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@#Although surgical resection remains to be the best treatment strategy for stageⅠnon-small cell lung cancer (NSCLC), percutaneous thermal ablation offers an important option for patients who are unable to undergo surgical resection. Currently, there are three main thermal ablation methods used in the treatment of lung cancer, including radiofrequency ablation (RFA), microwave ablation (MWA) and argon-helium cryoablation (AHC). With the improvement of technique and the accumulation of experience in the treatment of lung cancer, some limitations are disclosed in the initial application of RFA, such as heat sink effect, skin burns and rapid carbonization. These shortcomings have been overcome in the development of MWA and AHC. The feasibility and safety of thermal ablation for the treatment of lung cancer has been demonstrated and its efficacy has been significantly improved (especially for the tumour diameter≤3 cm). This article will focus on the application and recent research developments of these ablation techniques in the treatment of lung cancer.
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Objective To discuss the safety and curative effect of CT -guided percutaneous argon -helium cryoablation in treating leiomyosarcoma. Methods A total of 25 patients with leiomyosarcoma, who were treated at authors' hospital during the period from January 2012 to January 2016, were included in this study. CT-guided percutaneous argon-helium cryoablation was performed in all patients. The local changes of target lesions, the progression - free survival (PFS) and the survival rate were dynamically checked, and the complications were recorded. Results CT examination performed immediately after argon- helium cryoablation indicated that radical frozen ablation was achieved in 13 patients (52％), significant tumor -reductive frozen ablation in 11 patients (44％), effective tumor-reductive frozen ablation in one patient (4％), and invalid tumor-reductive frozen ablation in 0 patient. Follow - up CT examination performed at 3 months after argon - helium cryoablation showed that, based on solid tumor evaluation criteria, complete remission (CR) was obtained in 14 patients, partial remission (PR) in 8 patients and stable disease (SD) in one patient, the total remission rate (CR+PR) was 88％. The local PFS time was (9. 4±6. 2) months. The one-, 2-and 3-year survival rates were 64％, 48％ and 32％ respectively. In this group of cases, neither serious complications such as haemorrhage or tumor lysis syndrome nor procedure-related death occurred. Postoperative mild and moderate complications included fever, skin frostbite, immediate postoperative local pain exacerbation, nerve damage, etc., all of which disappeared or became relived after symptomatic treatment. Conclusion For the treatment of leiomyosarcoma, CT-guided percutaneous targeted argon-helium cryoablation has certain and definite short-term curative effect. CT-guided argon-helium cryoablation is a safe, reliable and minimally-invasive treatment, this technique is worth popularizing in clinical practice. (J Intervent Radiol, 2018, 27:228-232)
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Objective To investigate the influence of neutrophil-to-lymphocyte ratio (NLR) in peripheral blood in patients with hepatocellular carcinoma (HCC) before argon-helium cryoablation on the patient's prognosis.Methods The related clinical and pathological data of 72 HCC patients,who had received percutaneous argon-helium cryoablation,were retrospectively analyzed.Based on the preoperative NLR value,the patients were divided into low NLR group (NLR＜3.5) and high NLR group (NLR ＞ 3.5).The postoperative overall survival time of the patients in the two groups were statistically analyzed,and the risk factors that might affect the prognosis were evaluated by using univariate and multivariate analysis.Results Argon-helium cryoablation was carried out in all patients.The median overall survival time was 22.4 months;the median overall survival time of the high NLR group and the low NLR group was 13.2 months and 24.2 months respectively,the difference in the overall survival time between the two groups was statistically significant (P=0.003).Univariate analysis showed that the primary tumor size,liver function Child-Pugh classification,albumin,total bilirubin,cholinesterase and NLR value were the related factors that affected the postoperative overall survival time of HCC after argon-helium cryoablation (P＜0.05).Multivariate analysis revealed that the primary tumor size and NLR value were the independent prognostic factors that affected the postoperative overall survival time of HCC after argon-helium cryoablation (P＜0.05).Conclusion Preoperative NLR value in peripheral blood can be used as a prognostic indicator for patients with HCC undergoing argonhelium cryoablation;the larger the primary hepatic lesion is and/or the higher the NLR value is,the worse the prognosis of the patient will be.
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Objective To discuss the clinical significance of peripheral neutrophil-to-lymphocyte ratio (NLR) changes in patients with castration-resistant prostate cancer (CRPC) after receiving argon-helium cryoablation.Methods A total of 33 CRPC patients,who were treated with argon-helium cryoablation at Tianjin Medical University Cancer Hospital,were included in this study.The clinical and pathological data were collected and analyzed.The following factors that might affect the postoperative overall survival (OS) of patients were analyzed with univariate and multivariate analysis:age,baseline PSA level,hemoglobin,white blood cell count,platelet count,albumin,alkaline phosphatase,NLR,platelet-to-lymphocyte ratio (PLR),hormone sensitive time,chemotherapy,bone metastasis,Gleason score,ECOG score,PSA effective rate.Results A total of 33 patients were enrolled in this study,the average age was 69 years (50-82 years) and the median survival time was 28 months (6-55 months).Univariate analysis showed that the baseline PSA level,alkaline phosphatase,NLR,hormone sensitive time,chemotherapy,bone metastases,Gleason score and PSA effective rate were significantly correlated with OS of CRPC patients after receiving cryoablation (P＜0.05).Multivariate analysis showed that the baseline PSA level (P=0.003),NLR (P=0.009),Gleason score (P＜0.001) were independent predictive factors for OS of CRPC patients after cryoablation therapy.Conclusion NLR can be used as a prognostic predictor for CRPC patients undergoing argon-helium cryoablation,and the increased NLR indicates a poor prognosis.(J Intervent Radiol,2017,26:237-242)
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Objective To observe the response of tumor patient’s peripheral blood T-lymphocyte subset following CT guided per-cutaneous argon-helium cryoablation.Methods 122 patients with advanced of hepatocarcinoma or renal cell carcinoma undergone CT guided percutaneous argon-helium cryoablation.The percentage of peripheral blood CD3 + ,CD4 + ,CD8 + T-lymphocyte subset and the proportion of CD4 +/CD8 + T-lymphocyte were monitored at 2 h before and 20 h after the cryoablation respectively.Results The percentage of peripheral blood CD3+ ,CD4+ and CD3+ ,CD8+ T-lymphocyte were significantly increased after cryoablation,(measured by matched t-test,P<0.05).The ratio of CD4 +/CD8+ T-lymphocyte cells had an increase of 0.130(P =0.069).Conclusion The percentage of blood T-lymphocyte subset in patients with advanced hepatocellular carcinoma or renal cell carcinoma is increased significantly,when they are treated by using CT guided percutaneous cryoablation.The patient's tumor specific immunity is enhanced by CT guided percutaneous cryoablation.
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Objective To investigate the efficacy of sorafenib alone or combination with transarterial chemoembolization(TACE)and percutaneous local cryotherapy(PLCT)for advanced hepatocellular carcinoma patients without operation opportunity. Methods Sixty-four advanced hepatocellular carcinoma patients were selected as our subjects,who were underwent treatment of sorafenib alone or combination with TACE and PLCT. Thirty-two cases with sorafenib therapy were served as sorafenib group and another 32 cases with sorafenib in combination with transarterial chemoembolization and PLCT were served as combination group. All patients were followed up for 6 - 32 months. The treatment efficacy and tumor development were recorded. Results All surgeries of the patients were succeed and no death or serious operation complications occurred. Of 64 patients, 11 were achieved a complete remission( CR),31 cases with partial remission( PR),14 cases with stable development(SD),and 8 cases with progressive disease(PD). In the sorafenib group,3 cases were with CR,11 patients with PR,12 with SD,and 6 patients with PD. In the combination group,8 patients were with CR,20 patients with PR,2 patients with SD and 2 patients with PD,and the difference was significant between the two groups(χ2 = 14. 028,P = 0. 003). The median periods to tumor progression were 20 and 53 weeks in the sorafenib group and the combination group,and the difference was significant( χ2 = 14. 773,P = 0. 000). Conclusion For hepatocellular carcinoma patients without operation opportunity,sorafenib combined with TACE and PLCT can increase the tumor remission rate and prolong the periods to tumor progression in patients with hepatocellular carcinoma.
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Objective To observe the efficacy of percutaneous hepatic cryoablation for the treatment of primary or meta-static hepatic malignancies (<5 cm in diameter).Methods A total of 31 patients (39 tumors <5 cm in diameter) were treated with argon-helium cryoablation system under the guidance of CT or ultrasound.Results Tumor ablation range was 90%-100% in 39 lesions,including 69.23% (27/39) complete ablation.The 1- and 2-year survival rate was 90.32% (28/31) and 61.29% (19/31),respectively.No bleeding and injury of blood vessel or bile duct was noted.Complications of cryoablation included intraoperative shivering in 4 (12.90%) patients,postoperative fever (37.12-38.25℃ in 7 (22.58%) patients and hepatic pain in 6 (19.36%) patients.One patient had severe pain relief until 2 h after cryosurgery with ice-cold skin temperature and stable life index,analgesic had little effect,and no bleeding was found on CT image.Other patients had slight or moderate pain and remained untreated.Conclusion Percutaneous targeted argon-helium cryoablation is a feasible and safe technique in the treatment of small primary or metastatic hepatic malignancies not suitable for resection.
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Objective To observe the value of contrast-enhanced ultrasound (CEUS) in the evaluation of efficacy of Argon-Helium cryoablation therapy for liver malignancies.Methods A total of 27 patients with 27 lesions of liver malignancies underwent ultrasound-guided Argon-Helium cryoablation therapy.CEUS was used to evaluate the local response and compared with contrast-enhanced CT (CECT).Results One month after Argon-Helium cryoablation therapy,21 lesions (77.78%) were diagnosed as complete ablation with CEUS and 22 (81.48%) with CECT.Contrast enhancement within lesions was demonstrated in 6 lesions (22.22%) with CEUS and 5 (18.52%) with CECT.As compared to CECT,the sensitivity,specificity,positive and negative predictive value,and accuracy of CEUS in diagnosing tumor residue 1 month after treatment was 80.00% (4/5),90.91% (20/22),66.67% (4/6),95.24% (20/21),and 88.89% (24/27) .respectively.Conclusion CEUS is an effective alternative for the evaluation of efficacy of Argon-Helium cryoablation in the treatment of liver malignancies.
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Objective To observe the therapeutic effects of the parenchymal malignancies treated with argon-helium cryoablation percutaneouslly.Methods 49 foci in 45 patients with malignancies were treated with argon-helium cryoablation percutaneouslly.The temperature in the cryoablated area was dynamically recorded.The size and coverage of ice-balls formed were monitored.The imaging changes were observed.The shrinkage of tumor was followed 3 months post-cryoablation.The foci were divided into two groups in size:less than or equal to 3 cm and more than 3 cm.The chi-square test and spearman analysis were used by SPASS 11.0 software.Results The temperature in the cryoablated area descended fast to below-130℃ in a minute and relatively kept maintaince about-150℃ or so in the whole procedure.It ascended to 15℃ in a minute after rewarming.The ice-balls were formed within 50 seconds after cryoablation in 87.5% foci.And it increased in size as the time going.The coverages of the iceball more than or equal to and less than 80% were 72.7%、27.3% and 26.3%、73.7% in groups of less than or equal to 3 cm and more than 3 cm,respectively(P＜0.05).The ice-ball was demonstrated as arc hyperechogenicity with shadow and round-like low density on sonography and CT imaging,respectively.The shrinkage more than 50%of the foci was 81.8% and 30.6% in the groups of less than or equal to and more than 3 cm three months after the cryoabalated procedure(P＜0.01).Conclusion It is an actual/exact and convient way for the pereutaneous argon-helium cryoablation in treating malignancy.It can be used in the management of the parenchymal malignancy whole body.