Cryoablation of liver tumours – a review of mechanisms, techniques and clinical outcome

Abstract

Several techniques exist for in situ destruction or ablation of liver tumours not eligible for resection. Cryoablation, i.e. the use of low temperatures to induce local tissue necrosis, was among the first of the thermal ablative techniques widely used. The procedures have typically been performed by surgeons during laparotomy, but recently minimally invasive cryoablation has been reported feasible. The present review focuses on mechanisms of tissue destruction, techniques of ablation including procedural monitoring, and clinical outcome following cryoablation of liver tumours. Plausible causes of tumour persistence at the site of ablation, i.e. local treatment failure, are discussed. Shortcomings exist in monitoring of the freezing process and may be a main cause. The evidence for the long-term outcome following liver tumour cryoablation needs to be improved. Cryoablation has been challenged by other techniques of tumour ablation such as radiofrequency ablation. Randomised trials against these modern techniques may define the role of cryoablation in the treatment of liver tumours. With improved imaging technology and patient selection, cryoablation of liver tumours may hold promise for selected patients.

Radiofrequency Ablation Induces Antigen-presenting Cell Infiltration and Amplification of Weak Tumor-induced Immunity

“…For each of the five subsequent measurements after baseline (3,5,8,10, and 12 days after treatment), the distributions of differences from baseline were analyzed two ways by using nonparametric methods because the data were not normally distributed. First, distributions of differences from baseline were compared by using the Kruskal-Wallis test; for a P value of less than .05, the control group was compared with each of the other EXPERIMENTAL STUDIES: Radiofrequency Ablation and Antigen-presenting Cells Dromi et al three treatment groups.…”

“…Raw data from the tumor rechallenge study were analyzed, as baseline tumor volume measurements were identical (all zero). For each of the nine subsequent measurements after baseline (3,5,7,10,17,18,21,23, and 25 days after treatment) the treatment group distributions were analyzed by using nonparametric methods because the data were not normally distributed. Group distributions were compared by using the Kruskal-Wallis test; for a P value of less than .05, the control group was compared with each of the other three groups.…”

“…hermal ablation techniques such as radiofrequency (RF), microwave, cryotherapy, and focused ultrasound have been increasingly used for minimally invasive management of local unresectable malignancies (1)(2)(3). Among these modalities, RF ablation is now the most widely used and has proved to be safe, with a minor complication rate of less than 10% (4,5).…”

A histological evaluation and in vivo assessment of intratumoral near infrared photothermal nanotherapy-induced tumor regression

“…A variety of local, intratumoral therapies have been developed to provide advantages over surgery and chemo-radiation, that include minimal invasiveness, minimal side effects, and shorter hospitalizations. [1][2][3][4] These therapies are based on different physical mechanisms and ablation techniques including microwave, [5][6][7] focused ultrasound, [8][9][10] radiofrequency, 11,12 and cryoablation [13][14][15] therapies. The disadvantages of these therapies include limited specificity, limited delivery, and tumor recurrence.…”

Electrode displacement strain imaging of thermally‐ablated liver tissue in an in vivo animal model

“…2 An alternative to surgical resection, percutaneous thermal ablation can be used to destroy the tumor in situ, and is evolving into one of the more popular minimally invasive treatments for hepatic tumors. Several methods are available for delivering the thermal energy to the target tumor, [3][4][5] with radiofrequency ͑RF͒ ablation being the most popular choice worldwide.…”