Cryosurgery - a putative approach to molecular-based optimization
Cryosurgery - a putative approach to molecular-based optimization
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DOI：
10.1016/j.cryobiol.2004.01.005
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发表时间：
2004-04-01
期刊：
影响因子：
2.7
通讯作者：
Van Buskirk, R
中科院分区：
文献类型：
--
作者：
Baust, JG;Gage, AA;Van Buskirk, R
冷冻手术必须以在适当体积的组织中产生可预测反应的方式进行。在当今的临床实践中，这一目标并不总是能够实现。冷冻外科技术在癌症治疗中的作用部分集中在治疗部位复发性疾病的发生率上，在转移性肝肿瘤和前列腺癌中复发率通常为20 -40%。无论这种失败的原因是基于疾病还是与技术相关，用于癌症的冷冻手术通常需要抗癌药物或放射疗法形式的连续治疗的支持，以增加治疗性病变的外周区域中的细胞死亡率，其中细胞存活在治疗后的几天内处于平衡状态。最近的证据已经确定了与冷冻手术相关的第三种细胞死亡机制。这种机制（细胞凋亡或基因调控的细胞死亡）与手术冻融间隔期间发生的直接冰相关细胞损伤和治疗后数天内发生的凝固性坏死都是相加的。在这篇手稿中，我们讨论，通过结合文献综述和新的数据，这些不同的细胞死亡模式在前列腺癌和结直肠癌的综合作用。数据表明，低于冰点的温度，当顺序应用低剂量化疗，可以提供改善的癌细胞死亡的冷冻区周边。由于最常见的化疗药物的作用机制是启动癌细胞凋亡，观察到亚冷冻暴露产生类似的效果提供了一种可能的途径，以分子为基础的程序优化，以改善治疗效果。(C)2004年爱思唯尔公司All rights reserved.
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.