Cryosurgical ablation of soft tissue sarcomas: a phase I trial of feasibility and safety.
BACKGROUND
Cryosurgery is a therapeutic method of treating neoplastic tissue by freezing in situ to achieve devitalization. Cell death results from exposure to severe cold (below -40 degrees C for at least 1 minute) as well as from the process of freezing and thawing, which disrupts cellular integrity. Modern cryosurgical technique involves insertion of hollow probes into the tumor, through which circulating liquid nitrogen and gaseous nitrogen can achieve tissue and tumor freezing and thawing for tumor control. Cryoablation is now a recognized approach to the treatment of various malignant tumors, and it is generally well tolerated. This method has been used only sporadically to date in the treatment of patients with soft tissue sarcomas.


METHODS
The purpose of this study was to assess the feasibility and safety of cryosurgical ablation of soft tissue sarcomas utilizing a cryoprobe system. Twelve patients with soft tissue tumors of the extremity were included in this Institutional Review Board-approved protocol. Cryoablation was performed by inserting cryoprobes into the tumors, through which liquid nitrogen and gaseous nitrogen were pumped to achieve two freeze/thaw cycles. The entire process was monitored with intraoperative ultrasonography. All patients had subsequent resection of the residual tumor. Patients were monitored clinically and metabolically for toxicity.


RESULTS
Cryoablation was successfully performed on all 12 patients. Complications included peripheral nerve palsy (in 3 patients) and serous wound drainage (in 3 patients). There were no cases of wound infection, deep venous thrombosis, pulmonary embolism, wound dehiscence, skin slough, or metabolic abnormalities. All 3 cases of peripheral nerve palsy showed signs of recovery, 2 within 1 week and 1 within 4 months.


CONCLUSIONS
Cryosurgical ablation of soft tissue sarcomas is technically safe and feasible. This method can be used in conjunction with other modalities in the treatment of patients with these tumors. The complications associated with cryoablation of sarcomas are minor or transient, and the procedure is well tolerated by patients. The role of cryosurgery in the management of soft tissue sarcomas needs to be elucidated as more data regarding its safety and effectiveness become available.
Menendez
L R
LR
Department of Orthopaedic Surgery, USC University Hospital, University of Southern California, Los Angeles 90033, USA.
Tan
M S
MS
Kiyabu
M T
MT
Chawla
S P
SP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003452:Cryosurgery / Q000009:adverse effects / Q000379:methods*; D005121:Extremities / Q000473:pathology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014463:Ultrasonography