The molecular basis of cryosurgery.
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Apoptosis↗
Biomedical subjects
Andrew A Gage
Publications and source records attributed to Andrew A Gage.
Cryosurgery--a putative approach to molecular-based optimization.
Cryosurgery must be performed in a manner that produces a predictable response in an appropriate volume of tissue. In present-day clinical practice, that goal is not always achieved. Concerns with cryosurgical techniques in cancer therapy focus in part on the incidence of recurrent disease in the treated site, which is commonly approximately 20-40% in metastatic liver tumors, and prostate cancers. Whether the cause of this failure is disease-based or technique related, cryosurgery for cancer commonly needs the support of adjunctive therapy in the form of anti-cancer drugs or radiotherapy to increase the rate of cell death in the peripheral zone of the therapeutic lesion where cell survival is in balance for several days post-treatment. Recent evidence has identified a third mechanism of cell death associated with cryosurgery. This mechanism, apoptosis or gene regulated cell death, is additive with both the direct ice-related cell damage that occurs during the operative freeze-thaw intervals and coagulative necrosis that occurs over days post-treatment. In this manuscript we discuss, through a combination of literature review and new data, the combined roles of these distinct modes of cell death in a prostate and colorectal cancer. Data are presented suggesting that sub-freezing temperatures, when sequentially applied with low dose chemotherapy, may provide improved cancer cell death in the freeze zone periphery. Since the mechanism of action of most common chemotherapeutic agents is to initiate apoptosis in cancer cells, the observation that sub-freezing exposures yields a similar effect provides a possible route toward molecular-based procedural optimization to improve therapeutic outcome.
Antineoplastic Agents↗
Cryosurgery for tumors - a clinical overview.
Cryosurgery, a method of treating disease by the production of freezing temperatures in the tissue, is a useful technique for the treatment of tumors. When the modern era of cryosurgery began in the mid 1960's, the technique was used only for tumors easily accessible by direct observation or via endoscopy, such as those of the skin, oral cavity, and prostate gland. In general, the technique had limited usefulness in the next two decades. However, with the advent of intraoperative ultrasound as a method of monitoring the process of freezing and with the development of more effective cryosurgical apparatus, the cryosurgical treatment of tumors of the viscera and other deep tissues became practical in the 1990's. This review assesses the present day status of cryosurgery in the management of diverse tumors.
Cryosurgery↗
Cryosurgery - a review of recent advances and current issues.
Advances in cryosurgery since 1990 were initiated by the development of improved cryosurgical equipment and by the availability of intraoperative ultrasound to monitor the tissue-freezing process. Interest in research on the effects of freezing on tissue and on new clinical applications was then stimulated. The research led to a better understanding of the mechanisms of cryogenic injury, including cell death by apoptosis, which has emerged as a potential key to the use of adjunctive chemotherapy in the treatment of cancer. Optimization of cryosurgical technique will also improve clinical results.
Arrhythmias, Cardiac↗