Adjuvant approaches to enhance cryosurgery.
Adjuvant approaches to enhance cryosurgery.
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DOI：
10.1115/1.3156804
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发表时间：
2009-07
期刊：
影响因子：
--
通讯作者：
Bischof JC
中科院分区：
文献类型：
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作者：
Goel R;Anderson K;Slaton J;Schmidlin F;Vercellotti G;Belcher J;Bischof JC
分子佐剂可用于增强组织内冷冻的自然破坏机制。这篇综述讨论了它们在各种疾病的联合或辅助强化冷冻手术领域的应用。辅助使用的两个重要动机是：(1)加强对冷冻区域局部疾病的控制（即减少疾病的局部复发）和(2)减少因过度冷冻到邻近组织而引起的并发症（即减少治疗部位附近正常功能组织的破坏）。本文首先简要介绍了冷冻技术的发展概况，包括探针和冷冻剂，以及体内冻融对细胞、血管损伤的主要机制和可能产生的免疫效应。然后，回顾侧重于佐剂的每一个这些机制，使组织更敏感的冻融损伤。四大类佐剂进行了讨论，包括：热物理剂（共晶形成盐和氨基酸），化学治疗剂，血管剂和免疫调节剂。然后详细阐述了这些佐剂的选择、时间、剂量和递送等关键问题。最后，研究一种特别有前途的血管佐剂tnf - α，它显示了在冷冻冰球中摧毁所有癌症的能力。
Molecular adjuvants can be used to enhance the natural destructive mechanisms of freezing within tissue. This review discusses their use in the growing field of combinatorial or adjuvant enhanced cryosurgery for a variety of disease conditions. Two important motivations for adjuvant use are: (1) increased control of the local disease in the area of freezing (i.e., reduced local recurrence of disease) and (2) reduced complications due to over-freezing into adjacent tissues (i.e., reduced normal functional tissue destruction near the treatment site). This review starts with a brief overview of cryosurgical technology including probes and cryogens and major mechanisms of cellular, vascular injury and possible immunological effects due to freeze-thaw treatment in vivo. The review then focuses on adjuvants to each of these mechanisms that make the tissue more sensitive to freeze-thaw injury. Four broad classes of adjuvants are discussed including: thermophysical agents (eutectic forming salts and amino acids), chemotherapuetics, vascular agents and immunomodulators. The key issues of selection, timing, dose and delivery of these adjuvants are then elaborated. Finally, work with a particularly promising vascular adjuvant, TNF-alpha, that shows the ability to destroy all cancer within a cryosurgical iceball is highlighted.