Cryoablation (freezing) in pancreatic cancer

Cryoablation is an ablation method based on killing the tumor tissue by freezing at temperatures between -140 and -200 degrees. It is a safe and effective method that has been used for decades in many types of cancer such as prostate cancer and kidney cancer. As a result of developments in technology, cryoablation is currently used also in lung cancer, sarcomas and breast cancer. Since 2013, we have been applying this technique  in stage 3 and stage 4 pancreatic cancers in our centers and we are very happy with the outcome.

Why do we prefer cryoablation in pancreatic cancer?
1. Cryoablation is performed through a needle puncture under local anesthesia and the procedure takes only 1-2 hours.
2. There is very little pain during and after the procedure. The natural local anesthetic effect of cold prevents pain.
3. During the procedure, the frozen area is clearly seen on ultrasound and computed tomography. This area can be reduced or enlarged as desired to achieve maximum coverage of the tumor without damaging the surrounding tissue.
4. The patient can return to  normal life on the same day or after staying overnight in our center.
5. Cryoablation is one of the most effective methods for relieving pain due to pancreatic cancer. After cryoablation, the patient's pain decreases, making it easier for the patient to receive other treatments such as chemotherapy.
6. Approximately 80-90% of the mass in the pancreas can be killed by freezing with cryoablation in a single session. If necessary, long-term local control can be achieved by repeat cryoablation, radiotherapy and intratumoral immunotherapy methods. 
7. If the cancer recurs, cryoablation can be repeated as many times as necessary in the same area.

Which patients are suitable?
Cryoablation treatment is suitable for stage 3 (locally advanced) pancreatic cancers and in some stage 4 cancers. At these stages, the tumor has involved the large vessels around the pancreas and is not suitable for surgery. In such patients, cryoablation is able to freeze and kill roughly 80-90% of the tumor in a single session without damaging these vessels. Before cryoablation, we routinely do a celiac ganglion block to minimize pain during and after the procedure.  In our experience, the combination of celiac block + cryoablation provides the most effective local treatment for pancreatic cancer pain. In stage 3 patients, pancreatic cryoablation takes approximately 1.5 hours, and in addition to blockage, some sedation is given for patient comfort during the procedure. After the procedure, the patient is kept under surveillance for 3-4 hours and can go home if he has no serious complaints.



















When is it ideal to perform cryoablation treatment?
After pancreatic cancer is detected in a patient, chemotherapy is usually started if the patient is not suitable for surgery (85% is not). Although it is possible to perform ablation treatments after chemotherapy or between chemotherapy sessions, our preference is to perform this treatment in the very beginning for the following reasons;

1. After chemotherapy, some patients may become unsuitable for cryoablation due to Infection, decrease in blood cells ​​and deterioration of general condition. This may sometimes occur even after the first chemotherapy session and the patient may lose the chance of cryoablation.
2. Chemotherapy can sometimes make liver metastases difficult to see with ultrasound and make ablation technically difficult. 
3. If the patient does not respond to chemotherapy, existing tumors may grow and spread further. This can make ablation treatment difficult or impossible.
For these reasons, if the patient is suitable for cryoablation treatment at the time of diagnosis, we recommend that all our patients first undergo cryoablation and then other treatment methods including chemotherapy.