Abstract
Cryosurgery has been used increasingly to treat different neoplasia including liver, bone, breast, lung, and prostate and of course the variety of benign, premalignant, and malignant skin lesions. Proposed primary advantages of cryosurgery in comparison to surgical excision include minimal morbidity, less damage of surrounding structures, ease of use, and lower cost. Potential secondary advantages include the induction of antitumoral response triggered by natural absorption of malignant tissue, which releases hidden tumoral epitopes after intracellular cryoinjury. Several published studies and anecdotal reports have shown distal disease regression after cryoablation of primary tumor, or disappearance of untreated warts at the different location from the treated lesions in the same individual. Several mechanisms have been proposed to explain the therapeutic effects of cryosurgery, but until very recently the literature has been controversial on the issue. Lately, cryoimmunological responses have been more adequately measured due to a development of more accurate and reproducible, immunological assays. Factors affecting success of cryoablation are especially analyzed, including but not limited to time and amount of freeze, type of the tumor treated, ratio of induced apoptosis vs. necrosis, type of inflammatory infiltrate (macrophages, dendritic cells, neutrophils), and relationship of T-regulatory cells vs. T cytotoxic cells. Eventually the use of immunological adjuvants to optimize the effects of cryoinjury is discussed. It is not surprising that there is tremendous interest in immunological aspects of cryosurgery, since cryoablation has the potential for both local and systemic therapy, i.e., direct ablation of the tumor and eradication of micrometastases through the immune system with minimal systemic toxicity. However, the generation of antitumor immune response is complex, and several factors may contribute not only to a positive response but also tilt it to the opposite direction, including immune suppression. Further directions would possibly include clarification and definition of ideal parameters for optimal destruction of tumor and induction of strong protective immunity with the obliteration of metastatic disease.
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References
Sabel MS, Nehs MA, Su G, Lowler KP, Ferrara JL, Chang AE. Immunologic response to cryoablation of breast cancer. Breast Cancer Res Treat. 2005;90:97–104.
Miya K, Saji S, Morita T, Niwa H, Takao H, Kida H, et al. Immunological response of regional lymph nodes after tumor cryosurgery: experimental study in rats. Cryobiology. 1986;23:290–5.
Osada S, Imai H, Tomita H, Tokuyama Y, Okumura N, Matsuhashi N, et al. Serum cytokine levels in response to hepatic cryoablation. J Surg Oncol. 2007;95:491–8.
He T, Tang C, Xu S, Moyana T, Xiang J. Nterferon gamma stimulates cellular maturation of dendritic cell line DC2.4 leading to induction of efficient cytotoxic T cell responses and antitumor immunity. Cell Mol Immunol. 2007;4:105–11.
Matin SF, Sharma P, Gill IS, Tannenbaum C, Hobart MG, Novick AC, et al. Immunological response to renal cryoablation in an in vivo orthotopic renal cell carcinoma murine model. J Urol. 2010;183:333–8.
Gursel E, Roberts M, Veenema RJ. Regression of prostatic cancer following sequential cryotherapy to the prostate. J Urol. 1972;108:928–32.
Ablin RJ, Soanes WA, Gonder MJ. Immuno-cryourogenital treatment of benign and malignant diseases of the prostate. Gerontol Clin. 1970;12:302–13.
Staren ED, Sabel MS, Gianakakis LM, Wiener GA, Hart VM, Gorski M, et al. Cryosurgery of breast cancer. Arch Surg. 1997;132:28–33; discussion 4.
Wong LL, Limm WM, Cheung AH, Fan FL, Wong LM. Hepatic cryosurgery: early experience in Hawaii. Hawaii Med J. 1995;54:811–3.
Crews KA, Kuhn JA, McCarty TM, Fisher TL, Goldstein RM, Preskitt JT. Cryosurgical ablation of hepatic tumors. Am J Surg. 1997;174:614–7; discussion 7–8.
Wang ZS. Cryosurgery in rectal carcinoma–report of 41 cases. Zhonghua Zhong Liu Za Zhi. 1989;11:226–7.
Blackwood CE, Cooper IS. Response of experimental tumor systems to cryosurgery. Cryobiology. 1972;9:508–15.
Privalov PL. Cold denaturation of proteins. Crit Rev Biochem Mol Biol. 1990;25:281–305.
Mazur P, Rall WF, Leibo SP. Kinetics of water loss and the likelihood of intracellular freezing in mouse ova. Influence of the method of calculating the temperature dependence of water permeability. Cell Biophys. 1984;6:197–213.
Baust JG, Gage AA. The molecular basis of cryosurgery. BJU Int. 2005;95:1187–91.
Yang G, Zhang A, Xu LX. Intracellular ice formation and growth in MCF-7 cancer cells. Cryobiology. 2011;63:38–45.
Tatsutani K, Rubinsky B, Onik G, Dahiya R. Effect of thermal variables on frozen human primary prostatic adenocarcinoma cells. Urology. 1996;48:441–7.
Hanai A, Yang WL, Ravikumar TS. Induction of apoptosis in human colon carcinoma cells HT29 by sublethal cryo-injury: mediation by cytochrome c release. Int J Cancer. 2001;93:526–33.
Weber SM, Lee Jr FT, Chinn DO, Warner T, Chosy SG, Mahvi DM. Perivascular and intralesional tissue necrosis after hepatic cryoablation: results in a porcine model. Surgery. 1997;122:742–7.
Glasgow SC, Ramachandran S, Csontos KA, Jia J, Mohanakumar T, Chapman WC. Interleukin-1beta is prominent in the early pulmonary inflammatory response after hepatic injury. Surgery. 2005;138:64–70.
Seifert JK, Junginger T. Cryotherapy for liver tumors: current status, perspectives, clinical results, and review of literature. Technol Cancer Res Treat. 2004;3:151–63.
Bishoff JT, Chen RB, Lee BR, Chan DY, Huso D, Rodriguez R, et al. Laparoscopic renal cryoablation: acute and long-term clinical, radiographic, and pathologic effects in an animal model and application in a clinical trial. J Endourol. 1999;13:233–9.
Chosy SG, Nakada SY, Lee Jr FT, Warner TF. Monitoring renal cryosurgery: predictors of tissue necrosis in swine. J Urol. 1998;159:1370–4.
Campbell SC, Krishnamurthi V, Chow G, Hale J, Myles J, Novick AC. Renal cryosurgery: experimental evaluation of treatment parameters. Urology. 1998;52:29–33; discussion 33−4.
Todryk S, Melcher AA, Hardwick N, Linardakis E, Bateman A, Colombo MP, et al. Heat shock protein 70 induced during tumor cell killing induces Th1 cytokines and targets immature dendritic cell precursors to enhance antigen uptake. J Immunol. 1999;163:1398–408.
Gazzaniga S, Bravo A, Goldszmid SR, Maschi F, Martinelli J, Mordoh J, et al. Inflammatory changes after cryosurgery-induced necrosis in human melanoma xenografted in nude mice. J Invest Dermatol. 2001;116:664–71.
Ismail M, Morgan R, Harrington K, Davies J, Pandha H. Immunoregulatory effects of freeze injured whole tumour cells on human dendritic cells using an in vitro cryotherapy model. Cryobiology. 2010;61:268–74.
Zhou L, Fu JL, Lu YY, Fu BY, Wang CP, An LJ, et al. Regulatory T cells are associated with post-cryoablation prognosis in patients with hepatitis B virus- related hepatocellular carcinoma. J Gastroenterol. 2010;45:968–78.
Baecher-Allan C, Anderson DE. Regulatory cells and human cancer. Semin Cancer Biol. 2006;16:98–105.
Rayman P, Wesa AK, Richmond AL, Das T, Biswas K, Raval G, et al. Effect of renal cell carcinomas on the development of type 1 T-cell responses. Clin Cancer Res. 2004;10:6360S–6.
Sabel MS, Su G, Griffith KA, Chang AE. Rate of freeze alters the immunologic response after cryoablation of breast cancer. Ann Surg Oncol. 2010;17:1187–93.
Shulman S, Brandt EJ, Yantorno C. Studies in cryo-immunology. II. Tissue and species specificity of the autoantibody response and comparison with iso- immunization. Immunology. 1968;14:149–58.
Hoffmann NE, Coad JE, Huot CS, Swanlund DJ, Bischof JC. Investigation of the mechanism and the effect of cryoimmunology in the Copenhagen rat. Cryobiology. 2001;42:59–68.
Bahn DK, Lee F, Badalament R, Kumar A, Greski J, Chernick M. Targeted cryoablation of the prostate: 7-year outcomes in the primary treatment of prostate cancer. Urology. 2002;60:3–11.
Si TG, Guo Z, Wang HT, Han YP, Hao XS. Cryoablation for prostate cancer induces tumor-specific immune response. Zhonghua Nan Ke Xue. 2009;15:350–3.
Petersen DS, Milleman LA, Rose EF, Bonney WW, Schmidt JD, Hawtrey CE, et al. Biopsy and clinical course after cryosurgery for prostatic cancer. J Urol. 1978;120:308–11.
Waitz R, Solomon SB, Petre EN, Trumble AE, Fasso M, Norton L, et al. Potent induction of tumor immunity by combining tumor cryoablation with anti- CTLA-4 therapy. Cancer Res. 2012;72:430–9.
Kogel HGR, Fohlmeister I, Pichlmaier H. Cryotherapy of rectal cancer. Immunologic results. Zentralbl Chir. 1985;110:147–54.
Ravindranath MH, Wood TF, Soh D, Gonzales A, Muthugounder S, Perez C, et al. Cryosurgical ablation of liver tumors in colon cancer patients increases the serum total ganglioside level and then selectively augments antiganglioside IgM. Cryobiology. 2002;45:10–21.
Sabel MS, Arora A, Su G, Chang AE. Adoptive immunotherapy of breast cancer with lymph node cells primed by cryoablation of the primary tumor. Cryobiology. 2006;53:360–6.
Misao A, Sakata K, Saji S, Kunieda T. Late appearance of resistance to tumor rechallenge following cryosurgery. A study in an experimental mammary tumor of the rat. Cryobiology. 1981;18:386–9.
Sabel MS. Cryo-immunology: a review of the literature and proposed mechanisms for stimulatory versus suppressive immune responses. Cryobiology. 2009;58:1–11.
Urano M, Tanaka C, Sugiyama Y, Miya K, Saji S. Antitumor effects of residual tumor after cryoablation: the combined effect of residual tumor and a protein-bound polysaccharide on multiple liver metastases in a murine model. Cryobiology. 2003;46:238–45.
Goel R, Anderson K, Slaton J, Schmidlin F, Vercellotti G, Belcher J, et al. Adjuvant approaches to enhance cryosurgery. J Biomech Eng. 2009;131:074003.
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Glossary
- APCs
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Antigen-presenting cells
- Cryoimmunology
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process that involves a specific immune response formed against antigens and debris derived from cells and tissues destroyed by cryosurgery.
- DCs
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Dendritic cells
- MHC
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Major histocompatibility complex
- RCC
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Renal cell carcinoma
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Moioli, E.K., Krunic, A.L. (2014). Immunological Aspects of Cryosurgery. In: Baldi, A., Pasquali, P., Spugnini, E. (eds) Skin Cancer. Current Clinical Pathology. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4614-7357-2_24
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DOI: https://doi.org/10.1007/978-1-4614-7357-2_24
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