Cryosurgery - a putative approach to molecular-based optimization

被引:108
作者
Baust, JG [1 ]
Gage, AA
Clarke, D
Baust, JM
Van Buskirk, R
机构
[1] SUNY Binghamton, Inst Biomed Technol, Binghamton, NY 13902 USA
[2] SUNY Buffalo, Dept Surg, Buffalo, NY 14214 USA
[3] SUNY Syracuse, Upstate Med Ctr, Syracuse, NY 13210 USA
[4] SUNY Binghamton, Dept Bioengn, Binghamton, NY 13902 USA
关键词
tumor therapy; cryosurgery; persistent disease; imaging techniques; adjunctive therapy; chemotherapy; prostate cancer; colorectal cancer; apoptosis;
D O I
10.1016/j.cryobiol.2004.01.005
中图分类号
Q [生物科学];
学科分类号
07 ; 0710 ; 09 ;
摘要
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 similar to20-40% 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. (C) 2004 Elsevier Inc. All rights reserved.
引用
收藏
页码:190 / 204
页数:15
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