Results Of Cryosurgery Research Articles

Cryosurgery in the treatment of head and neck neoplasia.

Abstract The clinical and cellular changes which occur after cryosurgery are described. Its advantages as a form of therapy in the treatment of neoplasia are discussed, particularly with regard to pain relief in palliation. However, the limitations of the effectiveness of cryosurgery in cancer therapy are emphasized. The results of cryosurgery are presented in 30 cases of recurrent or persistent neoplasia, which followed more formal treatment. In 5 cases healing appeared to be complete; good palliation was achieved in 6 cases, and useful palliation in 13 cases. There was no response in 6 cases.

Cryosurgery of advanced tumors

Tumors of the skin include a wide variety of histologic types. The commonest malignant tumors are basal-cell or squamous-cell carcinomas but melanomas and diverse sarcomas are among the less common tumors which occur in the skin. Malignant neoplasms, if neglected and untreated or if resistant to treatment, can grow in size and present special problems in management because of size or location. Regardless of the histologic type, cryosurgery is capable of producing destruction. Small tumors are generally easy to treat. Advanced tumors present greater problems in treatment. This clinic defines the role of cryosurgery in the management of advanced tumors and describes cryosurgical techniques suitable for such lesions. Cryosurgery has been used for skin cancer for about 90 years, and the first clinical trials demonstrated the success of the method. 1–5 Though the early techniques lacked the equipment available today, the physicians using the techniques in those years clearly described the important factors needed and the effect of freezing on the tissue. Modern cryosurgery is scarcely 25 years old and in this time has shown its usefulness in the treatment of skin cancers. Almost any kind of skin cancer can be treated successfully by cryosurgery. Most skin cancers are small, i.e., less than 2 cm in skin surface diameter and 4–5 mm in thickness. Growth is ordinarily slow, and though differences in biologic behavior are evident between basal-cell and squamous-cell epitheliomas, metastatic spread is not common in either type. 6–11 The cryosurgical techniques used in these small skin cancers are well developed and vary chiefly in the choice of spray or probe techniques or in the use of curettage as a preliminary step to aid in diagnosis and facilitate freezing of the base of the cancer. The overall results have been excellent; they are competitive with other methods of management, such as excision or electrodesiccation, and are described in Chapter 8. Advanced skin tumors, on the other hand, provide a substantial challenge to therapy. This clinic focuses on advanced skin cancers, which may be defined as those causing difficult problems in management due to size, extent or location of disease. As a minimum, advanced cancers are those which are greater than 4 cm in diameter on the surface and are ulcerated into the subdermal tissues. Beyond this minimum, skin cancers may grow to a large size and still remain without distant spread, causing problems because of bulk or invasion of important structures, such as nerves and major blood vessels. The defined size is not a critical value. Even small lesions may invade critical structures, including bone and cartilage, and become advanced in the sense that special problems in treatment exist. Furthermore, some cancers may grow to 4 cm and yet remain superficial, perhaps only 3–4 mm deep. Such cancers must be treated carefully but they are not advanced as the term is used in this clinic. Relatively few skin cancers become advanced today, so that any physician is likely to see only small numbers in clinical practice. Recurrent skin cancers, however, or those persistent after diverse methods of therapy may present difficult problems in therapy, so these too are mentioned in this clinic. Advanced skin cancers, even those recurrent after radiotherapy or excision, may be curable by cryosurgery if the disease is still localized. The reasons cryosurgery might be chosen, in preference to excision or radiotherapy, include fixation of the cancer to underlying bone or patients who are at high-surgical risk due to associated disease. Neglected cancers or those cancers which persist after radiotherapy or excision are usually advanced cancers which present problems in management and cryosurgical techniques may be among the last options in therapy. Some cancers, not necessarily advanced, have special characteristics which present a challenge to the ability to freeze a sufficient volume of tissue to be certain of care. For example, in some types of skin cancers, such as sclerosing or morphea-type basal-cell carcinomas and cancers of the scalp or alae nasae, the results of cryosurgery have not been good as compared with other techniques. 12 These lesions require aggressive freezing in situ because of the difficulty in recognizing the extent of the cancer. Skin cancers with indefinite borders require extra care in treatment, and consideration should be given to selective biopsy of the edges to the healing wound.

Current progress in cryosurgery

The 4-day sessions of the Eighth Annual Meeting of the American College of Cryosurgery in New Orleans, February 18–21, 1988, provided an intense overview of the position of cryosurgery in modern day medical practice. The variety of speakers demonstrated that interest in the therapeutic technique of cryosurgery remains high and that usage is greater, more diversified, and more selective than in past years. Emphasis at the meeting was placed on the selective use of cryosurgery, that is, defining the terms under which the physician would choose between diverse methods of local therapy, such as excision, electrosurgery, laser surgery, and cryosurgery. Most of the presentations were oriented clinically with emphasis on the results of cryosurgery. This brief report is intended to mention the important new developments in cryosurgery and to focus on some of the issues and needs that affect the future of the technique.

Cryosurgery in stomato-oncology: A report of experiences gained over three years

An account is given of the application and results of cryosurgery in stomato-oncology based on experiences gained over a 3-year period. Altogether 277 patients were treated for oral neoplasia and hemangiomas. It is stressed that cryosurgery is especially appli, cable for treating benign and malignant lesions of the anterior third of the oral cavity where healing is good, complications few, and inspection fairly easy. To date the short observation period offers no adequate basis for making a direct comparison of this method with other more conventional techniques in complex tumor therapy.

Cryosurgical nitrogen apparatus and recent results of its application in the radical treatment of certain neoplasms.

Abstract In recent years a rapid development of equipment for controlled local freezing of tissues for cryosurgery has occurred. Depending on the velocity of freezing and on the technical parameters of the apparatus, diverse spreading of the ice front and tissue destruction are observed. The Research Centre of Medical Technology in Warsaw designed and produced an apparatus for cryosurgery, which was used in the Institute of Oncology in Warsaw for the radical treatment of skin, mucous membranes, and lip neoplasms. In the years 1973 to 1975 this technique was applied in 221 cases. In 167 patients radical treatment was performed (Group A); in 31 patients the treatment was paliativc (Group B); and in 23 patients non-neoplastic growths of the skin were treated (Group C). The present work concerns the results observed in Group A, where the mean duration of follow-up observations was 11 months. For the analysis of recent results of cryosurgery a subgroup was chosen from the Group A patients, i.e., those for whom the follow-up lasted at least 24 months (32 cases). The observations demonstrated that the apparatus is useful and simple to handle. In the clinical groups T 1 , T 2 , N 0 , and M 0 the recent results of cryosurgery were similar to those observed with other types of treatment. Cryosurgical treatment is painless, is without blood loss, and is easy to perform. The period of healing is not longer than 3 weeks, and the cosmetic effect is good. General debilitation and the patient's age do not serve as counterindications to the performance of such treatment.

Clinical results of cryosurgery in recurrent acute tonsillitis.

Clinical results of cryosurgery in recurrent acute tonsillitis.

Indications and Results of Cryosurgery in 47 High Risk Patients with Prostatic Hypertrophy or Carcinoma

The authors report their experience with cryosurgery in a group of high risk patients presenting with prostatic hypertrophy or carcinoma. The patients were of advanced age and, in most cases, presented with chronic complete urinary retention and indwelling catheter. In 75.6% of cases, good results were achieved immediately. Residual urine was slight or absent in long term follow-up. No post-operative mortality related to the operation was observed and complications were mild. Despite the good results obtained, the authors maintain that prostatic cryosurgery is not indicated in sclerosis of the bladder neck where TUR is preferred, and advocate that prostatic cryosurgery should be limited to otherwise inoperable patients with prostatic hypertrophy or carcinoma.

The curative, palliative, and adjunctive uses of cryosurgery in the head and neck.

AbstractThe tissue‐destructive, adhesive, hemostatic, and immunogenic properties of cryogenic therapy are sometimes useful in treating head and neck tumors. Successful cryosurgery for necrosis of a tumor requires that the entire mass, be accessible. Lethal subzero temperatures, rapid rate of freeze to the initial temperature, slow spontaneous thaw, and refreeze, are also requisites for cryonecrosis. The results of cryosurgery in a series of 44 patients treated for cure or palliation or as adjunctive therapy from 1968 to 1970 are limited but encouraging.