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冷冻手术在乳腺癌治疗中不断演变的作用:全面综述

The Evolving Role of Cryosurgery in Breast Cancer Management: A Comprehensive Review.

作者信息

Mokbel Kefah, Kodresko Alevtina, Ghazal Heba, Mokbel Ramia, Trembley Jon, Jouhara Hussam

机构信息

The London Breast Institute, Princess Grace Hospital, London W1U 5NY, UK.

Heat Pipe and Thermal Management Research Group, College of Engineering, Design and Physical Sciences, Brunel University, London UB8 3PH, UK.

出版信息

Cancers (Basel). 2023 Aug 26;15(17):4272. doi: 10.3390/cancers15174272.

Abstract

Breast cancer is the most commonly diagnosed type of cancer, accounting for approximately one in eight cancer diagnoses worldwide. In 2020, there were approximately 2.3 million new cases of breast cancer globally, resulting in around 685,000 deaths. Consequently, there is an ongoing need to develop innovative therapeutic approaches that can improve both clinical outcomes and patient quality of life. The use of ultra-low cryogenic temperatures, facilitated by cryogenic media such as liquid nitrogen, has revolutionized the biomedical field and opened up new possibilities for advanced clinical treatments, including cryosurgery. Cryosurgery has demonstrated its feasibility as a minimally invasive technique for destroying breast tumors and eliciting a significant antitumor immune response in the host. This feature sets cryosurgery apart from other ablative techniques. It has been shown to be well tolerated and effective, offering several advantages such as simplicity, the avoidance of general anesthesia, minimal pain, low morbidity, short recovery time, cost-effectiveness, and notably, improved aesthetic outcomes. The reviewed studies indicate that cryosurgery holds promise in the management of early-stage breast cancer and metastatic disease, especially in triple-negative and Her2-positive molecular subtypes in conjunction with checkpoint inhibitors and anti-Her2 antibodies, respectively. Furthermore, the effectiveness of cryosurgery in the management of ductal carcinoma in situ should be investigated as an alternative modality to surgery or surveillance. The minimally invasive nature of cryosurgery has the potential to significantly enhance the quality of life for patients.

摘要

乳腺癌是最常被诊断出的癌症类型,约占全球癌症诊断病例的八分之一。2020年,全球新增乳腺癌病例约230万例,导致约68.5万人死亡。因此,持续需要开发能够改善临床结果和患者生活质量的创新治疗方法。利用液氮等低温介质实现的超低温,彻底改变了生物医学领域,并为包括冷冻手术在内的先进临床治疗开辟了新的可能性。冷冻手术已证明其作为一种微创技术用于破坏乳腺肿瘤并在宿主中引发显著抗肿瘤免疫反应的可行性。这一特性使冷冻手术有别于其他消融技术。已表明它耐受性良好且有效,具有多种优点,如操作简单、无需全身麻醉、疼痛轻微、发病率低、恢复时间短、成本效益高,尤其值得注意的是,美容效果更佳。所综述的研究表明,冷冻手术在早期乳腺癌和转移性疾病的治疗中具有前景,特别是分别与检查点抑制剂和抗Her2抗体联合用于三阴性和Her2阳性分子亚型。此外,应研究冷冻手术在导管原位癌治疗中的有效性,作为手术或监测的替代方式。冷冻手术的微创性质有可能显著提高患者的生活质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c540/10486449/9be3431bf88d/cancers-15-04272-g001.jpg

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