Hi, thanks for your very detailed and personal account. Your courage and determination are inspiring. We are dealing with a large retroperitoneal liposarcoma, difficult to remove surgically – it can be done, but would involve radical surgery that is difficult to contemplate witbhout first seeking all other options. My question is, is cryoablation done for large tumours? And with what results? I'm unsure to what extent it is being done at all here in Australia, but it would be helpful to know if it is being done elsewhere on large tumours. Also, have you heard of using the nanoknife – it uses electrical currents to destroy tumours. If yes, what is your opinion of its use, particularly on large tumours? Kind regards, Jen
Hi Jen, We're so sorry you're dealing with liposarcoma.
Our understanding from Dr. Peter Littrup (Brown University, Rhode Island, US) is that the success of cryoablating small tumors (3cm diameter) is similar to surgery. ("Curing Cancer with Immunotherapy", Chapter 11, Section "Defying My Doctors", paperback pg 176) Larger tumors may lead to the incomplete killing of the tumor, or increasing side effects. It will vary with individual cases.
If the tumor is larger than 3cm, surgery may be a good option. But cryoablation can be used before surgery to generate tumor antigens for an immune response (Chapter 11, "Since surgery alone had a low chance...", paperback pg. 176). Or after surgery, cryoablation can be used to kill remaining smaller areas of tumor not removed by surgery, if the area of remaining tumor is amenable to cryoablation.
We haven't seriously considered nanoknife before, so cannot comment meaningfully about it.
Rene, Eddy,
I wanted to ask you about IRE, aka nanoknife - but someone already asked above. Any new thoughts on it as compared to cryo? If not, its OK. Thanks.
Hi AgreeableCoffee,
We did look into IRE because of the potential to ablate near blood vessels.
Unfortunately, being a new modality, there was a dearth of studies/data regarding any potential effect. Back then (2011/2012) we did not find any studies corroborating potential immune effect. There was one small study with animal tissue (not human I believe) that suggested there was no immune effect. Since then we have not studies IRE further.
Secondly, it was difficult to find IRE practitioners who were comfortable ablating Rene's tumors. Some ablationists we had spoken with seemed to be somewhat pessimistic about IRE as a modality in general.
For those reasons, we went with cryo.
Hi Rene, Eddy,
Thanks for the reply. Any concern about the needle track in the cryo? Seems to be debate about any kind of needle tracks, whether its with biopsies, etc. I've read different things. Thanks again.
We were not concerned about the cryo needle track because Dr. Littrup and Dr. Aoun do not insert the cryo needles into the tumor. They flank the tumor with the cryo needles, so the risk for tracking tumor out is low to none.
Needle biopsy (which has to go into the tumor) for sarcomas has a high risk for tracking tumor, so we were told that if the biopsy is positive for sarcoma, the needle track needs to be surgically removed.
Rene, Eddy,
In the book I read about the cycloph. but may I ask, who would be the one to prescribe that? Is that an oncologist or the cryo dr. prescribing it? Thanks
It can be any physician who is willing to prescribe and monitor off-label use cyclophosphamide: oncologist or primary care doctor. Usually the cryoablation doctor (interventional radiologist) will only focus on the procedure, and not prescribe or monitor off-label medications.
Hi,
Have you ever considered radiofrequency ablation (RFA) for those lesions? Any other factors for choosing cryoablation over other ablation methods?
Thanks
sn
Hi sn,
We have looked into RFA, but decided to use cryoablation instead because of cryoablation's 1) less severe and temporary side effects, and 2) the immune effect as described in Chp 11.