Review

Authors: Zenan Chen, Liangliang Meng, Jing Zhang...

With the rapid advancement of imaging equipment and minimally invasive technology, cryoablation technology is being used more frequently in minimally invasive treatment of tumors, primarily for patients with early tumors who voluntarily consent to ablation as well as those with advanced tumors that cannot be surgically removed or cannot be tolerated. Cryoablation is more effective and secure for target lesions than other thermal ablation methods like microwave and radiofrequency ablation (RFA). The study also discovered that cryoablation, in addition to causing tumor tissue necrosis and apoptosis, can facilitate the release of tumor-derived autoantigens into the bloodstream and activate the host immune system to elicit beneficial anti-tumor immunological responses against primary. This may result in regression of the primary tumor and distant metastasis. The additional effect called " Accompanying effects ". It is the basis of combined ablation and immunotherapy for tumor. At present, there is a lot of research on the mechanism of immune response induced by cryoablation. Trying to solve the question: how positively induce immune response. In this review, we focus on: 1. the immune effects induced by cryoablation. 2. the effect and mechanism of tumor immunotherapy combined with cryoablation. 3.The clinical research of this combination therapy in the treatment of tumors.

Topics: Humans; Cryosurgery; Neoplasms; Radiofrequency Ablation; Immunity; Immunotherapy

PubMed: 36761748
DOI: 10.3389/fimmu.2023.1094009

Review

Authors: Jason G Andrade, Oussama M Wazni, Malte Kuniss...

Atrial fibrillation (AF), the most common sustained arrhythmia observed in clinical practice, is a chronic and progressive disorder characterized by exacerbations and remissions. Guidelines recommend antiarrhythmic drugs as the initial therapy for the maintenance of sinus rhythm; however, antiarrhythmic drugs have modest efficacy to maintain sinus rhythm and can be associated with significant adverse effects. An initial treatment strategy of cryoballoon catheter ablation in patients with treatment-naïve AF has been shown to significantly improve arrhythmia outcomes (freedom from any, or symptomatic atrial tachyarrhythmia), produce clinically meaningful improvements in patient-reported outcomes (symptoms and quality of life), and significantly reduce subsequent health care resource use (hospitalization), and it does not increase the risk of serious or any adverse events compared with initial antiarrhythmic drug therapy. These findings are relevant to inform patients, providers, and health care systems regarding the initial choice of rhythm-control therapy in patients with treatment-naïve AF.

Topics: Atrial Fibrillation; Cryosurgery; Decision Making, Shared; Humans; Patient Selection; Quality of Life

PubMed: 34446164
DOI: 10.1016/j.jacc.2021.06.038

Authors: Daniël A Korevaar, Sara Colella, Markus Fally...

BACKGROUND

In patients with interstitial lung diseases (ILD), histopathological input is often required to obtain a diagnosis. Surgical lung biopsy (SLB) is considered the reference standard, but many patients are clinically unfit to undergo this invasive procedure, and adverse events, length of hospitalisation and costs are considerable. This European Respiratory Society (ERS) guideline provides evidence-based clinical practice recommendations for the role of transbronchial lung cryobiopsy (TBLC) in obtaining tissue-based diagnosis in patients with undiagnosed ILD.

METHODS

The ERS Task Force consisted of clinical experts in the field of ILD and/or TBLC and methodological experts. Four PICO (Patient, Intervention, Comparator, Outcomes) questions and two narrative questions were formulated. Systematic literature searches were performed in MEDLINE and Embase (up to June 2021). GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology was applied.

RESULTS

In patients with undiagnosed ILD and an indication to obtain histopathological data: 1) TBLC is suggested as a replacement test in patients considered eligible to undergo SLB, 2) TBLC is suggested in patients not considered eligible to undergo SLB, 3) SLB is suggested as an add-on test in patients with a non-informative TBLC, 4) no recommendation is made for or against a second TBLC in patients with a non-informative TBLC and 5) TBLC operators should undergo training, but no recommendation is made for the type of training required.

CONCLUSIONS

TBLC provides important diagnostic information in patients with undiagnosed ILD. Diagnostic yield is lower compared to SLB, at reduced serious adverse events and length of hospitalisation. Certainty of the evidence is mostly "very low".

Topics: Humans; Biopsy; Bronchoscopy; Cryosurgery; Lung; Lung Diseases, Interstitial

PubMed: 35710261
DOI: 10.1183/13993003.00425-2022

Authors: Domenico G Della Rocca, Lorenzo Marcon, Michele Magnocavallo...

AIMS

Pulsed field ablation (PFA) has emerged as a novel, non-thermal energy source to selectively ablate cardiac tissue. We describe a multicentre experience on pulmonary vein isolation (PVI) via the pentaspline Farapulse™ PFA system vs. thermal-based technologies in a propensity score-matched population of paroxysmal atrial fibrillation (PAF) patients.

METHODS AND RESULTS

Propensity score matching was adopted to compare PVI-only ablation outcomes via the Farawave™ system (Group PFA), cryoballoon (Group CRYO), or focal radiofrequency (Group RF) (PFA:CRYO:RF ratio = 1:2:2). Among 1572 (mean age: 62.4 ± 11.3 years; 42.5% females) PAF patients undergoing first time PVI with either PFA (n = 174), CRYO (n = 655), or RF (n = 743), propensity score matching yielded 174 PFA, 348 CRYO, and 348 RF patients. First-pass isolation was achieved in 98.8% of pulmonary veins (PVs) with PFA, 81.5% with CRYO, and 73.1% with RF (P < 0.001). Procedural and dwell times were significantly shorter with PFA, whereas the availability of a 3D mapping system led to a significant reduction in X-ray exposure with RF. Overall complication rates were 3.4% (n = 6) with PFA, 8.6% (n = 30) with CRYO, and 5.5% (n = 19) with RF (P = 0.052). The 1-year Kaplan-Meier estimated freedom from any atrial tachyarrhythmia was 79.3% with PFA, 74.7% with CRYO, and 72.4% with RF (log-rank P-value: 0.24). Among 145 repeat ablation procedures, PV reconnection rate was 19.1% after PFA, 27.5% after CRYO, and 34.8% after RF (P = 0.01).

CONCLUSION

Pulsed field ablation contributed to significantly shorter procedural times. Follow-up data showed a similar arrhythmia freedom, although a higher rate of PV reconnection was documented in post-CRYO and post-RF redo procedures.

Topics: Female; Humans; Middle Aged; Aged; Male; Atrial Fibrillation; Cryosurgery; Propensity Score; Treatment Outcome; Heart Atria; Pulmonary Veins; Catheter Ablation; Recurrence

PubMed: 38245007
DOI: 10.1093/europace/euae016

Meta-Analysis

Authors: Teodor Serban, Diego Mannhart, Qurrat-Ul-Ain Abid...

AIMS

Pulmonary vein isolation (PVI) plays a central role in the interventional treatment of atrial fibrillation (AF). Uncertainties remain about the durability of ablation lesions from different energy sources. We aimed to systematically review the durability of ablation lesions associated with various PVI-techniques using different energy sources for the treatment of AF.

METHODS AND RESULTS

Structured systematic database search for articles published between January 2010 and January 2023 reporting PVI-lesion durability as evaluated in the overall cohort through repeat invasive remapping during follow-up. Studies evaluating only a proportion of the initial cohort in redo procedures were excluded. A total of 19 studies investigating 1050 patients (mean age 60 years, 31% women, time to remap 2-7 months) were included. In a pooled analysis, 99.7% of the PVs and 99.4% of patients were successfully ablated at baseline and 75.5% of the PVs remained isolated and 51% of the patients had all PVs persistently isolated at follow-up across all energy sources. In a pooled analysis of the percentages of PVs durably isolated during follow-up, the estimates of RFA were the lowest of all energy sources at 71% (95% CI 69-73, 11 studies), but comparable with cryoballoon (79%, 95%CI 74-83, 3 studies). Higher durability percentages were reported in PVs ablated with laser-balloon (84%, 95%CI 78-89, one study) and PFA (87%, 95%CI 84-90, 2 studies).

CONCLUSION

We observed no significant difference in the durability of the ablation lesions of the four evaluated energies after adjusting for procedural and baseline populational characteristics.

Topics: Humans; Female; Middle Aged; Male; Atrial Fibrillation; Pulmonary Veins; Cryosurgery; Catheter Ablation; Time Factors; Treatment Outcome; Recurrence

PubMed: 37944133
DOI: 10.1093/europace/euad335

Authors: Ethan E Zimmerman, Paul Crawford

Cutaneous cryosurgery refers to localized application of freezing temperatures to achieve destruction of skin lesions. It can be used to treat a broad range of benign and premalignant skin conditions, and certain malignant skin conditions, with high cure rates. Cellular destruction is accomplished by delivery of the cryogen via dipstick, probe, or spray techniques. It is widely used in primary care because of its safety, effectiveness, low cost, ease of use, good cosmetic results, and lack of need for anesthesia. Cryosurgery is as effective as alternative therapies for most cases of molluscum contagiosum, dermatofibromas, keloids, and plantar or genital warts. It is a more effective cure for common warts than salicylic acid or observation. Cryosurgery is generally the treatment of choice for actinic keratosis. Contraindications to cryosurgery include cryofibrinogenemia, cryoglobulinemia, Raynaud disease, agammaglobulinemia, and multiple myeloma. Complications from cryosurgery include hypopigmentation and alopecia, and can be avoided by limiting freeze times to less than 30 seconds. Referral to a dermatologist should be considered in cases of diagnostic uncertainty or for treatment of skin cancer, which requires larger amounts of tissue destruction, resulting in higher complication rates.

Topics: Condylomata Acuminata; Cryosurgery; Histiocytoma, Benign Fibrous; Humans; Keloid; Keratosis, Actinic; Molluscum Contagiosum; Practice Guidelines as Topic; Skin Diseases; Skin Neoplasms; Treatment Outcome; United States; Warts; Wound Healing

PubMed: 23316984
DOI: No ID Found

Authors: William C Cranwell, Rodney Sinclair

BACKGROUND

Cryosurgery is an effective, simple and inexpensive treatment used extensively in general practice and dermatology. It is used most commonly for actinic keratoses and warts; however, a large number of benign, premalignant and malignant skin diseases can also be treated.

OBJECTIVE

The objective of this article is to help readers improve their cryosurgery technique.

DISCUSSION

Application of the cryogenic agent (most commonly liquid nitrogen) to the skin induces rapid freezing followed by slow thawing. This produces cell injury, vascular stasis and occlusion, and inflammation. The quantity of cryogen delivered onto the skin (dose), technique, duration of thawing and amount of surrounding tissue frozen are dependent on the body region and type of lesion. If clinical diagnosis is not possible, either a skin biopsy or referral to a dermatologist is recommended. We strongly discourage blind treatment of undiagnosed skin lesions.

Topics: Contraindications; Cryosurgery; Humans; Nitrogen; Skin; Skin Diseases

PubMed: 28472571
DOI: No ID Found

Authors: Myung-Gyun Han, Joon-Young Kim

BACKGROUND

Eyelid mass removal and cryotherapy application using only local anaesthesia and restraint may benefit patients with high anaesthesia risks.

OBJECTIVE

To evaluate and validate cryosurgery application using the CryoPen XL on palpebral masses under local anaesthesia for patients not suitable for general anaesthesia.

METHODS

Thirty patients underwent the procedure between November 2015 and April 2020. The procedure steps were as follows: skin preparation and local anaesthesia of the affected eyelid; debulking by resection and/or squeezing out the inspissated material; cryosurgery and post-operative care using topical medication, antibiotics and anti-inflammatory ointment. The medical records of the patients who underwent the operation were evaluated. Moreover, a telephonic survey with the pet owners was performed to determine recurrence, time to recurrence, survivability and side effects.

RESULTS

Among the 30 owners, 29 responded to the survey. Ten (10/38, 26.3%) masses recurred with an average time to recurrence of 6.0 months. The estimated average depths for all, non-recurred, and recurred masses were 1.89, 1.88 and 1.90 mm, respectively. The average recurrence rate and time to recurrence were higher and earlier, respectively, than previously reported values. However, no patient presented intra- or post-operative complications.

CONCLUSION

These findings suggest that local anaesthesia and cryosurgery using the CryoPen XL can be used in patients with eyelid masses who are not suitable for general anaesthesia. Compared with the surgical eyelid mass removal and blepharoplasty procedure, the reported procedure is time- and cost-effective, with the additional benefit of not requiring general anaesthesia.

Topics: Anesthesia, Local; Animals; Cryosurgery; Dog Diseases; Dogs; Eyelid Diseases; Eyelids; Recurrence

PubMed: 34919349
DOI: 10.1002/vms3.688

Review

Authors: Ramia Mokbel, Alevtina Kodresko, Kefah Mokbel...

Skin and subcutaneous diseases represent a significant public health burden, profoundly impacting quality of life, social interactions, mental health, and daily activities-raising concerns worldwide. In modern cryogenics, cryosurgery is among the therapeutic approaches employed by healthcare professionals to address this broad and complex range of diseases. Over the past four decades, cryosurgery has evolved into a valuable treatment option, used alone or as an adjunct therapy, and is adaptable to the needs of various special populations. This approach offers distinct advantages over established treatments due to its safety, efficiency, feasibility, and cost-effectiveness. However, a comprehensive, up-to-date review of cryosurgery's applications is lacking, which limits research dissemination and recognition among dermatologists. This review aims to provide an overview of cryosurgery principles and its current clinical practice in dermatology, covering a broad range of benign, premalignant, and malignant cutaneous conditions, and highlighting its potential as an essential approach in global healthcare.

Topics: Cryosurgery; Humans; Skin Neoplasms; Dermatology; Skin Diseases; Precancerous Conditions; Treatment Outcome; Skin

PubMed: 40010951
DOI: 10.21873/invivo.13865

Review

Authors: Ashok Bansal, Shivani Jain, Shipra Gupta...

Cryosurgery is a therapeutical method that uses freezing to obtain a tissue inflammatory and/or a destructive response. It has been successfully used for many cutaneous conditions. Its use is increasing for several conditions in the oral cavity. The oral mucosa, because of its characteristics of humidity and smoothness, is an ideal site for this technique. It shows a very good esthetic result and it may be either the first choice or an alternative option to conventional surgery. This article strives to review the modus operandi of cryosurgical instruments, the various indications, limitations and advantages of cryosurgery in the treatment of oral lesions.

Topics: Cryosurgery; Equipment Design; Esthetics; Face; Humans; Mouth Diseases; Mouth Mucosa; Mouth Neoplasms; Necrosis

PubMed: 22945736
DOI: 10.4103/0970-9290.100468