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Immunological Aspects of Cryosurgery

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Skin Cancer

Part of the book series: Current Clinical Pathology ((CCPATH))

Abstract

Cryosurgery has been used increasingly to treat different neoplasia including liver, bone, breast, lung, and prostate and of course the variety of benign, premalignant, and malignant skin lesions. Proposed primary advantages of cryosurgery in comparison to surgical excision include minimal morbidity, less damage of surrounding structures, ease of use, and lower cost. Potential secondary advantages include the induction of antitumoral response triggered by natural absorption of malignant tissue, which releases hidden tumoral epitopes after intracellular cryoinjury. Several published studies and anecdotal reports have shown distal disease regression after cryoablation of primary tumor, or disappearance of untreated warts at the different location from the treated lesions in the same individual. Several mechanisms have been proposed to explain the therapeutic effects of cryosurgery, but until very recently the literature has been controversial on the issue. Lately, cryoimmunological responses have been more adequately measured due to a development of more accurate and reproducible, immunological assays. Factors affecting success of cryoablation are especially analyzed, including but not limited to time and amount of freeze, type of the tumor treated, ratio of induced apoptosis vs. necrosis, type of inflammatory infiltrate (macrophages, dendritic cells, neutrophils), and relationship of T-regulatory cells vs. T cytotoxic cells. Eventually the use of immunological adjuvants to optimize the effects of cryoinjury is discussed. It is not surprising that there is tremendous interest in immunological aspects of cryosurgery, since cryoablation has the potential for both local and systemic therapy, i.e., direct ablation of the tumor and eradication of micrometastases through the immune system with minimal systemic toxicity. However, the generation of antitumor immune response is complex, and several factors may contribute not only to a positive response but also tilt it to the opposite direction, including immune suppression. Further directions would possibly include clarification and definition of ideal parameters for optimal destruction of tumor and induction of strong protective immunity with the obliteration of metastatic disease.

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Author information

Authors and Affiliations

  1. Section of Dermatology, University of Chicago, 5841 S.Maryland Ave, Chicago, IL, USA

    Eduardo K. Moioli

  2. Department of Dermatology, University of Illinois College of Medicine, Chicago, IL, USA

    Aleksandar L. Krunic MD, PhD, FAAD, FACMS

  3. Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Aleksandar L. Krunic MD, PhD, FAAD, FACMS

Authors
  1. Eduardo K. Moioli
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  2. Aleksandar L. Krunic MD, PhD, FAAD, FACMS
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Corresponding author

Correspondence to Aleksandar L. Krunic MD, PhD, FAAD, FACMS .

Editor information

Editors and Affiliations

  1. and Pharmaceutical Sciences and Technologies, Second University of Naples Department of Environmental, Biological, Naples, Italy

    Alfonso Baldi

  2. Department of Dermatology, Pius Hospital de Valls, Valls, Tarragona, Spain

    Paola Pasquali

  3. S.A.F.U. Department, Regina Elena Cancer Institute, Rome, Italy

    Enrico P Spugnini

Glossary

APCs

Antigen-presenting cells

Cryoimmunology

process that involves a specific immune response formed against antigens and debris derived from cells and tissues destroyed by cryosurgery.

DCs

Dendritic cells

MHC

Major histocompatibility complex

RCC

Renal cell carcinoma

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Moioli, E.K., Krunic, A.L. (2014). Immunological Aspects of Cryosurgery. In: Baldi, A., Pasquali, P., Spugnini, E. (eds) Skin Cancer. Current Clinical Pathology. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4614-7357-2_24

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  • DOI: https://doi.org/10.1007/978-1-4614-7357-2_24

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  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-4614-7356-5

  • Online ISBN: 978-1-4614-7357-2

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