Synthèse sur la cryoablation pour le traitement du cancer

Selon un récent article de synthèse, la cryoablation est désormais une technique bien établie pour le traitement de nombreux cancers. (en anglais)
 According to a review article by a team from the Institute of Biomedical Technology at Binghamton University, NY, United States, “cryoablation is a well-established therapeutic regime for the treatment of numerous cancers.” Often thought of as a simple ablative process, it is now seen as “a sophisticated, combinatorial therapy involving a complex cascade of destructive stresses” operating in various ways and with diverse effects. Its rate of success compared to alternative therapies varies according to the type of clinical applications:

-skin cancer: a very high cure rate (99%), however good comparative controlled studies of diverse treatments are scarce,

-lung cancer: presents a 3-year survival rate of 32%,

-breast cancer: clinical trials for small early-stage breast cancers rated cryosurgery as safe and effective. Further and clearly randomized trials are still needed,

-esophagus: benefits are achieved for 70% of patients. A whole range of alternatives to cryosurgery also exist,

-hepatic cancers: cryosurgery has found use in the 15-20% of patients with liver metastases from colon cancer, but the complication rate with cryosurgery vs other techniques of ablation was considered high,

-kidney tumors: recent reports compare cryoablation with radiofrequency ablation and reveal that treatment results and complication rates are similar in both techniques,

-prostate cancer: there is high interest in focal treatment by cryosurgery, however only a small percentage for these cancers are sufficiently focalized to be considered and the ability to anatomically localize portions of the gland is a central challenge,

-bone tumors: curettage with adjunctive cryosurgery and related supportive measures yields the most effective treatment.

Cryosurgical techniques have limited use for cancers in diverse sites, where other techniques are generally preferred. But on the whole, “while research and optimization remain ongoing, today cryoblation is a highly effective and practical means of treating numerous cancers with the long term studies (5 and 10-year follow up) demonstrating outcomes equivalent to or better than those achieved by other ablative techniques…” Further in-depth understanding of molecular mechanisms involved in cryogenic injury is likely to further enhance clinical efficacy.

Mechanisms of cryoablation: clinical consequences on malignant tumors, J.G. Baust et al., Cryobiology, Volume 68 (February 2014)