Current Technique and Application of Percutaneous Cryotherapy

Abstract

Purpose Local ablative therapies have become an established treatment option in interventional oncology. Radiofrequency ablation (RFA) and microwave ablation (MWA) are a standard of care in the treatment of hepatocellular carcinoma (HCC). Currently, there is an increasing interest in cryotherapy, one of the oldest ablation techniques. It has some unique characteristics with regard to technology and mechanism of action. Materials and Methods A systematic literature search using the terms cryotherapy, cryosurgery and cryoablation was performed. Selected studies are presented dealing with the mechanism of action, cryobiology and clinical use of percutaneous, image-guided cryoablation. Recent developments and perspectives are presented. Results Cryotherapy is increasingly used and has been included in guidelines for selected tumor entities such as renal cell carcinoma. Cryo-immunotherapy and combination treatments are future areas of interest. Conclusion Cryoabalation may be used in many indications. Its major advantages are its unique visualization and the anesthesiologic effects of cold. While there are only a few prospectively randomized trials, the existing data on the use of cryoablation is promising. Its use appears to be justified in selected tumors, oligometastatic patients and for palliative indications. Key Points Interventionalists need to know about the unique characteristics and advantages of cryoablation. Proper patient selection and optimal image guidance are essential for successful cryotherapy. Cryoablation offers unique advantages such as anesthesiologic effects and characteristic imaging features. The lack of prospective randomized trials is a key disadvantage of cryoablation. Citation Format Mahnken AH, König AM, Figiel JH. Current Technique and Application of Percutaneous Cryotherapy. Fortschr Röntgenstr 2018; 190: 836-846.