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冷冻治疗法提供无法接受手术和微创腹腔镜手术等方式的小肾脏肿瘤病患一个治愈选择；约翰霍普金斯大学的Christos Georgiades博士表示，这个影像导引技术利用一个探针穿过皮肤冷冻肿瘤，当肿瘤大小在4公分以下时，有很高的成功率。
在华盛顿特区举行的介入放射学会第33届年度科学会议中，他的团队是报告此一手术高成功率的两个团队之一。
Georgiades博士向记者表示，冷冻疗法有许多优于手术的好处；它需要微量的镇静；有半数病患可以在手术当天返家；另半数病患只需在医院住一天。病患术后仅感到些微疼痛或只有少许其他症状，只需在探针穿刺时的小伤口上贴个绷带。最常见的并发症是挫伤，但可解决。此外，此手术较不昂贵，花费仅开放手术的三分之一。
Georgiades博士表示，虽然冷冻手术获得美国食品药物管理局(FDA)核准且健保有给付，但此手术并未广为人知，即使医师间也是。我希望传递此一讯息，特别是对医师们，因为他们可以遇见这些有此类可治愈癌症、却未接受治疗手术的病患。直到数年前，医界仅追踪这些病患；我们未治疗癌症，因为我们担心治疗高风险病患会有恶化风险，不过，对许多病患而言，事实并非如此。
【小肿瘤的高成功率】
Georgiades博士发表了60名原发肾细胞肿瘤病患70个病灶的一系列资料，在追踪1年时，肿瘤大小在4公分以下的成功率为95%，肿瘤达7公分的成功率则将近 90%；治疗失败的3名病患(5%) 的肿瘤都比较大(7–10公分)；该团队计划再度治疗这些病患，希望再度治疗之后的效果可达100%。
另一个团队也报告了高成功率；韦恩州立大学的Hussein Aoun医师和Peter Littrup医师发表了90名病患的100个肿瘤的资料，平均肿瘤大小为3.1公分(范围：1.2 – 7.6)；研究者向与会听众表示，平均追踪1.3年之后，100个病例中有6个局部复发，成功率为94%；未治疗的案例之一是因为靠近其他器官，另外一个案例是因为探针失败。
Georgiades博士表示，最初，他对因为共病症而无法手术的病患进行冷冻治疗，但现在他也提供那些可以手术的病患此一替代治疗方式；他相信此一手术会渐渐普及，因为更容易进行；他预期，最终冷冻疗法将变成小肾脏肿瘤的标准照护方式。
他表示，目前，标准治疗方式为腹腔镜部分肾脏切除， 但是因为冷冻治疗的高成功率，这将有所改变，我们正在约翰霍普金斯进行两种治疗方式的比较研究 。
不过，未参与此研究的另一位冷冻治疗专家、纽约市Sloan Kettering纪念癌症中心的医师表示，冷冻疗法成为标准照护方式还是有点距离。
许多医师仍偏好切掉肿瘤，他向Medscape肿瘤学表示，在各医疗机构中以冷冻治疗的肾脏肿瘤比率各异；有些完全不用此方法，有些用此方法治疗约占15%的4公分大小肿瘤案例；需要更多有关冷冻疗法的案例来证明效果，成功率完全是因为筛选病患；较大的肿瘤和中央的肿瘤效果不好；他表示，目前此一技术已经有两家公司(Endocare和 Galil)参与，市场正在增加。
Georgiades博士表示，冷冻疗法已经被运用多年，不过，只有在过去9年因为探针缩小才可以经皮穿刺使用，现在还有影像可以导引探针放置与监控手术；Georgiades博士向Medscape肿瘤学表示，这是我们现在有的技术，这是第一次建立安全与有效的肾脏癌手术；冷冻疗法也可用于其他癌症，例如肺、肝、骨癌(后者用于减轻痛苦)，但冷冻疗法用于其他癌症的效果的资料不多。
介入放射学会第33届年度科学会议：摘要 100与摘要 101。发表于2008年3月17日。
High Success Reported With Cry
By Zosia Chustecka
Medscape Medical News
Cryoablation offers a curative option for small kidney tumors in patients who are unable to undergo surgery and a minimally invasive alternative to open or laparoscopic surgery for others. The image-guided procedure involves freezing the tumor with a needlelike probe inserted through the skin and has a very high success rate when used on tumors that are 4 cm or smaller in size, said Christos Georgiades, MD, PhD, from Johns Hopkins University, in Baltimore, Maryland.
His team was 1 of 2 reporting high success rates for the procedure at the recent Society of Interventional Radiology 33rd Annual Scientific Meeting, in Washington, DC.
Cryoablation has many advantages over surgery, Dr. Georgiades told journalists. It requires minimal sedation; about half the patients go home the same day and the other half stay in hospital overnight. Patients report that they feel very little pain or other symptoms and go home with only a bandage over the small puncture wound made by the probe. The most common complication is a bruise that resolves. In addition, this procedure is less expensive, costing about one-third of that for open surgery, he added.
Although cryoablation is approved by the Food and Drug Administration and is covered by health insurance, the procedure is not widely known, even among physicians, Dr. Georgiades commented. "I want to get the message out, mostly to my colleagues, because they will encounter many patients who have these treatable cancers but who cannot have treatment or surgery because of other diseases. Until a few years ago, we in the medical community simply followed these patients; we didn't treat the cancer for fear that we could make things worse if we tried to treat risky patients. But for many patients, that's no longer the case."
High Success Rates for Small Tumors
Dr. Georgiades presented data on a series of 70 lesions in 60 patients with primary renal cell carcinoma. At 1-year follow-up, the success rate was 95% for tumors that were 4 cm or smaller and nearly 90% for tumors up to 7 cm. Three patients (5%) who failed treatment all had large tumors (7 – 10 cm); the team plans to treat these patients again and hopes that secondary efficacy (after retreatment) will be close to 100%.
Another team also reported high success rates. Hussein Aoun, MD, and Peter Littrup, MD, both from Wayne State University, in Detroit, Michigan, presented data on 100 tumors in 90 patients. The mean tumor size was 3.1 cm (range, 1.2 – 7.6). After a mean follow-up of 1.3 years, local recurrences were seen in 6 of the 100 cases, giving a success rate of 94%. In 1 of these cases the mass was undertreated because of proximity to other organs, and in another case there was a probe failure, the researchers told the meeting.
Initially, Dr. Georgiades said that he performed cryoablation on patients who could not undergo surgery because of comorbidities, but now he also offers the procedure as an alternative to patients who can undergo surgery. He believes that the procedure will grow in popularity because it is much easier on the patient. Eventually, cryoablation will become the standard of care for small kidney tumors, he predicts.
Currently, the gold-standard treatment is laparoscopic partial nephrectomy surgery, "but given the high success rate of interventional cryoablation, that may change," he said. "We expect that the 2 treatments will be shown to be equivalent in a comparative study that is ongoing at Johns Hopkins."
However, another specialist in cryoablation not connected with this study, Stephen Solomon, MD, from Memorial Sloan Kettering Cancer Center, in New York, said that cryoablation is "still relatively far from becoming the standard of care. Many surgeons still prefer to cut out the tumor." He told Medscape Oncology that the proportion of kidney tumors treated by cryoablation varies among institutions; some do not use it at all, whereas others treat 15% of tumors smaller than 4 cm with this method. More data on cryoablation are needed to prove its effectiveness, he said, and its success will depend on the selection of patients; larger tumors and central tumors will likely do worse. The technology is widely available, with 2 companies involved (Endocare and Galil), and the market is growing, he said.
"Cryoablation has been in use for many years," commented Dr. Georgiades. However, it is only in the past 9 years that the technology has led to probes small enough to be used percutaneously, with imaging now available to guide probe placement and to monitor the procedure. "It is just now that we are, for the first time, establishing the safety and effectiveness of this procedure in kidney cancer," Dr. Georgiades told Medscape Oncology. Cryoablation is also used for other cancers, such as lung, liver, and bone (the latter to alleviate pain), but there are few data on the effectiveness of cryoablation in these other tumors, he said.
Society of Interventional Radiology (SIR) 33rd Annual Scientific Meeting: Abstract 100 and Abstract 101. Presented March 17, 2008.