed.The unenhanced CT data were used to retrospectively create fusion images of the intraoperative CT images on a workstation.The minimal ablative margin(MAM)was assessed on the fusion images.The concordance between the site of LTP and the MAM area was also assessed.Results:Eight of the nine lesions with LTP were in the subcapsular region of the liver.Seven of the nine cases were treated by cryoablation combined with transcatheter arterial chemoembolization.The median time required to fuse the images for the nine lesions was 5:17 min(range,5:04-7:37 min).The site of LTP relative to the HCC lesion was craniocaudal in nine,dorsoventral in six,and lateral in seven lesions.In all lesions,the site of LTP was congruent with the MAM area.Conclusions:CT-CT fusion imaging enables a real-time intraoperative treatment evaluation for HCC lesions visible on unenhanced CT images.Fused imaging evaluation has proved to be an accurate and useful tool for assessment of the cryoablation margins.

Cryoablation Combined with TACE for Treating Large Hepatocellular Carcinoma： Tumor Load and Cellular Immunity

OBJECTIVE To study the effectiveness on the tumor load and cellular immune function of percutaneous cryoablation （argon-helium cryoablative system, AHCS） combined with transarterial chemoembolization （TACE） for treating large hepatocellular carcinomas （HCCs） with diameters over 10 ca. METHODS A total of 48 HCC patients were treated with AHCS after TACE. Tumor sizes ranged from 10 to 14 cm. All cases were a hypervascular type. There were 38 Child A cases and 10 Child B cases. Forty were AFP positive and 8 negative. The patients were randomized with therapy group consisting of 26 cases and the control group 22 cases. The therapy group received AHCS 4 weeks following TACE treatment. Reexamination included pathology, tumor markers, T-lymphocyte subgroup levels and computed tomography or MRI. The necrosis rate of the tumor load was calculated by Cavalieri＇s theory. EORTC QLQ-C30 was used in quality of life evaluation. RESULTS The average tumor-load reduction rate （necrosis rate） was 8.07% after TACE, and 28.65% after AHCS. Coagulation necrosis was produced in the target area. The tumor markers deceased significantly after AHCS. Tumor-load reduction after AHCS was more significant than after TACE. Suppression of cellular immunity after TACE was significant. In contrast, CD3^＋, CD4^＋ and NK increased after AHCS and an abnormal T-lymphocyte distribution was corrected. Quality of life after AHCS increased according to the EORTC QLQ-C30 evaluation. No severe complications occurred. CONCLUSION Percutaneous AHCS cryoablation after TACE reduced the tumor load in the short term. At the same time, cellular immune function was increased after AHCS. TACE was critical in increasing the therapeutic efficacy of AHCS because of its embolisation of blood vessels preventing a Flow Effect. Reduction of the tumor load in the short term may conduce to increase cellular immunity. Percutaneous AHCS cryoablation combined with TACE can reduce the tumor load, improve cellular immunity and increase quality of life of HCC patients. This type of therapy deserves to be studied further research.

Cryoablation for liver metastasis from solid pseudopapillary tumor of the pancreas: A case report

BACKGROUND Solid pseudopapillary tumor(SPT) of the pancreas is a rare pancreatic tumor and 10% to 15% of cases are associated with metastasis. Cryoablation is a new method that can induce tumor necrosis, and treatment of tumors by cryoablation can cause anti-tumor immune responses.CASE SUMMARY A 16-year-old woman with SPT of the pancreas developed liver metastases 5.3 years after complete resection of the primary pancreatic tumor. She was admitted with chief complaints of abdominal pain in the upper abdomen and a weight loss of approximately 5 kg over 4 mo. Carbohydrate antigen(CA) 125,carcinoembryonic antigen, and CA 199 were normal. An abdominal computed tomography scan found multiple nodules in the right lobe of the liver that measured approximately 13.5 cm × 10.8 cm × 21.4 cm. Immunohistochemical staining results showed that CD10 and CD56 were positive, and the patient was diagnosed with SPT of the pancreas with liver metastasis. The patient underwent percutaneous cryoablation and interventional embolization. During the 5-year follow-up, the patient remained disease-free after cryoablation, with relatively normal immune function.CONCLUSION Herein, we for the first time report the treatment of liver metastasis from SPT of the pancreas using cryoablation plus interventional embolization, which could be a promising alternative therapy for pancreatic SPT liver metastasis.

Argon-helium cryoablation for thoracic vertebrae with metastasis of hepatocellular carcinoma-related hepatitis B: A case report

BACKGROUND Spinal metastasis of hepatocellular carcinoma(HCC) is rare, with an extremely poor prognosis and results in severe pain. Argon-helium cryotherapy is a local ablation method for HCC.CASE SUMMARY A 54-year-old man was diagnosed with HCC related to hepatitis B one year ago and underwent surgical tumor resection and tenofovir antiviral treatment.However, a new lesion developed on the right liver after 1 mo. Transarterial chemoembolization was performed four times. One month ago, the patient developed back pain, and metastasis on the 11 th thoracic vertebra was detected.Argon-helium cryoablation was performed to treat the right occupancy and metastatic lesion, which immediately alleviated the pain and prolonged survival.CONCLUSION The use of argon-helium cryoablation for thoracic vertebrae with metastasis of HCC achieved favorable results.