Phase I study of percutaneous cryotherapy for colorectal liver metastasis.
BACKGROUND
The aim was to determine the safety and feasibility of percutaneous cryotherapy for treating irresectable colorectal liver metastases.


METHODS
Liquid nitrogen cryoprobes were inserted percutaneously into metastases using the Seldinger technique under computed tomographic guidance. Single-probe treatments were performed with either 3.6- or 6.3-mm cryoprobes (ice-ball volumes 18 and 59 cm3 respectively), or dual-probe treatments with two adjacent 6.3-mm probes (ice-ball volume 205 cm3). Treatment involved a single freeze--thaw cycle.


RESULTS
Fifteen patients received 25 single-probe treatments and seven patients received 14 dual-probe treatments. The treatment-related mortality rate was zero and complications occurred after six of 39 treatments. Liver metastasis growth was significantly delayed for 2 months after dual-probe but not single-probe treatment. Metastasis cryotherapy stimulated an immediate rise, followed by a fall, in serum carcinoembryonic antigen (CEA) level, associated with immune upregulation that was significantly greater after dual-probe treatments.


CONCLUSIONS
Ablation zones that were approximately four times larger than those produced by previously described percutaneous techniques delayed the growth of metastases, reduced serum CEA concentration, and induced detectable inflammatory and T-lymphocyte responses. Percutaneous cryotherapy for treatment of colorectal liver metastases is feasible and may have a place in conjunction with chemotherapy.
Huang
A
A
Department of Surgery, Faculty of Medicine, Imperial College of Science, Technology and Medicine, Chelsea, UK. t.allenmarsh@ic.ac.uk
McCall
J M
JM
Weston
M D
MD
Mathur
P
P
Quinn
H
H
Henderson
D C
DC
Allen-Mersh
T G
TG
D000368:Aged; D002272:Carcinoembryonic Antigen / Q000097:blood; D015179:Colorectal Neoplasms; D003452:Cryosurgery / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D007958:Leukocyte Count; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000097:blood / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D010976:Platelet Count; D011183:Postoperative Complications / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D002272:Carcinoembryonic Antigen