https://www.techvir.com/article/S1089-2516(13)00063-2/pdf

Tumor Ablation: Common Modalities and General Practices

Therapeutic targets of neuroprotection and neurorestoration in ischemic stroke: Applications for natural compounds from medicinal herbs.

Percutaneous imaging-guided cryoablation (PICA) is a recently developed technique, which applies extreme hypothermia to destroy tumours under close imaging surveillance. It is minimally invasive, safe, repeatable, and does not interrupt or compromise other oncologic therapies. It presents several advantages over more established heat-based thermal ablation techniques (e.g. radiofrequency ablation; RFA) including intrinsic analgesic properties, superior monitoring capability on multi-modal imaging, ability to treat larger tumours, and preservation of tissue collagenous architecture. There has been a recent large increase in reports evaluating the utility of PICA in a wide range of patients and tumours, but systematic analysis of the literature is challenging due to the rapid pace of change and predominance of extensively heterogeneous level III studies. The precise onco-therapeutic role of PICA has not been established. This narrative review outlines the available evidence for PICA in a range of tumours. Current indications include curative therapy of small T1a renal tumours; curative/palliative therapy of small primary/secondary lung tumours where RFA is unsuitable; palliation of painful bone metastases; and urologic treatment of organ-confined prostate cancer. There is growing evidence to support its use for small hepatic tumours, and encouraging results have been obtained for breast tumours, extra-abdominal desmoid tumours, and management of higher-stage tumours and oligometastatic disease. However, the overall evidence base is weak, effectively restricting PICA to cases where standard therapy and RFA are unsuitable. As the technique and evidence continue to mature, the benefits of this emerging technique will hopefully become more widely available to cancer patients in the future.

Percutaneous image-guided cryoablation: current applications and results in the oncologic field

Liver Ablation: Best Practice.

Author(s): Rong, Guanghua; Bai, Wenlin; Dong, Zheng; Wang, Chunping; Lu, Yinying; Zeng, Zhen; Qu, Jianhui; Lou, Min; Wang, Hong; Gao, Xudong; Chang, Xiujuan; An, Linjing; Li, Hongyan; Chen, Yan; Hu, Ke-Qin; Yang, Yongping | Abstract: BackgroundAccumulating evidences have suggested that percutaneous cryoablation could be a valuable alternative ablation therapy for HCC but there has been no large cohort-based analysis on its long-term outcomes.MethodsA series of 866 patients with Child-Pugh class A-B cirrhosis and HCC within Milan criteria who underwent percutaneous cryoablation was long-term followed. The safety, efficacy, 5-year survival, and prognostic factors of percutaneous cryoablation in the treatment of HCC were analyzed.ResultsA total of 1197 HCC lesions were ablated with 1401 cryoablation sessions. Complete response (CR) was achieved in 1163 (97.2%) lesions and 832 (96.1%) patients with 34 (2.8%) major complications, but no treatment-related mortality. After a median of 30.9 months follow-up, 502 (60.3%) patients who achieved CR developed different types of recurrence. The cumulative local tumor recurrence rate was 24.2% at 5-years. Multiple tumor lesions, tumor size g 3 cm, and repeated ablation of same lesion were independent risk factors associated with local recurrence. The 5-year overall survival (OS) rates were 59.5%. Age l 36 years, HCC family history, baseline hepatitis B virus DNA g106 copies/ml, and three HCC lesions were independently and significantly negative predictors to the post-cryoablation OS.ConclusionsPercutaneous cryoablation is an effective therapy for patients with HCC within Milan criteria, with comparable efficacy, safety and long-term survival to the reported outcomes of radiofrequency ablation.

/pdf/long-term-outcomes-of-percutaneous-cryoablation-for-patients-2tx2nhq1ed.pdf

Long-term outcomes of percutaneous cryoablation for patients with hepatocellular carcinoma within Milan criteria.

Purpose
To evaluate the efficacy and safety of ultrasound (US)-guided percutaneous argon-helium cryoablation for hepatocellular carcinoma (HCC) and determine appropriate indications.

/pdf/outcomes-of-ultrasound-guided-percutaneous-argon-helium-4u066o49ay.pdf

Outcomes of ultrasound-guided percutaneous argon-helium cryoablation of hepatocellular carcinoma

Abstract Context Folium Ginkgo extract and tetramethylpyrazine sodium chloride injection (Xingxiong injection) is a compound preparation commonly used for treating cerebral ischaemia/reperfusion injury in ischaemic stroke in China. However, its potential mechanisms on ischaemic stroke remain unknown. Objective This study explores the potential mechanisms of Xingxiong injection in vivo or in vitro. Materials and methods Sprague-Dawley (SD) rats were randomly assigned to five groups: the sham (normal saline), the model (normal saline) and the Xingxiong injection groups (12.5, 25 or 50 mL/kg). The rats were subjected to 2 h of middle cerebral artery occlusion (MCAO) followed by reperfusion for 14 d. Xingxiong injection was administered via intraperitoneal (i.p.) injection immediately after ischaemia induction for 14 d. Afterwards, rats were sacrificed at 14 d induced by administration of Xingxiong injection. Results Xingxiong injection significantly reduces infarct volume (23%) and neurological deficit scores (93%) compared with the MCAO/R group. Additionally, Xingxiong injection inhibits the loss in mitochondrial membrane potential (43%) and reduces caspase-3 level (44%), decreases NOX (41%), protein carbonyl (29%), 4-HNE (40%) and 8-OhdG (41%) levels, inhibits the expression of inflammatory factors, such as TNF-α (26%), IL-1β (34%), IL-6 (39%), MCP-1 (36%), CD11a (41%) and ICAM-1 (43%). Moreover, Xingxiong injection can increase p-Akt/Akt (35%) and Nrf2 (47%) protein expression and inhibit NLRP3 (42%) protein expression. Conclusions Xingxiong injection prevents cerebral ischaemia/reperfusion injury via activating the Akt/Nrf2 pathway and inhibiting NLRP3 inflammasome. These findings provide experimental evidence for clinical use of drugs in the treatment of ischaemic stroke.

https://www.tandfonline.com/doi/pdf/10.1080/13880209.2021.2014895?needAccess=true

Folium Ginkgo extract and tetramethylpyrazine sodium chloride injection (Xingxiong injection) protects against focal cerebral ischaemia/reperfusion injury via activating the Akt/Nrf2 pathway and inhibiting NLRP3 inflammasome activation

We present the case of one 58-year-old man with advancd hepatocellular carcinoma and hepatitis-B virus-related liver cirrhosis who received hepatic cryoablation. Magnetic resonance imaging (MRI) showed multiple liver tumors and the diameter of the largest tumor was more than 10cm. The patient received 2 percutaneous cryoablations in December 2009 and January 2010. Ten months later, MRI showed that not only the treated areas underwent necrosis but also the non-treated area decreased. The a-fetoprotein (AFP) level and the frequency of circulated regulatory T cell (Treg) before treatment were 13,800ng/mL and 15.6%, respectively. Following the cryoablations they dropped to 436ng/mL and 7.6%, respectively, 10 months later. The patient remains in good condition until now.

Decrease in size of non-treated lesions after cryoablation for hepatocellular carcinoma.

Objectives Investigate the clinical efficacy of cryotherapy ablation treatment for advanced hepatocellular carcinoma.analyse the predictive factors of cryotherapy ablation treatment.Methods There were 190 cases of hepatitis B-related HCC patients with advanced HCC from 2005 to 2008 in our hospital.By using clinical cohort method,they included cryoablation group (147 eases) and control group (43 cases),The median survival time and time to disease progression were compared.Evaluate clinical significance of age,gender,location of portal vein tumor thrombus,HBeAg,tumor histological grade,Child-Pugh classification,end-stage liver disease (MELD) score,advanced liver cancer prediction system (ALCPS) score and the Eastern Cooperative Oncology Group performance status (ECOG PS) score for predicting the efficacy of eryoablation.Group rates were compared with the x 2 test,survival analysis by using Kaplan-Meier method,survival rates were compared by Log-rank analysis; multiple factor survival analysis by using Cox regression model.Results Median survival time of cryoablation goup and Control group was 7.5 (4.2 to 14.6) months and 3.2 (1.2 to 8.6) months,median TTP was 3.5 (2.5 to 4.5) months and 1.5 (1.0 to 3.5 months),the differences were statistically significant (P ＜0.05 ).Median OS and TTP of advanced HCC patients who had Well-differentiated tumor,Child-pugh A-class and low score of MELD score,ALCPS score,ECOG PS score were significantly longer than the poorly differentiate,Child-Pugh B-class and the high those scores (P＜0.05).ECOG PS (P＜0.05,95％ CI 1.074 ～ 2.143) and ALCPS (P＜0.05,95％ CI 1.005 - 2.121) were independent predictors for OS of advanced HCC.Conclusions Cryoablation treatment can prolong median OS and TTP of advanced HCC; ECOG PS and ALCPS are important predictors for survival time of advanced HCC.

Key words: 
Carcinoma, hepatocellular; Cryosurgery,Survival rate,Time to progression

Clinical efficacy and prognostic factors for cryoablation patients with advanced hepatocellular carcinoma

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Outcomes of ultrasound-guided percutaneous argon-helium cryoablation of hepatocellular carcinoma

Folium Ginkgo extract and tetramethylpyrazine sodium chloride injection (Xingxiong injection) protects against focal cerebral ischaemia/reperfusion injury via activating the Akt/Nrf2 pathway and inhibiting NLRP3 inflammasome activation

Decrease in size of non-treated lesions after cryoablation for hepatocellular carcinoma.

Clinical efficacy and prognostic factors for cryoablation patients with advanced hepatocellular carcinoma