文章一：梅奥医院

Cryosurgery/cryoablation in musculoskeletal neoplasms: history and state of the art

Peter S. Rosecorresponding author and Jonathan M. Morris

Department of Orthopedic Surgery–Gonda 14S, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA

Department of Radiology, Mayo Clinic, Rochester, MN USA

Peter S. Rose, Phone: 507-284-2995, Email: ude.oyam@reteP.esoR.

摘要及结论

CT引导经皮穿刺冷冻消融（氩氦刀）治疗肌肉骨骼治疗具有特别意义，因为氩氦刀治疗形成的冰球作为治疗区域可以清楚显示并区分骨骼与软组织。作为治疗良性肿瘤以及复发转移的治疗具有临床应用指证。

40年前开始的冷冻治疗技术在过去10年中得到了迅速发展，极大改善了冷冻能力。虽然这种技术具有一定局限性，但是得到不断发展，它提供了许多患者的肌肉骨骼肿瘤的传统上与开放手术和/或放疗互补的治疗选择。虽然长期效果仍有待日趋完善，但是适当选择病人出现达到效果等于或优于常规治疗方案。因此，梅奥教授认为这些是治疗病人肌肉骨骼肿瘤熟悉相关技术的医生很有价值的技术。

Cryoablation or Radiofrequency Ablation of the Small Renal Mass: A Meta-analysis

David A. Kunkle, MD and Robert G. Uzzo, MD

Robert G. Uzzo, MD Department of Urologic Oncology Fox Chase Cancer Center 333 Cottman Avenue Philadelphia, PA

结论：在治疗较小肾肿瘤方面，冷冻消融效果优于射频消融，复发率低，局部控制更好。

 

Prostate Cryotherapy Monitoring Using Vibroacoustography: Preliminary Results of an Ex Vivo Study and Technical Feasibility

Farid G. Mitri, Brian J. Davis, Department of Radiation Oncology, Mayo Clinic

 

文章四：纽约州立大学Binghamton医院

Mechanisms of Cryoablation: Clinical Consequences on Malignant Tumors

Institute of Biomedical Technology, State University of New York at Binghamton, Binghamton, NY 13902

   冷冻消融为治疗众多癌症行之有效的治疗方案。虽然通常被认为是一个简单的烧蚀机理依靠癌细胞的主要物理破坏，冷冻现在被理解为是涉及破坏压力，其中包括细胞内外和冰晶形成的复杂的一个复杂的，组合疗法，初始后坏死因子从冰晶体局部细胞损伤，快速膜的激活基于低温损伤的核心内凋亡反应，通过在冰球由于周边的延迟基于线粒体凋亡反应，部分地严重氧化应激，由于血管导致细胞缺氧，然后凝固性坏死继发性坏死。造成的物理破坏是立竿见影的。基于冷冻细胞应激相关的生理基础毁灭（凋亡）发生在数小时至数天。此外，可以在多天发生周血管损伤和炎症的延长的细胞毒性作用。

而有效冷冻的标志是公知的（即快速冷冻到致死最低点的温度，缓慢解冻，并冻融循环重复）以下冷冻持续性疾病的发病率表明，这些原理的应用需要继续调查和优化。这导致了各种辅助治疗策略（分子为基础的治疗）的探索，以提高和保证在整个冷冻组织大规模癌症破坏。今天冷冻治疗与长期研究（5年和10年的随访）展示成果相当于或优于那些其他非常有效和实用的肿瘤治疗技术及方法，如射频消融治疗和放射治疗。

 Cryoablation is a well-established therapeutic regime for the treatment of numerous cancers. While often thought of as a simple ablative mechanism relying on primarily physical destruction of cancer cells, cryoablation is now understood to be a sophisticated, combinatorial therapy involving a complex cascade of destructive stresses which include extra- and intra-cellular ice crystal formation, initial post-thaw necrosis due to partial cellular damage from ice, the activation of a rapid membrane based apoptotic response within the core of a cryogenic lesion, by a delayed mitochondrial-based apoptotic response in the periphery of the iceball due, in part, to severe oxidative stress, secondary necrosis due to hypoxia and then coagulative necrosis due to vascular stasis. Destruction due to physical events is immediate. Freezing based cell stress related physiological-based destruction (apoptosis) occurs over hours to days. Further, the prolonged cytotoxic effects of vascular damage and inflammation may occur over many days to weeks.

While the hallmarks of effective cryoablation are well known (i.e. fast freezing to a lethal nadir temperature, slow thawing, and repetition of the freeze-thaw cycle) the incidence of persistent disease following freezing suggests that application of these principles requires continued investigation and optimization. This has resulted in the exploration of various adjunctive therapeutic strategies (molecular-based therapy) to enhance and assure cancer destruction throughout the entire frozen tissue mass. While research and optimization remain ongoing, today cryoablation is a highly effective and practical means of treating numerous cancers with the long term studies (5 and 10 year follow-up) demonstrating outcomes equivalent to or better than those achieved with other ablative techniques such as RFA and radiation therapy. As a more in-depth understanding of the molecular mechanisms involved in cryogenic injury and adjunct therapy evolves, further enhancement of the efficacy of cryosurgical technique is anticipated.