Cryoablation Group Research Articles

03:18 PM Abstract No. 85 Percutaneous radiofrequency ablation vs. cryoablation for treatment of renal tumors: a single-center experience

To compare the outcomes and complication rates in patients with small renal masses treated with percutaneous Radiofrequency Ablation (RFA) vs. Cryoablation. A retrospective study was performed evaluating 163 renal tumors treated with either ablative therapy between 2003 and 2017. Of the evaluated data, a total of 75 were biopsy proven RCC tumors and 27 biopsy proven Oncocytoma tumors. The remaining were treated based on classical imaging characteristics suggestive of RCC. Tumor characteristics were described using the RENAL Nephrometry scoring system based on cross-sectional imaging prior to the procedure. Time to recurrence was measured and determined by the first cross-sectional imaging study date to report residual/recurrent disease. Major complications requiring intervention in the immediate post-ablative setting were also recorded. 86 renal tumors treated with RFA and 77 were treated with Cryoablation. The average tumor size (cm) and nephrometry score for the RFA group was 2.4 and 5.9, respectively. The average tumor size and nephrometry score for the Cryoablation group was 2.0 and 6.2, respectively. There was no significant difference between the tumor characteristics of the two groups. A total of 22 tumors in the RFA group had residual/recurrent disease and a total of 6 tumors in the Cryoablation group had residual/recurrent disease. The average time to recurrence in RFA and Cryoablation group was 440.6 days and 1579.5 days, respectively (p = 0.045) There were no major complications requiring intervention reported in the RFA group, although there were 4 cases (5%) in the Cryoablation group (p = 0.032). When evaluating renal tumors with an average size of 2.2 cm and Renal Nephrometry scores in the range of 6, percutaneous Cryoablation was shown to have a statistically significant lower recurrence/residual disease rate, as well as overall longer time for disease recurrence. Overall, major complication rates requiring interventions are low; although, Cryoablation did show a statistically significant increased rate when compared to RFA.Tabled 1Ablation TypeAverage Size (cm)Average RENAL Nephrometry Score# of RecurrencesAverage Time to Recurrence (days)Major Complications Requiring InterventionRFA2.45.922440.60Cryoablation26.281579.54 Open table in a new tab

Clinical success of cryoballoon pulmonary vein isolation in patients with atrial fibrillation

Aim. To estimate the clinical success of cryoballoon pulmonary vein isolation (PVI).Methods.230 patients (males: 49.6%, mean age 57 (53; 62) with symptomatic paroxysmal and persistent atrial fibrillation (AF) resistant to antiarrhythmic therapy were included in a single-center prospective study. The patients were randomized into 2 groups to undergo either cryoballoon ablation (n = 122) or radiofrequency (RF) (n = 108) ablation. Both groups were comparable in baseline parameters. The follow-up period was 12 months. Clinical outcomes were estimated with the use of a three-stage scale. The rates of cardiovascular rehospitalizations, direct-current cardioversions and repeated ablations during were estimated within the follow-up. The quality of life (QoL) in the cryoablation group was measured using the AFEQT scale.Results.77% (n = 94) of patients in the cryoballoon ablation group and 71.3% (n = 77) of patients in the RF group (р = 0.71) demonstrated reported the optimal clinical effects. Both groups, cryo ablation and RF ablation, had similar rates of cardiovascular hospitalizations (23.8 vs 28.7%, OR 0.8, 95% CI 0.4–1.4; р = 0.39), direct-current cardioversions (12.3 vs 17.6%, OR 0.7, 95% CI 0.3–1.4; р = 0.26) and repeated ablations (9.8–11.1%, OR 0.9, 95% CI 0.4–2.0; р = 0.75). The patients treated with cryoballoon as opposed to RF ablation had significantly more successful usage of “pill-in-pocket” strategy – 14.8 vs 6.5% (OR 2.5, 95% CI 1.01–6.2; р = 0.04). Significant improvements of the QoL parameters with strong size effect have been found in the cryoablation group, i.e. global score (GS) increased by 8.9±6.9 (95% CI 6.6–10.1; dCohen 1.2; р<0.001), symptoms (S) – by 8.3±7.9 (95% CI 4.2–8.8; dCohen 1.5; р<0.001), daily activities (DA) – by 10.0±6.9 (95% CI = 6.4–10.6; dCohen 0.9; р<0.001), treatment concerns (TC) – by 5.5±6.0 (95% CI 6.3–9.2; dCohen 1.2; р<0.001) and treatment satisfaction (TS) – by 5.5±6.0 (95% CI 5.4–9.8; dCohen 0.9; р<0.001).Conclusion.The both catheter-based technologies had comparable clinical success. Cryoablation was characterized by improvement in all QoL parameters based on the AFEQT score.

Cryoablation versus Partial Nephrectomy for Clinical Stage T1 Renal Masses: A Systematic Review and Meta-Analysis.

Introduction: Cryoablation has been considered as the most efficacious ablative alternative to partial nephrectomy (PN) for selected patients. Our objective is to assess the existing evidence relating to the safety and efficacy of cryoablation compared with PN for clinical T1 renal masses.Materials and Methods: A comprehensive search of PMC, EMBASE, and the Cochrane Library was conducted to identify studies containing comparison of cryoablation and PN. By utilizing those included studies, a systematic review and cumulative meta-analyses were performed to assess the safety and efficacy between cryoablation and PN for T1 renal masses.Results: 17 retrospective studies providing available data were included in our study. Significant differences were found about all oncological variables including all-cause death, cancer-specific death, metastasis and local-recurrence (p < 0.001, p = 0.03, p < 0.001, and p < 0.001, respectively) between the PN group and the cryoablation group. The mean difference between two groups for percent estimated glomerular filtration rate decrease and creatinine increase was -4.84 and 0.15 respectively (p < 0.001 and p = 0.006, respectively). The incidences of overall and postoperative complications in the PN group were significantly higher than that in the cryoablation group (p = 0.001 and p < 0.001, respectively), but the result about intraoperative complications didn't show a significant difference between the two groups (p = 0.53).Conclusions: Comparing with PN, cryoablation for clinical T1 renal tumors is associated with poorer oncological outcomes, but the existing disadvantages are accompanied by lower rate of overall and postoperative complications and superior renal functional preservation. For patients with imperative indications for nephron-sparing surgery who can't risk more invasive PN, cryoablation could be an attractive option. Owing to the inherent limitations of eligible studies, conclusions drawn from our meta-analyses should be interpreted cautiously and be confirmed further with well-designed randomized controlled trials with extensive follow-up length.

Early Immunologic Response of Irreversible Electroporation versus Cryoablation in a Rodent Model of Pancreatic Cancer

PurposeTo investigate the differences in immune responses between cryoablation and irreversible electroporation (IRE) in a preclinical mouse model. Material and MethodsA mouse pancreatic cancer cell line (PANC-2) was implanted in the bilateral flanks of mice, and tumor-bearing mice were divided into 6 groups. One of the tumors was ablated either with contact cryoablation using an argon-cooled cryoablation probe for 1 minute at 5% power or by IRE for a total of 64 100-μs-duration, 1250-V/cm2 pulses with 100-ms spacing. The contralateral tumors in the same animal served as controls. At immediate, 6, 12, and 24 hours after ablation, the tumors were processed for immunostaining with F480 (macrophages), CD3 (T cells), and CD-56 (natural killer cells) antibodies. ResultsCD3 staining demonstrated significantly more T cells in the IRE group than in the cryoablation group at 6 hours (45 vs 16; P = .027), 12 hours (67 vs 33; P = .020), and 24 hours (161 vs 94; p = .003), with almost a 2-fold increase at every time point. Although the mean number of natural killer cells in the treated tumors was higher, no significant differences were observed between the 2 groups at any of the time points. A significant difference was observed in F480 positivity between the cryoablation group and the IRE group at 12 hours (210 vs 356; P = .0004) and 24 hours (220 vs 328; P = .04), respectively. ConclusionsIn a mouse model of pancreatic cancer, IRE evokes a more robust infiltration of macrophages and T cells than cryoablation within 24 hours.

Outcomes Using Cryoablation for Postoperative Pain Control in Children Following Minimally Invasive Pectus Excavatum Repair.

Pain is the main factor that determines the postoperative course for patients undergoing pectus bar placement. Cryoablation of the intercostal nerves has been suggested to mitigate this pain. We instituted a protocol for using intercostal cryoablation and report our early results compared to our immediately previous cohort. A retrospective study was conducted on patients undergoing minimally invasive repair for pectus excavatum between January 1, 2017, and August 21, 2017. Demographic data, anthropometrics, operative times, type and duration of patient analgesia, and postoperative length of stay were collected. Descriptive statistics were performed with all means reported ± standard deviations. Comparisons between groups were analyzed on STATA using T-tests with a P value <.05 determined as significant. Twenty-eight patients were treated for pectus excavatum during the study period with 9 (32%) undergoing cryoablation. Mean number of rib spaces ablated was 5 ± 0.53 with no reported intraoperative complications. Mean operative time was 30 minutes longer in the cryoablation group (P = .00). Days to only oral pain medication was shorter in the cryoablation group, (1.22 ± 0.66 day versus 2.63 ± 0.68 day, P = .00). Length of stay, in days, was shorter in the cryoablation group (1.4 ± 0.72 days versus 4.0 ± 1.0 days, P = .00). There were no reported complications from cryoablation or bar placement during the study period. Days to discontinuation of oral narcotics were less in the cryoablation group (8.2 ± 7.0 versus 18.2 ± 10.4, P = .00). Cryoablation after pectus bar placement dramatically decreases narcotic usage and postoperative length of stay.

Pirfenidone inhibits cryoablation induced local macrophage infiltration along with its associated TGFb1 expression and serum cytokine level in a mouse model

PurposeTo investigate the effects of pirfenidone (PFD) on post-cryoablation inflammation in a mouse model. Materials and methodsIn this IACUC-approved study, eighty Balb/c mice were randomly divided into four groups (20/group): sham + vehicle, sham + PFD, cryoablation + vehicle, and cryoablation + PFD. For cryoablation groups, a 20% freeze rate cryoablation (20 s to less than −100 °C) was used to ablate normal muscle in the right flank. For sham groups, the cryoprobe was advanced into the flank and maintained for 20 s without ablation. PFD or vehicle solution was intraperitoneally injected (5 mg/kg) at days 0, 1, 2, 3, and then every other day until day 13 after cryoablation. Mice were euthanized at days 1, 3, 7, and 14. Blood samples were used for serum IL-6, IL-10, and TGFβ1 analysis using electrochemiluminescence and ELISA assays, respectively. Immunohistochemistry-stained ablated tissues were used to analyze macrophage infiltration and local TGFβ1 expression in the border region surrounding the cryoablation-induced coagulation zone. ResultsCryoablation induced macrophage infiltration and increased TGFβ1 expression in the border of the necrotic zone, and high levels of serum IL-6, peaking at days 7 (70.5 ± 8.46/HPF), 14 (228 ± 18.36/HPF), and 7 (298.67 ± 92.63), respectively. Animals receiving PFD showed reduced macrophage infiltration (35.5 ± 16.93/HPF at day 7, p < 0.01) and cytokine levels (60.2 ± 7.6/HPF at day 14, p < 0.01). PFD also significantly reduced serum IL-6 levels (p < 0.001 vs. all non-PFD groups). ConclusionsPFD mitigates cryoablation induced muscle tissue macrophage infiltration, increased IL-6 levels, and local TGFβ1 expression in a small animal model.

3:27 PM Abstract No. 243 Microwave ablation vs cryoablation in the treatment of T1a renal cell carcinoma: a single-center comparison of safety and outcomes

To compare the safety and efficacy of percutaneous ablation of T1a renal cell carcinoma (RCC) performed utilizing microwave ablation (MWA) and cryoablation (CRYO). Retrospective analysis spanning 9/2006 to 9/2014 was performed to identify RCC patients treated with MWA or CRYO. 37 patients with RCC underwent 40 percutaneous ablation procedures during the study period. 22 CRYO procedures (mean tumor diameter: 2.6 ± 0.9 cm, mean RENAL score: 7.3 [range 4-10], mean PRAC score: 8.3 [range 4-11.5]) were performed for 20 patients (age: 69.9 ± 8.1 years, male sex: 65%). 18 MWA procedures (mean tumor diameter: 2.4 ± 0.8 cm, mean RENAL score: 7.2 [range 4-10], mean PRAC score: 7.7 [range 4-11.5]) were performed for 18 patients (age: 66.8 ± 12.8 years, male sex: 61.1%). Outcomes variables included technical success, pre- and posttreatment lab values, complications, imaging response, and overall survival. Technical success was achieved in all cases. There was no significant difference in baseline renal function between MWA (BUN: 19.6 ± 7.2 mg/dl, creatinine: 1.4 ± 0.8 mg/dl) and CRYO (BUN: 24.6 ± 16.0 mg/dl, creatinine: 1.2 ± 0.5 mg/dl) groups (p = 0.238 and p = 0.465 respectively) or significant change in either BUN post-ablation for MWA and CRYO (p = 0.852 and p = 0.805 respectively) or creatinine (p = 0.355 and p = 0.599 respectively). There were 7 complications (MWA:5, Cryo:2) including 6 perinephric hematomas and an episode of urinary retention, 2 being major (SIR C) complications, without significant difference in the complication incidence between the 2 groups (p = 0.259). At median follow-up time of 3.2 years, 7 instances of disease progression (Cryo:5, MWA: 2) occurred at an average of 14.7 months post-ablation with no difference in disease progression between modalities (p = 0.205). Overall cohort survival was 5.1 (95% CI: 4.3–6.0) years with no significant difference between treatment groups (p = 0.486). There is no difference in technical success, renal function change, complication incidence, imaging outcomes, or overall survival in RCC patients treated with either microwave ablation or cryoablation. Overall survival in the present cohort was 5.1 (95% CI: 4.3–6.0) years.

Cryoablation inhibition of distant untreated tumors (abscopal effect) is immune mediated.

Cryoablation is moderately effective against prostate cancer. Of note, the off-target or enlarged therapeutic effect after cryoablation is reported in routine clinical practice. To uncover it, we constructed a bilateral inguinal transplantation model of prostate cancer. All the mice were randomly subdivided into three groups: Group A (Control group), Group B (Surgery group), and Group C (Cryoablation group). All the procedures in three groups were conducted only for tumors in the target region (right groin). The tumors in untargeted region (left groin) received no treatment. We measured the growth of untargeted tumors and lung metastasis rate, and then explored the changes in a series of immune cells and danger signals. First, our results revealed the protective effect of cryoablation treatment against the abscopal tumor. The possible mechanism was mediated by an increase in the number of CD4+ T cells, CD8+ T cells, ratio T helper 1 (Th1)/Th2, the killing activity of cytotoxic T lymphocytes and NK cells. Hsp70 may be involved in the modulation of the immune response. The combination of weakened Ki67 activity and activated immune response delayed spectator tumor growth, decreased the pulmonary metastasis rate, and prolonged animal survival, with an inducible abscopal effect.

Comparison of incidences of pulmonary vein stenosis between radiofrequency and cryoablation in atrial fibrillation ablation

Cryoablation is an alternative technique to radiofrequency (RF) catheter ablation to achieve pulmonary vein isolation for atrial fibrillation (AF) ablation. Comparative data between cryoablation and RF ablation on the safety, and moreover on the risk of pulmonary vein stenosis (PVS) are still lacking. To evaluate and compare the incidence of PVS in the ablation of AF by cryoballon and RF. We performed a retrospective, monocentric observational study between 2012 and 2016 of consecutive patients who underwent a first AF ablation (RF or cryoballoon). All patients had a computed tomography (CT) scanner of left atrium and pulmonary veins before and 3 months after the procedure. All RF ablations were guided with last generation 3-dimensional electroanatomic mapping using the Carto (Biosense ® ) or Velocity (SJM ® ) systems and intergration of 3d-CT imaging. All cryoablations were performed with the 2nd generation cryoballon (Articfront Advance, Medtronic ® ). Clinical and all pre and post-ablation imaging data were retrospectively assessed. Overall, 653 patients were included in the study (mean age 60 ± 11 years, 490 males, 472 patients with Paroxysmal AF [72%]). No patients had PVS before ablation. In the RF group (387 patients), severe (≥ 70%) PVS was detected in 12 patients (3.1%) but only one stenosis was detected in the cryoablation group (1/266 patients −0.4%). Post-ablation PVS was significantly more frequent in the RF group (3.1% vs 0.4%, P = 0.03) This study shows that cryoablation result in lower risk of pulmonary vein stenosis than radiofrequency. A systematic post-ablation CT after cryoablation seems unnecessary.

A comparative analysis of clinical outcomes and disposable costs of different catheter ablation methods for the treatment of atrioventricular nodal reentrant tachycardia.

BackgroundCatheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) is a commonly performed electrophysiology (EP) procedure. Few data exist comparing conventional (CONV) versus novel ablation strategies from both clinical and direct cost perspectives. We sought to investigate the disposable costs and clinical outcomes associated with three different ablation methodologies used in the ablation of AVNRT.MethodsWe performed a retrospective review of AVNRT ablations performed at Augusta University Medical Center from 2006 to 2014. A total of 183 patients were identified. Three different ablation techniques were compared: CONV manual radiofrequency (RF) (n=60), remote magnetic navigation (RMN)-guided RF (n=67), and cryoablation (CRYO) (n=56).ResultsBaseline demographics did not differ between the three groups except for a higher prevalence of cardiomyopathy in the RMN group (p<0.01). The clinical end point of interest was recurrent AVNRT following the index ablation procedure. A significantly higher number of recurrent AVNRT cases occurred in the CRYO group as compared to CONV and RMN (p=0.003; OR =7.75) groups. Cost-benefit analysis showed both CONV and RMN to be dominant compared to CRYO. Cost-minimization analysis demonstrated the least expensive ablation method to be CONV (mean disposable catheter cost = CONV US$2340; CRYO US$3515; RMN US$5190). Despite comparable clinical outcomes, the incremental cost of RMN over CONV averaged US$3094 per procedure.ConclusionAVNRT ablation using either CONV or RMN techniques is equally effective and associated with lower AVNRT recurrence rates than CRYO. CONV ablation carries significant disposable cost savings as compared to RMN, despite similar efficacy.

The oncologic results of cryoablation in prostate cancer patients with bone metastases

Objective: To explore the role of whole gland cryoablation plus ADT in prostate cancer (PCa) with bone metastases compared with ADT treatment alone in metastatic PCa.Methods: A total of 30 patients with biopsy-proven PCa with bone metastases underwent cryoablation and ADT treatment. The control group consisted of 30 men who were initially treated with ADT only and who were followed until progression, development of castration resistant PCa or death. Patients were pair matched for age, PSA level, clinical stage, preoperative biopsy Gleason score and bone metastases. Time to clinical progression, time to CRPC, cancer-specific survival and overall survival were analysed using descriptive statistical analysis.Results: Age at diagnosis, baseline PSA, biopsy Gleason score and ECOG status were comparable between the two groups. Prostate cryoablation was well tolerated and no serious complications occurred. At the last follow-up, patients in the cryoablation and ADT treatment group had a lower median PSA nadir (0.4 ng/ml vs. 0.8 ng/ml, p < 0.01) and longer time to CRPC (33 ± 0.9 mo vs. 22 ± 0.8 mo, p < 0.01). Further analyses detected the statistically significant benefits of cryoablation treatment not only in PFS (41 ± 1.4 mo vs. 22 ± 0.8 mo, p < 0.01), but also in CSS (52 ± 1.9 mo vs. 32 ± 2.4 mo, p ± 0.01) and OS (41 ± 1.5 mo vs. 28 ± 1.7 mo, p < 0.01). Moreover, there were fewer palliative procedures for local progression in the cryoablation group than the controls.Conclusions: Cryoablation plus ADT might be a treatment option in the multimodality management of metastatic prostate cancer. Further investigations are warranted.

Tumor cryoablation in combination with natural killer cells therapy and Herceptin in patients with HER2-overexpressing recurrent breast cancer

In this study, we investigated the clinical benefits of a combination of tumor cryoablation with natural killer (NK) cells therapy and Herceptin for human epidermal growth factor (HER) 2-overexpressing recurrent breast cancer. From May 2015 to May 2016, 48 patients who met the enrollment criteria were assigned to three groups (n=16): cryoablation group (group I), cryoablation-NK cells therapy group (group II) and cryoablation-NK cells therapy-Herceptin group (group III). Safety and short-term effects were evaluated. All the adverse effects were manageable and acceptable. The three-therapy combination treatment not only yielded good clinical efficacy, it also improved the quality of life; reduced levels of circulating tumor cells (CTCs); reduced carcino-embryonic antigen (CEA) and cancer antigen 15-3 (CA15-3) expression; enhanced immune function significantly. Furthermore, it can resulte in significant prolongation of progression free survival (PFS). This is the first clinical study to demonstrate the benefit of the three-therapy combination of tumor cryoablation, NK cells therapy, and Herceptin for HER2-overexpressing recurrent breast cancer.

Effects of radiofrequency ablation versus other ablating techniques on hepatocellular carcinomas: a systematic review and meta-analysis

BackgroundPercutaneous ablation has quickly arisen as one of the important alternative treatments for hepatocellular carcinoma (HCC). We aimed to compare the therapeutic effects of radiofrequency ablation (RFA) and other ablative techniques on HCCs.MethodsDatabases were searched to identify literature on complete tumor ablation (CTA), overall survival (OS), local tumor recurrence (LTR), and complications of RFA in the treatment of HCC, compared with those of microwave ablation (MWA), percutaneous ethanol injection (PEI), PEI plus RFA, cryoablation (CRA), laser ablation (LSA), and high-intensity focused ultrasound. Randomized controlled trials and high-quality cohort studies were included in the assessment.ResultsThe effects of MWA and CRA appeared to be similar to those of RFA, but lower rates of LTR and higher rates of CTA in large tumors compared with RFA were reported (P < 0.05). CTA rates were lower in patients treated with PEI (odds ratio [OR] 0.16, 95% confidence interval [CI] 0.06–0.42), and higher in those treated with PEI plus RFA (OR 2.28, 95% CI 1.19–3.60), with an increased incidence of fever (P < 0.05). LSA resulted in lower CTA rates (OR 0.32, 95% CI 0.13–0.81) and OS (hazard ratio 1.47, 95% CI 1.01–2.15), with a lower incidence of complications.ConclusionsCompared with RFA, identical effects were found in MWA and CRA groups. Fewer complications were observed in PEI and LSA group. PEI plus RFA appeared more effective, with a higher rate of complications. Well-designed randomized controlled trials are further needed to confirm above results.

Cryoablation combined with allogenic natural killer cell immunotherapy improves the curative effect in patients with advanced hepatocellular cancer.

In this study, the clinical efficacy of cryosurgery combined with allogenic natural killer cell immunotherapy for advanced hepatocellular cancer was evaluated. From October 2015 to March 2017, we enrolled 61 patients who met the enrollment criteria and divided them into two groups: 1) the simple cryoablation group (Cryo group, n = 26); and 2) the cryoablation combined with allogenic natural killer cells group (Cryo-NK group, n = 35), the safety and short-term effects were evaluated firstly, then the median progression-free survival, response rate and disease control rate were assessed. All adverse events experienced by the patients were recorded, and included local (e.g., pain, pleural effusion, and ascites) and systemic (e.g., chills, fatigue, and fever) reactions, fever was more frequent. Other possible seriously side effects (e.g., blood or bone marrow changes) were not detected. Combining allogeneic natural killer cells with cryoablation had a synergistic effect, not only enhancing the immune function, improving the quality of life of the patients, but also reducing the expression of AFP and significantly exhibiting good clinical efficacy of the patients. After a median follow-up of 8.7 months (3.9 –15.1months), median progression-free survival was higher in Cryo-NK (9.1 months) than in Cryo (7.6 months, P = 0.0107), median progression-free survival who received multiple natural killer was higher than who just received single natural killer (9.7 months vs.8.4 months, P = 0.0011, respectively), the response rate in Cryo-NK (60.0%) was higher than in Cryo (46.1%, P < 0.05), the disease control rate in Cryo-NK (85.7%) was higher than in Cryo group (69.2%, P < 0.01). Percutaneous cryoablation combined with allogeneic natural killer cell immunotherapy significantly increased median progression-free survival of advanced hepatocellular cancer patients. Multiple allogeneic natural killer cells infusion was associated with better prognosis to advanced hepatocellular cancer.

Prospective study of percutaneous cryoablation combined with allogenic NK cell immunotherapy for advanced renal cell cancer

In this study, the clinical efficacy of cryosurgery combined with allogenic NK cell immunotherapy for advanced renal cell cancer was evaluated. From July to December 2016, we enrolled 60 patients who met the enrollment criteria and divided them into two groups: (1) the simple cryoablation group (n=30); and (2) the cryoablation combined with allogenic NK cells group (n=30). The clinical efficacy, quality of life, immune function, and other related indicators were evaluated. Combining allogeneic NK cells with cryoablation had a synergistic effect, not only enhancing the immune function and improving the quality of life of the patients, but also significantly exhibiting good clinical efficacy of the patients. This study is the first clinical trial that has evaluated the safety and efficacy of allogenic NK cells combined with cryosurgery for the treatment of renal cell cancer.

COMPARISON OF THE DISORDERED MECHANICAL FUNCTION OF THE LEFT ATRIUM AFTER ANTRAL ISOLATION OF PULMONARY VEINS BY RADIOFREQUENCY OR CRYOBALLOON ABLATION

Aim. To assess and compare mechanical functioning of the left atrium before and just after cryoballoon or radiofrequency ablation. Material and methods . Totally, 43 patients included, with sympthomatic atrial fibrillation resistant to drug treatment. Of those 21 — for cryoballoon ablation (mean age 57,8±8,7 y. o., 11 males and 10 females) and 22 candidates for radiofrequency ablation, at the age 54,4±11 y. o., 16 males and 6 females. Before procedure, just after and on the 5th day, transthoracal echocardiography was performed, with measurement of Doppler parameters of intracardiac hemodynamics, as mechanical function of the left atrium assessment, including 3D imaging. Results. By the data from transthoracal echocardiography and direct intraoperation manometry, the significant disorders of the left atrium (LA) mechanical function were found in both treatment groups, with some differences. Pulmonary veins (PV) isolation by any method does not influence diastolic and systolic function of the left ventricle, that confirmed by invasive measurements of the end-diastolic pressure in LV, as the changes of volumes and ejection fraction by echocardiography. Therefore transmitral blood flow dynamics, as PV and pulmonary artery flow, related to PV isolation procedure, is a result of the LA functioning disorder due to its passive dilatability and active contractility decrease, dysfunction of the PV sleeves, increase of pulmonary vascular resistance. The significant decrease found in LA pumping function, more prominent in radiofrequency group just after the procedure, with further improvement to the 5th day after procedure. Also, mean pulmonary artery pressure increase, and till the 5th day in radiofrequency group it was significantly higher than in cryoablation group. Conclusion. Both cryo and radio ablation procedures of PV isolation significantly impact on the mechanical functioning of the LA, however cryo ablation leads to less severe disorder at short follow-up.

Impact of cavotricuspid isthmus morphology in CRYO versus radiofrequency ablation of typical atrial flutter

Objectives. Cryoablation (CRYO) is an alternative to radiofrequency (RF) for catheter ablation of cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL). We aimed to study whether different CTI morphologies had different impacts on procedural success for CRYO and RF. Design. This study randomized 153 patients with CTI-dependent AFL (median age 65 years; range 34–82) to RF or CRYO (78 CRYO; 75 RF). Biplane angiography (RAO 30° and LAO 60°) was done before the ablation procedure and isthmuses were classified as straight (n = 81), concave (n = 43) or pouch-like (n = 29). RF was performed with a 3.5-mm open-irrigated tip catheter and CRYO was performed with a 9 F, 8-mm tip catheter. The ablation endpoint was bidirectional block of CTI. Results. Acute procedural success was achieved in 70/75 patients in the RF group and in 72/78 patients in the CRYO group. With regard to CRYO or RF, acute procedural success rates were similar between the three isthmus types: straight: CRYO (92%) and RF (96%); concave: CRYO (92%) and RF (94%); and pouch-like: CRYO (94%) and RF (85%). There were no significant differences regarding success rate between the different morphologies in the CRYO or the RF group. The CTI was longer in patients with acute failure compared to the patients with acute success (38 ± 7 mm versus 33 ± 6 mm, p = 0.045). Conclusion. The CTI morphology did not influence the acute success rate for either the CRYO or the RF ablation of CTI-dependent AFL. A longer CTI was associated with a lower success rate regardless of energy source.

Cryoablation versus Partial Nephrectomy for Clinical T1b Renal Tumors: A Matched Group Comparative Analysis

BackgroundThe traditional treatment for a cT1b renal tumor has been radical nephrectomy. However, recent guidelines have shifted towards partial nephrectomy (PN) in selected patients with cT1b renal tumors. Furthermore, practitioners have extended the role of cryoablation (CA) to treat cT1b tumors in selected patients. ObjectiveTo evaluate the efficacy of CA compared to PN for cT1b renal tumors. Design, setting, and participantsWe performed a retrospective review of patients who underwent either renal CA (laparoscopic or percutaneous) or PN (robot-assisted) for a cT1b renal mass (>4cm and ≤7cm) between November 1999 and August 2014. To reduce the inherent biases of a retrospective study, CA and PN groups were matched on the basis of key variables: tumor size, Charlson comorbidity index (CCI), age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, preoperative serum creatinine, preoperative estimated glomerular filtration rate (eGFR), gender, and solitary kidney. The matching algorithm was 1:1 genetic matching with no replacement. Outcome measurements and statistical analysisSurvival analysis was performed only for patients diagnosed with renal cell carcinoma according to histopathologic evaluation of a tumor biopsy or resected tumor specimen. Recurrence-free, overall, and cancer-specific survival were analyzed using Kaplan-Meier survival curves. Survival outcomes were compared between groups using the log-rank test. Results and limitationsA total of 31 patients were treated using CA and 161 using PN during the study period. After matching, there was no significant difference between the PN and CA groups for tumor size (4.6 vs 4.3cm; p=0.076), CCI (6 vs 6; p=0.3), RENAL score (9 vs 8; p=0.1), age (68 vs 68 yr; p=0.9), BMI (30 vs 31kg/m2; p=0.2), ASA score (3 vs 3; p=0.3), preoperative creatinine (1.2 vs 1.4mg/dl; p=0.2), preoperative eGFR (63 vs 53ml/min/1.73 m2; p=0.2), and proportion of patients with a solitary kidney (19% vs 32%; p=0.4). The total postoperative complication rate was higher for PN than for CA (42% vs 23%; p=0.10). There was no significant difference in percentage eGFR preservation between PN and CA (89% vs 93%; p=0.5). The rate of local recurrence was significantly higher for CA than for PN (p=0.019). There was no significant difference in cancer-specific mortality (p=0.5) or overall mortality (p=0.15) between the CA and PN groups. ConclusionsPatients treated with CA for cT1b renal tumors had a significantly higher rate of local cancer recurrence at 1 yr compared to those treated with PN. Until further studies are performed to clearly define the role of CA in cT1b renal tumors, CA should be reserved for patients with imperative indications for nephron-sparing surgery who cannot be subjected to the risks of more invasive PN. Patient summaryWe evaluated the efficacy of renal cryoablation compared to partial nephrectomy for clinical T1b renal tumors. The cryoablation and partial nephrectomy groups were matched to provide a better comparison. We concluded that renal cryoablation had a higher rate of local cancer recurrence.

Treatment of osteolytic solitary painful osseous metastases with radiofrequency ablation or cryoablation: A retrospective study by propensity analysis.

The present study aimed to measure the improvement in pain relief and quality of life in patients with osteolytic solitary painful bone metastasis treated by cryoablation (CA) or radiofrequency ablation (RFA). Fifty patients with solitary osteolytic painful bone metastases were retrospectively studied and selected by propensity analysis. Twenty-five patients underwent CA and the remaining twenty-five underwent RFA. Pain relief, in terms of complete response (CR), the number of patients requiring analgesia and the changes in self-rated quality of life (QoL) were measured following the two treatments. Thirty-two percent of patients treated by CA experienced a CR at 12 weeks versus 20% of patients treated by RFA. The rate of CR increased significantly with respect to baseline only in the group treated by CA. In both groups there was a significant change in the partial response with respect to baseline (36% in the CA group vs. 44% in the RFA group). The recurrence rate in the CA and RFA groups was 12% and 8%, respectively. The reduction in narcotic medication requirements with respect to baseline was only significant in the group treated by CA. A significant improvement in self-rated QoL was observed in both groups. The present study seems to suggest that CA only significantly improves the rate of CR and decreases the requirement of narcotic medications. Both CA and RFA led to an improvement in the self-rated QoL of patients after the treatments. However, the results of the present study should be considered as preliminary and to serve as a framework around which future trials may be designed.

Comparison between cryoablation and irreversible electroporation of rabbit livers at a location close to the gallbladder.

BackgroundThe ablation of liver tumors located close to the gallbladder is likely to lead to complications. The aim of this article is to compare the safety and efficacy of irreversible electroporation (IRE) and cryoablation in rabbit livers at a location close to the gallbladder.Materials and methodsWe performed cryoablation (n = 12) and IRE (n = 12) of the area of the liver close to the gallbladder in 24 New Zealand white rabbits in order to ensure gallbladder damage. Serum aminotransferase and serum bilirubin levels were measured before and after the ablation. Histopathological examination of the ablation zones in the liver and gallbladder was performed on the 7th day after the ablation.ResultSeven days after the ablation, all 24 animals were alive. Gallbladder perforation did not occur in the IRE group; only mucosal epithelial necrosis and serous layer edema were found in this group. Gallbladder perforation occurred in four rabbits in the cryoablation group. Serum aminotransferase and serum bilirubin levels obviously increased in both groups by Day 3 and decreased gradually thereafter. The elevation in aminotransferase and bilirubin levels was greater in the cryoablation group than the IRE group. Pathological examination revealed complete necrosis of the liver parenchyma from the ablation center to the gallbladder in both groups, but bile duct and granulation tissue hyperplasia were observed in only the IRE group. Full-thickness gallbladder-wall necrosis was seen in the cryoablation group.ConclusionsFor ablation of the liver area near the gallbladder, IRE is superior to cryoablation, both in terms of safety (no gallbladder perforation in the IRE group) and efficacy (complete necrosis and rapid recovery in the IRE group).