What is an argon helium knife?
The Ar-He knife is a minimally invasive treatment system that combines argon cooling, helium heating, biosensing, and timely monitoring.
Argon Helium Knife, short for Argon Helium Targeted Minimally Invasive Tumor Therapy System, is the latest international cryogenic targeted local ablation therapy for tumors, combining ultra-low temperature freezing, vascular embolization, and immunotherapy with a number of computer and aerospace technologies, including argon cooling, helium heating, bio-sensing, timely monitoring, and minimally invasive. The newest technology in the world for cryogenic targeted local ablation of tumors, combining ultra-low temperature freezing, vascular embolization and immunotherapy.
The argon helium knife was developed primarily by Endocare, Inc. and is currently used in more than 450 hospitals in the United States, treating tens of thousands of cases each year.
The argon helium knife was formally introduced in China in 1999.
How does argon helium knife treat tumors?
Ultra-cold freezing directly destroys tumor cells
The cryogenic freezing of Ar-He knife rapidly drops the temperature of tumor tissue cells to below -100 °C, causing rapid formation of ice crystals inside and outside the cells, which not only freezes the cells, but also freezes some micro-veins and micro-arteries, causing the expansion of blood vessels; by the time the cryogenic freezing is lifted (thawing period), the cell membrane dehydrates and ruptures leading to cell death. At the same time, it leads to microvascular rupture and hypoxia causing cell death.
Ultra-cold freezing causes tumor tissue destruction
Ultra-cryoablation therapy with argon helium knife leads to irreversible congestion, edema, hemorrhage, degeneration, and coagulative necrosis of tumor tissue.
Ultra-low temperature freezing also has immune enhancing effects
Ultra-low temperature therapy not only effectively destroys cancer cells, but also enhances the body’s anti-tumor immunity in the following three ways:
- Modulation of the body’s immune response against cancer cells: Ultra-low temperature cryotherapy can proliferate T lymphocytes and significantly activate the function of T lymphocytes;
- Modulation of cytokine and antibody secretion: Ultra-low temperature freezing destroys cells causing cell membrane rupture, exposing tumor antigens, and causing anti-tumor antibody elevation;
- Modulation of tumor antigens and reversal of tumor immune evasion: Freezing causes tumor cells to rupture and cell membrane to lyse, prompting the release of tumor antigens. And the necrosis of tumor cells causes the normal secretion of tumor antigens to stop, and the tumor immunosuppression state is lifted.
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How does argon helium knife treatment for prostate cancer work?
Preoperative preparation
After admission, the patient may be prepared for the procedure, usually with routine blood work, coagulation, blood biochemistry, and the four preoperative tests (hepatitis B, C, HIV, and syphilis) to rule out contraindications to surgery, and an IV needle is left in place to establish intravenous access, and the provider prepares postoperative monitoring equipment for ECG, heart rate, and oxygen saturation.
Intraoperative maneuvers
- The argon helium knife is accurately penetrated into the cancerous tumor tissue using X-ray, ultrasound, large-aperture multilevel spiral CT, MRI, or lumpectomy guidance;
- The patient’s surface skin is disinfected, sterile sheets are placed, and local anesthesia with 2% lidocaine is injected;
- Puncture was performed using an 8-G bone puncture needle to allow the biopsy needle to enter the tumor nest. Real-time monitoring was performed during the puncture using CT or MRI.
- Argon helium knife accurately penetrates into the cancerous tumor tissue, it can freeze the cancerous tumor cells to -140~160℃ within 60 seconds, and the temperature can reach as low as -175℃, freezing the cancerous tumor tissue into ice balls within minutes, causing the tumor tissue cells to rupture and necrosis; the helium gas rapidly causes heat, accelerating the degeneration and necrosis of the cancerous tumor tissue; the cold and heat cycles are reversed, causing the cancerous tumor tissue to be completely destroyed.
Post-operative care
- After removal of the needle, the surgeon will apply pressure to the puncture site for 5-15 minutes to prevent bleeding and observe for 30 minutes, and if there is no discomfort, the patient can return to the ward and have cardiac monitoring for 6 hours;
- Oral antibiotics are required for 3 days after surgery, and intravenous drip of lithotripsy, alkalinization of urine and diuretics for 2 to 3 days.
Which patients are suitable for argon helium knife treatment?
Patients with prostate cancer who meet the following criteria may choose argon helium knife treatment:
- Patients with early-stage prostate cancer that is not very malignant: For these patients, doctors usually recommend regular observation, but patients are concerned about tumor progression on the one hand and complications associated with surgical treatment on the other, so argon helium knife treatment may be considered for these patients;
- Patients older than 75 years with non-metastatic prostate cancer: These patients are not well enough for surgery, but the patient wants to actively manage the disease, so argon helium knife treatment can also be considered and can achieve similar results as surgery;
- Patients with metastatic prostate cancer: Adjuvant treatment with argon helium knife in addition to endocrine therapy can delay disease progression to desmoresistant prostate cancer compared to taking endocrine therapy alone.
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In summary, argon helium knife can rapidly and maximally reduce tumor load and can provide efficacy assurance for radiotherapy, chemotherapy, and biologic therapy. Ar-He knife therapy can perform targeted inactivation of solid tumors that are revealed on imaging, rapidly reducing patient pain and improving quality of life. However, as with other problems faced with local physiotherapy, argon helium cryotherapy must still be followed by appropriate systemic therapy for subclinical lesions and potential residual cancer cells throughout the body.
In addition, because argon-helium ultra-low temperature freezing is not selective for cell destruction, it can cause cryosurgical damage to normal tissue structures if not performed properly. Therefore, during argon helium knife surgery for prostate cancer, the surgeon uses a urethral insulating system; the bladder is continuously flushed with warm saline intraoperatively to minimize or avoid urethral frostbite.
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