Cancer research results and successful cases of Cryoablation

Cryoablation for Cancer reaseach base on 8000 cases in,reported in 5th Int Forum on Cancer treatment Guangzhou, China Jul 2 2016,edited by Dr,Kecheng Xu.

Why do we use cryoablation?

Tumor ablation is more important to aim at Prolong survival period and improve quality of life.

Cancer is a chronic disease which can be controlled.Ablation is one of the most effective means to control progressive parenchyma tumor.

Cryosurgery is a novel technique for treatment of cancer which has been approved by the United States~ Food & Drug Administration (FDA) in 1998 and China~s SFDA in 1999.Fuda Cancer Hospital-Guangzhou has used the technique since 2000. To date, Fuda has the greatest amount of experience in this minimally invasive operation; often Fuda trains doctors from around the world on the cryosurgery technique. And number of cryosurgery cases has nearly topped 8,000 cases with a variety of malignant tumors (more than 34 different kinds of cancers).  At the same time, Combined the new idea of " 3C+P" (Cryoablation, Combined immunotherapy,  Cancer mincrosphere intervention, Personalized therapy) treatment model has been successful to apply to treat  a variety of cancers too, 

In the latest edition of NCCN guidelines, cryoablation has been recommended for unresectable cancers.  For example: 

Cryoablation is an local regional therapy for Hepatocellular Carcinoma (HCC)

cryo-therapy is a preferred local treatment modality  in Surgical therapy for Non-small Cell Lung Cancer.

Ablation techniques can be considered when   Colon cancer have been metastases

Use of cryoablation in Fuda

1.“Radical” eradication of “small” cancer

2.“Debulky” for unresectable tumors

3.Freezing-assisted operation 

1.To alleviate pain caused by tumor

8000 patients treated by cryoablation in Fuda

Two types of cryosurgical equipment designed to use in Fuda 

Percutaneous cryoablation under CT or US

No.1  “Radical” eradication

Those patients who cannot undergo operation due to weak condition or co-morbidity, and those who refuse to receive operation, percutaneous cryoablation is to achieve great efficacy for cancer and even get cancer cured.

Unresectable, metastases on operation, no response on chemo/radio and recurrent advanced cancer

            

Laureate of Rank Prize Ms.Lu from Britain with Advanced Liver Cancer survive after Nanoknife

On March 24, 2016, Ms. Lu Mingying, a renowned scientist and Rank Prize laureate was discharged from hospital after receiving comprehensive treatment at Fuda Cancer Hospital for two months. One day before discharge, she put on her scarf and, to express her joy and appreciation, she said good-bye to doctors and nurses who had been taking care of her express “It is the doctors at FUDA that have saved me from the verge of death.” 

     Xu Kecheng, Chief President of Fuda Cancer Hospital and Ms. Lu Mingying

                   Ms. Lu Mingying and nurses of the 4th ward

One week before her discharge, we visited her. During the interview, she worn the same red scarf. “This is a present from a friend of mine cause wearing red makes me look more radiant.” She felt much betteras she just stooped her oral chemotherapy medicine on that day. She shared with us her experience of studying in UK, her Rank Prize winning stories and her journey of fighting against cancer. 

The influence of her father

Lu Mingying was born in a scholarly family in 1954. Her father Lu Zhongzuo, the founder of vacuum electronic devices major in China, had long engaged in the research of microwave tube and wrote the first batch of textbooks and monographs on microwave electronics in China. “Being raised in such an environment, I developed a keen interest in mathematics, physics and optoelectronics since I was a little child.”she said. Unfortunately, she had to suspend her schooling as the Great Cultural Revolution broke out when she was just enrolled into middle school.Two years later, she resumed her schooling in a nearby middle school. In 1970, Lu Mingying, who just turned to 16, was assigned to a small factory and worked there for seven years.

Lu Mingqi, Lu Ming’s elder sister, noted, “Before the college entrance examination system was resumed in China, my sister had never quit learning. She worked during the day and studied at night”. It was with her persistence that she made her way into the Department of Electronic Engineering of Nanjing Institute of Technology (currently Southeast University) in 1977.

                 Lu Mingying (R) and her elder sister Lu Mingqi

In university, Lu Mingying met her life partner - Wang Guoyu, her classmate. In her memory, they spent most of time doing research in the lab instead of going dating. Upon graduation from university, Lu Mingying was accepted into the postgraduate program of Southeast University while Wang Guoyu was accepted into the postgraduate program of Tsinghua University. They got married after finished their master degree. In 1984, they had their fist child. Later, Lu Mingying served as a lecturer in Southeast University while her husband also chose to work as lecturer in the same university.

Studying in England

In the end of 1980s, digital camera was very expensive and it cost thousands of dollars to buy one. The main reason was that the imaging sensor of digital camera was very costly. Even researchers in Japan, Europe and America were not able to tackle the difficult problem.

Wang Guoyu and Lu Mingying, who were then studied in the University of Edinburgh, were enrolled into an experimental group in 1987 and 1989 respectively. They joined two professors of the University of Edinburgh with a clear purpose, that was to develop new imaging sensors. They put forward a bold proposal, which was whether common semiconductor integrated circuit can be applied to imaging sensor as it can greatly reduce the cost of imaging sensor.

After years of unremitting efforts, they successfully applied common semiconductor integrated circuit into imaging sensor. The technological innovation has brought about great changes. The cost of imaging sensor reduced by one third; imaging sensor can be mass produced; the price of digital camera fell from several thousands dollars to around 10 USD. In 2002, the technology began to be applied to Nokia mobile phones and widely has been applied to 
mobile phones since then. Mobile phone photographing has become an easy thing. It has turned from a luxury to popular consumable goods. “The 50million chips for mobile phone photographing produced every day are using our technology.” Lu Mingying said proudly. 

A surprising award

The application of common semiconductor integrated circuit in imaging sensors is an epoch-making shift in the industry of digital camera. The four researchers including Lu Mingying were awarded the Rank Prize in 2008.

Established in 1972, the Rank Prize is one of the top science awards in England in recognition of researchers who have made tremendous contribution to the fields of optoelectronic science and nutriology. It is reputed as the Nobel Prize in the fields of optoelectronic science and nutriology. As of now, only a few Chinese, including Charles Kao, the Father of Fiber Optic Communications and Yuan Longping, the Father of Hybrid Rice, have won the Rank Prize. 

“It’s really surprising”, Lu Mingying said when she delivered her acceptance speech. It turned out that in March 2007, Lu Mingying received a letter, asking if she would like to participate in the selection of the Rank Prize. “The scientific research achievement was made over 10 years ago. We almost forget about it.” The couple felt that it must be someone who was playing tricks with them so they did not pay any attention to it. Shortly after that, Lu Mingying received a letter from her previous supervisor, asking if she had received an invitation letter for the selection of the Rank Prize. It was until then did the couplerealized that it was not a trick.

”I was so surprised and excited”, said Lu Mingying. They had invested so much time and efforts in order to overcome the technical difficulty. It was really a surprise for them to finally get the recognition after over 10 years. 

Facing up to the devil of cancer

In December, 2015, Lu Mingying started to feeling unwell and often had lower abdomen pain. She had thought it was just urinary system infection and took a lot of antibiotics but the symptoms showed no remission. In December, she come to China for an academic conference. Her husband insisted that she should do a  physical examination. Ultrasound result showed that there was a tumor sizing 7x8cm in liver. The doctor said that she was at advanced stage and an immediate CT scan was suggested. Further examinations proved that she was suffering from cholangiocarcinoma with metastases in bones, lymph nodes and abdominal cavity.

“It was the first time I’ve heard of this term and I had no idea what it is exactly. I searched on the Internet and learned that cholangiocarcinoma cannot be easily treated.” In the face of the unexpected disease, Lu Mingying did nor show extreme sadness and despair as other cancer patients. She did not She was so emotionally peaceful when she was telling us her story.

Some doctors suggested her to do radiotherapy and chemotherapy first but she declined. She kept on looking for new and mini-invasive treatments on the internet. One day, she accidentally read a piece of news, saying that cholangiocarcinoma can be treated with NanoKnife. “I saw a light of hope after I read the news”. At first, she chose to go back to England for treatment. She consulted a renowned Nanoknife specialist from the Medical School of Imperial College London. However, it would take long time waiting for NanoKnife in England. She chose to go back to China for NanoKnife for fear that her condition would progress.  

Getting to know FUDA by virtue of NanoKnife

Lu Mingying set her mind on the new technology of NanoKnife. She searched about NanoKnife on the Internet and finally traced down to Guangzhou Fuda Cancer Hospital. After learned that FUDA had completed over 70 cases of NanoKnife, she decided to come to Guangzhou Fuda Cancer Hospital for treatment. 

Her sister said, “Before we come to FUDA, I went all the way to a major hospital in Xi’an cause I read from a newspaper that the hospital has completed successful cases of NanoKnife. I even consulted a specialist about my sister’s case but the specialist said the tumor was too big to be ablated. ”

In January 13, 2016, Lu Mingying was admitted into Fuda Cancer Hospital. Due to rapid disease progression, she was too weak to walk upon admission and she had ascites and fever. “From the first day that I was admitted into the hospital, I have had the feeling that it was right for me to choose FUDA. All medical staffs, from the president to doctors and nurses have been very nice to me. On the second day of my admission, Xu Kecheng, the Chief President of FUDA, Niu Lizhi, the Executive President of FUDA and other experts made rounds and they gave me a lot of encouragement. I felt assured. I’mconvinced that I could entrust my life to FUDA. If FUDA cannot do any treatment for me, I won’t be treated in anywhere else.”

In the following days, Lu Mingying received comprehensive treatments, including photodynamic therapy, NanoKnife, iodine seeds implantation therapy, etc. “It is the doctors at FUDA that have saved me from the verge of death.” Lu Mingying said.

After two months’ treatments, she has built up more and more confidence in FUDA. Where does the confidence come from? First of all, it comes from the excellent skills of the doctors. They have been very patient in explaining to me the upcoming treatment and I’m very clear about the possible side effects; secondly, it comes from the “green therapy” offered by FUDA. The green therapy, or minimally invasive treatment, has inflicted no pain, which accords 
with my concept of treatment; thirdly, the confidence comes from the humanitarian service provided by FUDA. Doctors, nurses and cleaners always greet patients with smile. I have been feeling very comfortable for the last two months.

“One of my supervisors died of brain cancer. I thought how nice it would be if he had been treated at FUDA. That’s why I want to share my treatment experience and feelings with other patients so that more patients can get to know FUDA and gain survival benefits here. ”

What Kind Of Cancers Do The Cryoablation Can Treat?

What is percutaneous cryoablation?

In percutaneous cryoablation, no large incisions are made. Instead, an interventional radiologist inserts a thin, needle-like probe through the skin and into the tumor, using advanced imaging technology for guidance. This technique helps avoid larger incisions that are associated with cryoablation during traditional open surgery or minimally invasive laparoscopic surgery.

How does cryoablation work?

Depending on the tumor's size, one or more probes are inserted into the tumor. Pressurized gas is pumped to a chamber at the needle's tip, where it expands then cools, creating an ice ball chilled to minus 160 degrees Celsius. The ice ball engulfs and destroys the tumor while sparing healthy tissue. Ultrathin sensor needles also are inserted at the tumor's margins to monitor temperatures and ensure that all the cancerous tissue is destroyed.

What kind of cancer do the cryoablation can treat?

Cryoablation is performed by using argon-helium system. Two to three cycles of the freezing/thawing are performed. The freezing continues until the "ice-ball" formed at the tip if the cryoprobe is large enough to cover tumor. A 5-10 mm margin of normal tissue is included in the freezing process. For larger tumors, multiple cryoprobes were used. In some cases, it may become necessary to perform at least 2-3 sessions of the cryoablation procedure. This is possible because the procedure is minimally invasive, and often does not require cutting. The probes are simply inserted through the skin and guided by real-time ultrasound.

Kidney cancer and bone metastases, pancreatic endocrine tumor, pancreatic cancer, retroperitoneal liposarcoma, “ dough figurine” retroperitoneal liposarcoma, non-small-cell lung cancer (NSCLC), melanoma, esophagus cancer, multiple neuroendocrine tumor, breast cancer, ovarian cancer, neck giant teratoma,  uterine Cancer, lymphoma , liver cancer, bone cancer, colon cancer, lung cancer, skin cancer and etc.

Breast Cancer-------From Indonesia Cancer Patient

Ms. Divniahnina is from West Kalimatan of Indonesia,Ms.Lin, 42 years old, has had breast cancer 2 years ago. She was shy to speak it out and just had some herbal medicines by herself. She couldn’t do anything but cry silently in her room. Her elder sister, who has been doing business outside, found it out and brought her to hospital for operation and chemotherapy. Half a year later, tumor recurrence was found. The mass in breast enlarged day after day. She felt pain in back and could not walk in the end. Incontinence happened sometimes. Her elder sister got her a wheelchair and helped her with boarding on the plane. They transferred from Jakarta to Guangzhou. She was taken off by airport staff and then transferred to Guangzhou Cancer Hospital by ambulance.

Relevant checkups after being admitted showed that left breast was swollen and hard. A 6cm large mass was found in left breast. The muscle strength of both lower limbs was level 2. She couldn’t walk alone. X-ray and CT scan on the second day after admission found out multiple bone metastases in lumbar vertebra, compressed fracture, sclerotin pressing inward to spinal canal to compress spinal cord. Pathological result of biopsy on left breast mass suggested infiltrating ductal carcinoma. Swollen lymph nodes were seen in left axilla.

Expert team at FUDA performed cryoablation on left breast cancer and lymph nodes in left axilla. After two months, the paralysis of lower limbs miraculously relieved and she could walk gradually. Then, she was given I125 seeds implantation in thoracic vertebra metastases and cancer microvascular intervention. She boarded the plane by herself and went back home. 12 months later, she came back to FUDA for follow-up visit. Examination showed that left breast tumor decrease significantly in size. She was given combined immunotherapy.

Examination after 35 months showed that patient had a good general condition. PET-CT scan showed no tumor residue and recurrence in breast and axilla. Multiple bone destruction in thoracolumbar spine still presented with no increasing metabolism, which showed tumor activity was inhibited.

Cancer can be treated without chemotherapy

Oncologists from Fuda Cancer Hospital, Guangzhou, China on Monday said that a cancer treatment technique ‘Cryosurgical Ablation (CSA)’ has been effective in treatment of the disease without the need for painful chemotherapy. The surgeons said that between 2008 and 2016, they have treated close to 10,000 patients with a success rate of more than 70 per cent in China.

On Monday, while interacting with presspersons, oncologist and vice-president, Fuda Cancer Hospital, Dr. Mu Feng said that there was no need for chemotherapy and radiation under CSA. “Cancer side effects have the potential to complicate patients’ recovery process. In CSA, there is no need for chemotherapy, a huge advantage for patients,” he said.

CSA is a procedure where cryo-probes are inserted around tumours to lower temperature of the targeted area to minus 160 degree Celsius or even lower. Later, temperature is raised and brought up to 20 to 40 degree Celsius. This is repeated two to three times, resulting in the destruction of tumour cells.

“Once the tumour cells are destroyed, they start releasing antigens, stimulating immune system to react. This eventually eradicates the remaining cancer cells and reduces chances of recurrence. This is applicable for small and large tumours, single tumour or several tumours and there is less pain for patients,” the doctor said.

However, this technique is only to manage localised tumours and not for ailments like blood cancer or brain cancer, the doctors clarified. The brain cancer effective therapy is photodynamic therapy (PDT).  The blood cancer like leukemia  the comprehensive cancer treatment is the best way for cancer patients.

According to the hospital officials, this year, close to 63 Indian patients underwent CSA at its facility in China. “While there is not much difference in cost of treatment, the big advantage is no side effects. The recovery process is quick. This procedure has already been adopted in US,” the doctors said. For details contact on 0086-020-3899-3966 or email: cryosurgeryfuda@163.com.

Dr.Xu: How To Live With Cancer For Advanced Cancer Patients

'Living with cancer'

The capital of Guangdong province, in south China, sprawls across the Pearl River Delta and around Baiyun Mountain. The tropical city boasts a tradition of medical expertise. Sun Yat-sen, the celebrated father of Chinese democracy, and a doctor, founded one of the city's major universities, which carries his name.

Fuda Cancer Hospital was established here as a private facility in 2003. Its founder, Xu Kecheng, had previously led a hepatic disease research centre in the nearby city of Shenzhen, where he was also a chief physician.

From his office inside the hospital, 76-year-old Xu explained that he wanted to open a cancer hospital to explore new methods of treatment. 

With a ready smile, he listens intently, giving the impression that he has all the time in the world, although his phone rarely stops buzzing.

He had been disillusioned with the global "war on cancer", ignited in 1971 by then US President Richard Nixon, he explained. In 2004, he read a story in Fortune magazine that resonated with him. The article, titled Why We're Losing the War on Cancer, centred on how efforts to fight advanced forms of cancer were largely unfruitful.

Xu decided he wanted to explore ways to "live with cancer".

"Cancer originates in a gene mutation, so it's actually not an enemy from the outside," the doctor explained. "It's not like a bacteria or a virus that invades our body from the outside to produce a disease; it's a changing of our own cells."

If the cancer is identified early, then it has high chances of being eradicated from the body. But for many patients, the cancer has recurred or has already spread before its detection. In those cases, fighting it aggressively with chemotherapy and radiation is purposeless, Xu believes.

"It's like the Americans invading Iraq - you do a lot of damage, but you're fighting a war you can't win," he said.

So Xu decided he would build the hospital around offering palliative treatments to advanced-stage cancer patients, with the aim of making them comfortable and prolonging their lives.

He wanted to use new, minimally invasive procedures, such as cryoablation, which destroys tumours by repeated cycles of freezing and thawing produced by probes inserted into the body; and the NanoKnife, which uses high-voltage current to puncture the membrane of cancer cells. 

He paired the minimally invasive treatments with immunotherapy to boost the body's immune response to cancer, and with transarterial chemoembolisation, where microspheres containing chemo drugs are directed through an artery straight into the tumour, thus increasing the drug concentration that reaches the tumour and reducing the overall side-effects. 

A common area in Fuda Cancer Hospital's patient ward is decorated with paintings sent by former patients [Simina Mistreanu/Al Jazeera]

The standard treatment at Fuda Cancer Hospital was called "3C P" - which stands for cryosurgical ablation, cancer microsphere intervention, and combined immunotherapy for cancer, as well as a personalised approach. But the specific treatments for each patient are decided by a board of doctors based on their individual case, explained Niu, who is also the hospital's chief surgeon for minimally invasive surgery.

"My thinking is problem-based medicine," said Niu. "I first solve the patient's problem.

"If the patient feels pain, I'll solve the pain. If the patient cannot eat, I'll help him to eat. If the patient has a psychological problem, we call in a psychologist. If he has a nutrition problem, we call in the nutritionist. After all these problems have been solved, then the second aim is to prolong the life."

 The hospital has thrived: From a 20-bed capacity when it opened in 2003, it has now grown to include 400 beds and a second, 11,000-square-metre facility that opened in 2011. Xu has won a slew of awards from the Chinese government and other institutions, including the Bethune Medal, which is considered China's highest medical award.

Yet scepticism about the hospital has lingered through the years. In 2008, a Danish newspaper covered the case of a patient from Copenhagen who sought treatment for her stage-4 pancreatic cancer at Fuda. Ulrik Lassen, the chief physician at Copenhagen University Hospital Unit for Experimental Cancer Treatment, was quoted as saying Fuda's treatments were "unethical" for offering patients false hope.

And in 2014, when Xu gave a presentation in Perth, Australia, together with an Australian patient, the vice president of a regional chapter of the Australian Medical Association, Andrew Miller, accused Fuda of quackery. Both Lassen and Miller haven't responded to requests to expand on their concerns.

Gurli Gregersen, the Danish patient profiled in the 2008 story, is still alive today. The 68-year-old retired teacher was diagnosed with stage-4 pancreatic cancer in 2007. She underwent a few rounds of chemotherapy, after which her Danish doctors told her to go home and enjoy the last months of her life with her family.

But Gregersen's daughter wouldn't hear about her giving up. She had read a story about Fuda and suggested Gregersen give it a try. The retiree sold her apartment to pay for the treatment and flew to Guangzhou in the spring of 2008. She received cryosurgery, immunotherapy and other treatments, and then flew back home.

"I was just expecting to live a little longer, maybe half a year. I would have been happy," Gregersen said. "But then I could see I was not tired, I was not getting skinny, and I didn't have pain. You know, it got better and better." 

Since then, Gregersen has taken annual trips to Fuda for immunotherapy and other minimally invasive procedures. The doctors and nurses there have become her second family, she said. 

She now lives an idyllic retiree life – she has a small house in the country outside Copenhagen, where she gardens, knits, takes long walks on the beach, looks after her grandchildren and spends time with her friends visiting museums and art galleries. She even started attending an evening class on Chinese history.

She said her Danish doctors prefer not to discuss her treatments in China, and request that new tests be done even when she brings recent scans from Guangzhou. 

Xu is proud to talk about Gregersen's case. He calls her a "miracle patient". The doctor takes pride in taking on cases other doctors have deemed untreatable and his office is decorated with gifts from patients and pictures they've taken with him.

He opens a book that catalogues some of Fuda's most famous cases, including patients with visible external tumours: "Before, after; before, after," he says as he thumbs through the pages.

In January 2006, Xu was himself diagnosed with liver cancer - a disease that also affected his mother and sister. He received surgery and immunotherapy then, but is unaware of his current status. He said he feels great, and he still comes to the office every day.

"Most doctors like to treat early-stage cancer," Xu said. "But there are larger and larger groups of people who suffer from advanced cancer. Early-stage cancer can't always be discovered on time. We have no choice but to deal with this matter. These things are very difficult for doctors to do, but I'm willing to try."

Not losing hope 

At Fuda, Pietroiu received immunotherapy as well as an injection with strontium-89, a radioactive substance used to reduce pain in patients with metastatic bone cancer. She didn't have any serious side-effects and after three weeks, returned home, full of hope.

Her years battling cancer had been some of the most important of her life. When she was in remission, she met Bogdan. They clicked instantly. She told him she was a cancer survivor. A few weeks later, in the spring of 2013, Pietroiu learned during one of her regular checkups that the cancer had reappeared in her spine. Bogdan joined her on some of her visits to hospitals abroad, and every time they tried to make a trip of it.

In February 2015, they married.

Raluca and Bogdan Pietroiu met during Raluca's remission [Photo Courtesy of Bogdan Pietroiu]

After the immunotherapy, she felt better, but tests showed that her liver had been invaded by thousands of tiny metastatic cancer cells. She returned to Fuda with Bogdan in May, two months after her first visit. This time the doctors took several days to suggest a treatment - transarterial chemoembolisation to her liver. 

Pietroiu wrote an article for her friends and for people who had started supporting her with donations.

"It won't be an overnight miracle," she wrote. "It's not a one-time intervention, after which I can go back home, and it's over. The road ahead is longer. I will continue to come here once every two or three months, upon these wonderful doctors' recommendations, to stabilise my situation if the results are good. If not, I will look for something else, but I won't stop."

Xu Kecheng: Cancer treatment need to change a new idea--------- The specific thougt and experience

Different fate of revelation

I am a liver cancer patient. On 18^th January,2006. I did a regular body examination and found that there was a space occupying lesion in my left lobe of liver ,so i accepted the resection surgery immediately, the pathology showed that it was cholangiocellular carcinoma.After the surgery ,whether i should do the radio? Someone suggested me just did like usually do to accept the radiation. I refused and accepted a long-term immunotherapy.

Other two cancer patients who are my friends also have cholangiocelluar carcinoma and they both accepted the hepatectomy, and had the smooth operation. One of them is a general manager in a public company from Henan province,after his surgery, he also accepted the chemo and radiation. The later of 4 months, his tumor recurred again and found the liver, kidney and bone metastases. The tumor constricted spinal nerves and caused a great pain. Then he came to accept some comprehensive treatments which could remit pain in Guangzhou. Finally, he died for the hepatic failure;Another cancer patients is a lady from Shandong province, had the operation of hepatectomy in Shanghai, for consolidating the curative effect, she accepted the radiation and chemo. During her chemo, found the liver,lung and bone metastases in her body, when she came to the Guangzhou, she suffered more from jaundice,anemia and bleeding.Except the symptomatic treatment for her, we can not bring her any particular treatment.both of my friends’ survival were not more than 1 year.

The same cancer with them, why i am so lucky that have survived about 8 years without any disease symptom, however, both of them passed away in less than one year？Just like the general manager said：for your tumor accepted the “manual operation”treatment, and mine is for “stylized line” treatment; The husband of the lady from Shangdong spoke a point that: “whether do the radiation and chemo or not after the surgery, the doctors have different advice. But we always think the more treatments she gets the faster she cured, now,it proved its wrong for us.”they are both upset and said to me: it would be better if we go with you for the same treatment.

Face the challenge

Cancer therapies are faced with challenge: First, though the surgical resection is the main treatment to treat cancer,  but “ radical cure” not equal to “healing”. Just like my two cancer friend s i mentioned above, they were “radical cure”, but there were several metastases and recurrent tumors after the surgery. We always to say “5-year survival rate was 50%, 60%, what about the cancer patients with 50%, 40%? They died?; second, when the cancer found, 70% of them lost the chance with surgical treatment. How to treat these patients? can we prolong their life? Third, chemo and radiation are the most generally used cancer treatment, but most of the patients can not live longer.

Why cancer will recur after the  “Radical surgery”? Because cancer is a systemic disease, tumor just a part of them,even in the early stage, cancer cells may also exist in external bleed and marrow, these cancer cells often exist in the form of “cancer stem cells”and go into “ sleep” state,once it reaches the right time, the cancer cells will wake up and grow rapidly to be new tumor,this is “metastasis”. Cancer metastases are the main reason to kill the cancer patients.Chemotherapy is kind of treatment to use the chemical medicine to kill cancer cells. The malignant disease like leukemia,lymphoma are mainly depend on chemotherapy.

But less cancer patients are healing by chemo, someone estimated only 7% cancer patients can be healing, and may be effective to the other 15% of cancer patients.Though chemo is widely used for most of cancer patients,what is the great effect from chemo? Our famous chemotherapist and academician Sun Yan said: radiation and chemo are not all-powerful for everything, for some advanced cancer patients, radiation and chemo will increase their pain, which should be used vary seriously.In the process of treatment, should pay attention to the chemotherapy moderation, prevent its excessive use. Famous oncology Zhao Yuntang said:chemotherapy is a double-edged sword. After chemo the cancer cells will produce drug resistance so far as to increase residual cancer’s level of malignancy. The current molecular targeting treatment is like a “magical bullet”of molecular level, but it may also increase the ability of survival cancer cells and the metastases.

The present abused chemo to be a serious problem, the patients could not bear the pain and side effect from chemo have been done the chemotherapy. The medical college from Harvard University found that nearly 10% of advanced cancer patients accepted the chemo in the last two weeks of death ,also in 1999,the number increase to nearly 12%.Domestic incomplete statistics found that 15% of terminal cancer patients who were in the excessive and unreasonable treatments hasten their death.

New strategy

The world  health organization declared: 1/3 cancer patients who can not do resection can prolong their life after the comprehensive treatments.Ablation and immune therapies are the main combined therapy and play an important role in treating middle-advanced cancer.

Ablation” is under the guidance of ultrasound or CT to insert cold or hot probe into tumors by ultra-low temperature or high temperature to destroy the tumors.Modern cryotherapy is the arisen technology in the 1990s,during the treatment, the ultra-low temperature is limited to the top of the probe, needle bar is the normal temperature,therefore,it could only freeze tumors to death without damage to normal tissue.

Cryoblation is mainly used for removing the tumor that doesn’t work by surgical resection, such as lung cancer,liver cancer and etc,if the tumor is small, the effect of cryoablarion is similar with surgical radical resection, it is vary helpful and good for the aged, bad heart-lung-liver function, intolerable surgery cancer patients. For big tumor, can reduce the “load” of cancer and create conditions for other treatment.

The final use of hot ablation or cold ablation depends on the surgeon experience. According to our experience in more than 8000 cases, we tend to use “cryoablation”, because (1) cryoablation  not only cure small tumor but also treat large tumor; (2) for general, cryosurgery won’t damage big blood vessel and windpipe, so the close tumor around these tissue also can be used cryoablation; （3）when doing the cryoablation treatment the patients cause less pain, in fact, the cryoablation itself relieve pain; （4）after the death of cancer cells by cryoablation, it will release antigen to stimulate human immune system, on the contrary, it will kill survival cancer cells. Clinic found that after the main tumors are killed by cryoablation, the survival tumor mass can disappear gradually, this is why the cryoablation stimulate the body’s immune system.

Immune therapy is a systemic treatment aim at strengthening the immune cells in the body to kill the survival or hidden cancer cells  with  few side effects. In 2008, the world's most famous magazine "New England journal of medicine “reported a 52 - year - old male patient from US has recurrent melanoma with right lung and pleura, multiple transfer to left iliac fossa and groin area, and various kinds of treatment are invalid to him.The authors isolated the immune cells from peripheral blood of patient, and then use particular antigen stimulated T cells back to the patients. 2 months later, the lung and other metastases diseases disappear entirely, and return to the hospital to review found there was no any recurrence after 26 months. The author has applied immunotherapy to treat a patient with advanced melanoma, he lived for 13 years from now, which far more than the patients from US.

At present, Immunotherapy is regard as the treatment can cure cancer. In order to improve the treatment effect, we must be aware of the following: （1）Before the immune therapy, need to do the immune cells and cytokines’test so as to choose the right immunotherapies; （2）Must to do the short -time chemo, at least using small dose cyclophosphamide for 1-2 times, this is because the blood has the adjustable T cells which can control lethal immune cells,the chemo can destroy this adjustable cells; （3）Several methods must be used simultaneously or successively, because the cancer cells have diversity and cancer gene is unstable and change constantly, therefore anti-cancer immune cells must be large and variable;（4）must insist for a long-time treatment.

New Idea

Cancer is considered a “chronic disease”. It is almost impossible to kill all the caner cells completely. Not satisfied with local tumor removal, the target of treatment is to prolong cancer patients’ life. To this end, firstly, need to prevent the recurrence after the surgery, including smoking, avoid alcohol,proper exercise,optimistic,eliminate inflammation,eat more fruit and vegetable, as well as regular monitoring of immune state to correct cancer; Secondly, For the inoperable patients, need to reduce their tumor “load”as soon as possible, apply the cryoblation and systemic therapies include chemo,immunotherapy and etc; Thirdly, for the middle-advanced cancer,which can not expect to give a therapy and a doctor can save the patients, we should depend on the patients’ personalized conditions and specific situation to combine different treatments to treat cancer; Fourthly, maintain the health and moderate treatments. American cancer society have declared: For the advanced cancer patients can prolong life with right treatments, but chemo is impossible.

In the treatment of locally advanced cancer, such as liver cancer, pancreatic cancer or lung cancer, our experience is:(1) first to use ultrasound or CT guided cryoablation;（2）for the tumor tissues that cryoablation failed to kill,implant 124 iodine seed is for close to do radiotherapy;（3）if the patients never accept the chemo before, was estimated as chemotherapy sensitivity, these patients can accept the chemo before or after cryoablation;（4）do genetic tests,if there is pointers, given the molecular targeted therapy;（5）if the patients have accepted the chemo before, can be given vascular intervention ( effective perfusion or embolism, or “cancer microvascular interventional therapy”);（6）Apply immnuotherapy to prevent the disease progression or recurrence.

We combine the cryosurgical ablation( seed implantation)(CRA),cancer miscrovascular intervention (CMI)and combined immunotherapy for cancer (CIC), and then according to personalized therapy (p) to form the model “3C+P”. Nearly ten thousand cancer cases showed that 70% of middle-advanced cancer patients included non-response on chemo/radio, or recurrent cancer patients can be improved or prolong their survival, some of them can be totally heal by using “3C+P”treatment model. It also make a great effect with the middle lung cancer, large liver cancer.The pancreatic cancer are the malignant tumors grow fastest for human,world literature shows that the survival rate of pancreatic cancer patients who can not accept surgical resection is lower than 10%, “ no effect” living days about 3-6 months, and there are 300 patients accepted the treatment of “3C+P”whose survival rate for one year reach 60%, for three years reach 15%, some of patients have survived more than 5 years. This achievement respectively awarded golden medal on International Low temperature medical conference in Tokyo 2008 and Vienna 2011.

Conclusion

There is a famous oncology from US have said that the future cancer therapies depend on personalized medicine, this need a large change for our traditional medical system, the cancer patients accept a best and right treatment or several treatments are good to a general treatment. This is the hope of cancer treatment.

As a oncology, I hope every patient can be given the best treatment to improve and prolong their life. As a cancer patient, I hope the most effective and no pain treatments can prolong my life and live happily.Oncology is a optimist, I feel honor to be one of them, in order to benefit the cancer patients, we all hope the current medical treatments' reform which is not only offer every patients a “standard treatment”as a insurance, but also promote the true value of various treatment for every doctor.

                                         Pro. Xu Kecheng

【The author: Chinsese famous digestive disease expert and ocologist . Chief president of Fuda Cancer Hospial, Jinan university school of medicine, president of international society of cryosurgery (ISC), Winner of National "Bethune Medal". The mian composition «Modern Therapy of Digestive Disease», «Modern Cryosurgery for Cancer»,«I Tell the Truth for Cancer Patients»,«Anti-cancer With Me»】