cryoablation

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olafa

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Does anyone do much cyroablation? I was reading a review in "chest clinics of north america" treatment of non-surgical tumors either becasue the patient can't undergo anesthesia or location...
I tried to post it, but it was over the limit for attchments.(barely)
I have only seen it used in acedemic setting?

RadiofrequencyAblation of LungTumors
Roberto F. Casal, MDa, Alda L.Tam, MDb, GeorgeA. Eapen, MDa,*

SUMMARY​
Radiofrequency ablation may play a useful role in the management of patients with medically inoperable early-stage lung cancer, and in a selected group of patients with lung metastases. Being a minimally invasive technique, it can provide local tumor control with negligible mortality and low morbidity. Appropriate patient selection is critical,
and it is fairly clear that lesions smaller than 3.5 cm have a much higher rate of response. Follow-up imaging for assessment of treatment response remains very challenging, and further studies are needed in this area.​
 
olafa said:
Does anyone do much cyroablation? I was reading a review in "chest clinics of north america" treatment of non-surgical tumors either becasue the patient can't undergo anesthesia or location...
I tried to post it, but it was over the limit for attchments.(barely)
I have only seen it used in acedemic setting?

RadiofrequencyAblation of LungTumors
Roberto F. Casal, MDa, Alda L.Tam, MDb, GeorgeA. Eapen, MDa,*

SUMMARY​
Radiofrequency ablation may play a useful role in the management of patients with medically inoperable early-stage lung cancer, and in a selected group of patients with lung metastases. Being a minimally invasive technique, it can provide local tumor control with negligible mortality and low morbidity. Appropriate patient selection is critical,
and it is fairly clear that lesions smaller than 3.5 cm have a much higher rate of response. Follow-up imaging for assessment of treatment response remains very challenging, and further studies are needed in this area.​
Click to expand...

Great success in actinic keratosis. Not so good for pain. I believe it can relieve pain, just not for long enough to be practical.
 
There is cryo and then there is cryo. Lung tumors require an extremely cold cryo probe typically using liquid nitrogen, and creating an ice ball within the tissue of 2-5 cm. For pain medicine, a lesion of that size could have devastating side effects, therefore typically CO2 or nitrous oxide is used with rapid expansion of the compressed gas in an expansion chamber causing the temperature drop, typically to minus 50-60 deg C. The cryoprobes available are large, typically 16 ga or 14 ga diameter, however I have worked with an 18ga before. If you believe Trescott, you can cryo any nerve in the body. I agree with Steve that it is short term gratification only, typically lasting only 2-3 months in effect of pain reduction, and is technically challenging due to the use of such a large probe that must be moved in tissues in order to find the nerve via rather non-selective stimulation given the tip size. I have largely stopped doing cryo since reimbursement is poor and it is a very time consuming procedure with short term gains only, and is beset by not infrequent failure of the probe or the machine freezing up. It is almost an obsolete procedure now.
 
Well I have had some success with open cryo. I think getting the probe right on top (literally) and creating a couple of different lesions really makes a difference. However, it is terribly time consuming and financially a loss of your time. And it is temporary, as pointed out above. But, I have a couple of chronic facial pain patients that get 2-3 years relief each time. -70C 2min freeze, 2-3 cycles. These are patients that have failed everything else and are not candidates for peripheral neuromodulation. I have another one coming up. A young college student who has had a benign tumor resected twice by the greater occipital nerve. She doesn't want to pursue periph stim at this time and can't tolerate meds. I've not injected neurolytics in this area, though that may be an option. She knows the cryo may only last a few months, but she'd rather go this route. I suspect if the pain returns in couple months she'll be more open to potentially longer lasting (PNS) relief.
 
algosdoc said:
There is cryo and then there is cryo. Lung tumors require an extremely cold cryo probe typically using liquid nitrogen, and creating an ice ball within the tissue of 2-5 cm. For pain medicine, a lesion of that size could have devastating side effects, therefore typically CO2 or nitrous oxide is used with rapid expansion of the compressed gas in an expansion chamber causing the temperature drop, typically to minus 50-60 deg C. The cryoprobes available are large, typically 16 ga or 14 ga diameter, however I have worked with an 18ga before. If you believe Trescott, you can cryo any nerve in the body. I agree with Steve that it is short term gratification only, typically lasting only 2-3 months in i effect of pain reduction, and is technically challenging due to the use of such a large probe that must be moved in tissues in order to find the nerve via rather non-selective stimulation given the tip size. I have largely stopped doing cryo since reimbursement is poor and it is a very time consuming procedure with short term gains only, and is beset by not infrequent failure of the probe or the machine freezing up. It is almost an obsolete procedure now.
Click to expand...

Algos as I respect your opinions I'm curious what you offer instead of cryo? One cannot argue with your observations above, but sometimes cryo seems to be the only longer term pain relief option short of a peripheral nerve field stimulator...
 
Sometimes I have to use cryo, sometimes PRF US guided, rarely phenol. If I could only get my hands on some tetrodotoxin... 🙂
 
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