Co-Ablation — Combined Thermal & Cryoablation Therapy
Co-Ablation® is the first minimally invasive tumor treatment system to integrate deep cryoablation and high-intensity thermal ablation into a single ablation needle. This represents a fundamental departure from conventional cryotherapy systems, which can only freeze — not heat — and must rely on multiple external high-pressure gas cylinders using restricted agents such as argon and helium.
Under real-time CT or MRI imaging guidance, the Co-Ablation® needle is inserted percutaneously through the skin and positioned precisely within the tumor target. No open surgery, no general anesthesia, and no incision is required. The needle tip first releases liquid nitrogen to produce freezing at −196°C, then switches to an alcohol-based heating cycle at 85°C. This dual cycle is repeated multiple times within a single session to maximize tumor cell destruction.
Beyond direct tumor elimination, the procedure triggers the release of tumor-specific antigens from dying cancer cells, activating the patient's own immune system in a way that conventional ablation methods cannot reliably replicate. This immune-stimulatory property makes Co-Ablation® a natural complement to the cellular immunotherapies — including CAR-T therapy, TILs therapy, and NK cell therapy — that form the core of BIOOCUS Medical Group's clinical offering.
Co-Ablation® is performed at over 200 top hospitals across China, including Cancer Hospital of the Chinese Academy of Medical Sciences, Beijing Cancer Hospital, PLA General Hospital, Fudan University Shanghai Cancer Center, and Sun Yat-sen University Cancer Center, among many others. More than 20,000 patients have benefited from this technology to date.
Mechanism of Action
The Freeze-Heat Cycle
The Co-Ablation® procedure is built around a precisely controlled freeze-thaw-heat sequence. During the cryoablation phase, liquid nitrogen is delivered through the needle tip to rapidly cool the tumor tissue to −196°C. At this extreme temperature, intracellular water crystallizes into ice, physically rupturing cell membranes and dehydrating tumor cells to the point of irreversible destruction. The tissue is held at this temperature for a sustained freezing period — typically 8 to 16 minutes per cycle depending on tumor size and location — before the rewarming phase begins.
During rewarming, an ethanol-based heating agent raises the needle tip temperature to 85°C. This high-intensity heat phase achieves thermal coagulation of residual tumor cells, seals the needle tract to prevent bleeding, and eliminates the risk of tumor cell seeding along the puncture path — a complication associated with some other ablation approaches. The freeze-heat cycle is repeated two to four times per treatment session to ensure complete coverage of the target lesion and any immediately surrounding safety margin.
Vascular Disruption and Ischemic Necrosis
Ultra-low temperature causes direct physical injury to the walls of the microvasculature within the tumor. This damage triggers the coagulation cascade, leading to the formation of numerous microthrombi that obstruct blood flow through the tumor's internal circulation. With its blood supply blocked, the tumor tissue undergoes progressive ischemic necrosis due to oxygen and nutrient deprivation. The dramatic temperature changes during the rewarming phase further exacerbate this vascular injury, causing reperfusion-related tissue damage that compounds the necrotic effect and ensures more thorough tumor destruction than freezing alone can achieve.
Immune Activation and the Abscopal Effect
As tumor cells are destroyed in situ, they release large quantities of tumor-specific antigens directly into the surrounding tissue environment. This localized antigen release functions as a powerful immunological signal — alerting the immune system to the molecular identity of the cancer and enabling immune effector cells, including T lymphocytes and natural killer (NK) cells, to recognize and pursue tumor cells at sites throughout the body, including distant metastatic lesions that were never directly treated.
This phenomenon — in which local ablation triggers regression of untreated distant tumors — is known as the abscopal effect, and it has been documented in real clinical cases treated with Co-Ablation®. Cryoablation has been shown to generate a more significant increase in interferon-α levels compared to thermal ablation alone, which is believed to underlie its superior immunostimulatory properties.
When Co-Ablation® is combined with immune checkpoint inhibitors — such as anti-PD-1 or anti-PD-L1 agents — or with cellular immunotherapy approaches such as CAR-T therapy, the resulting synergy can produce clinical responses substantially greater than either treatment could achieve individually. Clinical data from published trials using the Co-Ablation® system combined with immunotherapy have demonstrated disease control rates reaching 100% in selected patient groups.
Efficient and Thorough Tumor Destruction
The nearly 300°C temperature differential between the freezing and heating phases of Co-Ablation® exceeds what any single-modality ablation system can produce. The 85°C heating phase reaches and surpasses the threshold required for complete tissue necrosis — a level that conventional cryotherapy rewarming phases do not achieve. The combination of direct cellular destruction by ice crystal formation, ischemic necrosis from vascular occlusion, and thermal coagulation during rewarming ensures that tumor cells are attacked simultaneously through multiple independent mechanisms, substantially reducing the likelihood of residual viable disease.
Minimally Invasive with Rapid Recovery
Co-Ablation® is performed under local anesthesia only. The patient remains fully conscious throughout the procedure and no surgical incision or suturing is required. The ablation needle's minimum outer diameter of 1.7 mm means the only wound left on the patient's body is a pinhole-sized puncture site. Most patients are able to get out of bed and move around on the day of surgery or the following day. The minimally invasive nature of the procedure means it can be repeated if necessary — at the original site or at a new lesion — without the cumulative trauma associated with repeated open surgery.
Precise Visualization and Controlled Boundaries
The formation of an ice ball around the needle tip is clearly visible under both CT and ultrasound imaging in real time throughout the entire procedure. This allows the treating physician to observe the exact extent of the ablation zone as it develops, confirm that the tumor is fully encompassed, and identify any areas requiring additional treatment before the needle is withdrawn. This level of real-time visual control is unique among ablation modalities and significantly reduces the risk of undertreated residual disease at the tumor margins.
Immune Activation to Enhance Systemic Treatment
Because cryoablation releases tumor antigens in situ rather than destroying them as heat-based methods tend to do, Co-Ablation® creates an immunostimulatory environment that complements systemic anti-cancer strategies. Published data confirm that patients treated with Co-Ablation® show significantly elevated interferon-α levels compared to those treated with thermal ablation alone. When integrated into a treatment plan that includes immunotherapy or cellular therapy, this immune priming effect can substantially enhance the overall treatment response, including at metastatic sites remote from the ablation target.
No Systemic Toxicity
Co-Ablation® is a physical, image-guided intervention. It does not produce the systemic toxicities — bone marrow suppression, gastrointestinal damage, nephrotoxicity, cardiotoxicity — associated with chemotherapy and radiation therapy. This makes it a viable option for patients whose general condition, organ function, or prior treatment history would make additional rounds of systemic therapy poorly tolerated. The procedure can be offered to elderly patients, patients with poor cardiopulmonary reserve, and patients who have received multiple prior lines of treatment without precluding future systemic options.
Superior Economics and Operational Safety
Unlike traditional argon-helium cryotherapy systems — which require external high-pressure gas cylinders operating at 7–20 MPa, use argon and helium classified as strategic materials with restricted supply chains, and carry significant logistical and safety risks for operators — Co-Ablation® uses liquid nitrogen and ethanol as its working fluids. These are widely available, low-cost, and present no extraordinary transport or handling risks. The system operates at a safe working pressure of 0.2–1.0 MPa, incorporates an all-in-one compact unit design with no external cylinders required, and features a minimalist high-sensitivity touchscreen interface with RFID login — making it straightforward to operate and maintain in a clinical environment.
Co-Ablation® vs. Traditional Cryotherapy Systems
|
Co-Ablation® |
Traditional Cryotherapy |
|
|
Temperature range |
−196°C to +85°C |
−150°C to +40°C |
|
Heating efficacy |
Reaches tissue necrosis threshold at 85°C |
High temperature insufficient to achieve complete necrosis |
|
Working pressure |
0.2–1.0 MPa — safe for operators and transport |
7–20 MPa — high risk; difficult and restricted transport |
|
Cooling / heating agent |
Liquid nitrogen and ethanol — widely available, low cost |
Argon and helium — classified as strategic materials; restricted supply, high cost |
|
System design |
All-in-one compact unit; no external gas cylinder required |
Requires external high-pressure gas cylinders |
|
Needle diameter |
From 1.7 mm; single probe large-volume ablation |
Typically requires multiple larger needles |
|
Operator interface |
Minimalist touchscreen with RFID login |
Conventional interface design |
|
Bleeding prevention |
Needle tract sealed at 85°C during rewarming |
Not reliably achieved |
|
Tumor seeding prevention |
Needle tract ablated on withdrawal |
Not reliably achieved |
Tumor Types
Co-Ablation® is indicated for ablation therapy of solid tumors across a broad range of organ systems. Tumors in hollow viscera are excluded. Suitable tumor types include:
Lung cancer (peripheral type, small lesions, oligometastasis) · Hepatocellular carcinoma (single or multiple lesions ≤5 cm; also applicable in recurrent cases) · Pancreatic cancer (unresectable or oligometastatic) · Renal cell carcinoma · Adrenal tumors · Prostate cancer · Breast cancer and breast tumors · Bone tumors and soft tissue tumors (including metastatic cases and those with severe cancer pain) · Thyroid cancer · Maxillofacial tumors · Retroperitoneal metastatic tumors
Suitable Patient Conditions
Co-Ablation® is particularly appropriate for patients in the following clinical situations:
Patients for whom surgery is not an option — including those of advanced age, with poor general physical condition, or with impaired cardiopulmonary function that makes general anesthesia or open surgery inadvisable.
Patients who prefer to avoid surgery — for patients who are medically eligible for resection but prefer a minimally invasive alternative that avoids the risks, recovery time, and physical impact of open surgery.
Patients with recurrence or residual disease — including those who have experienced tumor recurrence following surgical resection, or who have residual lesions remaining after radiotherapy or chemotherapy.
Tumors in high-risk anatomical locations — when a tumor is located deep within the body or adjacent to major blood vessels and vital organs, making surgical resection technically hazardous or impossible.
Early and mid-stage solid tumors — where the treatment goal is radical cure through complete local tumor eradication.
Advanced solid tumors — where the treatment goals are tumor reduction (debulking), disease control, and palliation of cancer-related pain, in conjunction with systemic therapies.
Clinical Evidence
The clinical effectiveness of Co-Ablation® has been validated across multiple tumor types in studies published in some of the world's most influential oncology and medical science journals. The following represent landmark publications from the Co-Ablation® clinical research program.
Advanced Intrahepatic Cholangiocarcinoma — Nature Cancer (Impact Factor: 28.5)
A phase II investigator-initiated single-arm clinical trial (CASTLE-01, NCT05010668), led by Dr. Wang Peng's team at the Department of Hepatobiliary Oncology, Zhongshan Hospital, Fudan University, evaluated Co-Ablation® combined cryo-thermal ablation paired with sintilimab and lenvatinib as second-line therapy for patients with advanced intrahepatic cholangiocarcinoma — a disease for which no effective second-line standard of care currently exists. Conventional second-line therapies for this indication achieve an objective response rate of approximately 5% and a median progression-free survival of only 2–4 months.
In this study, the novel "CASTLE regimen" — comprising Co-Ablation® cryoablation to release tumor antigens and trigger immune responses, lenvatinib to remodel tumor blood vessels and stroma to promote T-cell infiltration, and sintilimab to relieve T-cell inhibition — produced the following results among all enrolled patients:
- Objective Response Rate (ORR): 75%
- Complete Response (CR): 7.1% (2 patients)
- Partial Response (PR): 67.9% (19 patients)
- Stable Disease (SD): 25.0% (7 patients)
- Disease Control Rate (DCR): 100%
- Median Progression-Free Survival (PFS): 16.8 months
- Median Overall Survival (OS): 25.4 months
The trial also documented significant regression of distant untreated lesions in multiple patients — a clear demonstration of the systemic abscopal immune effect triggered by cryoablation. The treatment demonstrated a favorable overall safety profile.
Advanced Non-Small Cell Lung Cancer — Signal Transduction and Targeted Therapy (Impact Factor: 52.7)
A single-center, open-label, randomized controlled phase II clinical trial conducted by research teams led by Ren Shengxiang, Chen Bin, and Xu Yaping at Shanghai Pulmonary Hospital evaluated local ablation combined with maintenance immunotherapy for patients with advanced non-small cell lung cancer (NSCLC) who had developed oligoresidual disease after anti-PD-1/PD-L1 immunotherapy. Key outcomes included:
- Progression-Free Survival (PFS): 26.7 months in the combined ablation group versus 11.7 months in the immunotherapy-only group (p<0.001)
- Within the ablation group, the cryoablation subgroup outperformed the thermal ablation subgroup: median PFS was not yet reached in the cryoablation arm versus 22.4 months in the thermal ablation arm
- After randomization, continued PFS superiority was maintained: 17.1 months versus 4.4 months
Mechanistic analysis demonstrated that patients in the cryoablation arm showed a significantly greater increase in circulating interferon-α levels compared to those treated with thermal ablation, providing a plausible immunological explanation for the survival difference observed between the two ablation modalities.
Breadth of Published Evidence
Beyond these landmark trials, Co-Ablation® clinical research findings covering liver cancer, lung cancer, and pancreatic cancer have also been published in the Journal of Clinical Oncology and other top-tier international oncology journals, collectively providing robust evidence-based support across multiple solid tumor types for the integration of Co-Ablation® into multimodal cancer treatment strategies.
Real Patient Outcomes
Case 1 — Pulmonary Adenocarcinoma, Stage Ia (Adjacent to Pleura)
A 77-year-old male patient was found to have a solid space-occupying lesion in the inferior lobe of the left lung on routine examination. Percutaneous biopsy confirmed pulmonary adenocarcinoma. Chest CT showed a single solid nodule of approximately 21×19×19 mm in the dorsal segment of the left lower lobe with high malignant probability. Clinical staging: T1cN0M0, Stage Ia. The patient refused surgical resection. Given the close proximity of the lesion to the pleura — where cryoablation also provides pain-relieving benefit — Co-Ablation® was selected as the treatment approach.
A single ablation needle was used for three complete freeze-heat cycles: eight minutes of freezing followed by three minutes of rewarming per cycle. Follow-up CT conducted seven months after treatment demonstrated that the lesion had shrunk significantly with no contrast enhancement, confirming radical ablation of the local lesion.
Case 2 — Central-Type Pulmonary Metastatic Carcinoma Following Colon Cancer Surgery
A 66-year-old male patient had undergone radical resection of colon cancer more than four years prior. Imaging subsequently revealed irregular consolidation shadows near the hilum of the right lung — right hilar metastatic carcinoma — with the maximum cross-section measuring approximately 3.0×2.2 cm, representing growth since prior imaging. Pathological review confirmed ulcerative moderately differentiated adenocarcinoma of the left colon origin. The patient had already received radiotherapy, chemotherapy, targeted therapy, and immunotherapy for this metastatic disease, all without adequate response. After MDT discussion, Co-Ablation® combined cryo-thermal ablation was selected.
A single probe was applied for four ablation cycles. Three-month postoperative follow-up imaging demonstrated significant reduction in the size of the treated lesion.
Case 3 — Liver Cancer with Bilateral Lung Metastases and Documented Abscopal Effect
A 36-year-old female patient was diagnosed with hepatocellular carcinoma complicated by bilateral lung metastases. She had received four sessions of transcatheter arterial chemoembolization (TACE), one session of hepatic arterial infusion chemotherapy (HAIC), and multiple lines of targeted and immunological systemic therapy — all of which proved ineffective. Following MDT discussion, Co-Ablation® combined cryo-heat ablation was performed on the primary liver lesion. One ablation needle was used with a two-cycle protocol; the surgery was completed without complication. The patient was discharged on the third postoperative day and commenced combination therapy with lenvatinib and cadonilimab.
Follow-up re-examinations at one, three, and six months post-treatment revealed: complete ablation of the treated local liver lesion; marked reduction and shrinkage of the remaining untreated lesions in both lungs; and a significant decline in tumor marker AFP levels. This case represents a clinically documented abscopal effect — the immune activation triggered by local Co-Ablation® drove a meaningful systemic anti-tumor response against distant, untreated metastatic disease.
Case 4 — Locally Advanced Unresectable Pancreatic Body and Tail Carcinoma
Abdominal CT angiography revealed carcinoma of the pancreatic body and tail measuring 7.8×3.1 cm, with invasion of the celiac trunk and its branches, the superior mesenteric artery, and the splenic vein. The tumor was classified as locally advanced, and radical surgical resection was deemed not feasible. Co-Ablation® combined cryo-thermal ablation was performed intraoperatively under direct laparotomy visualization, using a tunnel needle approach. Sequential single-agent gemcitabine chemotherapy was administered after surgery. The patient achieved an overall survival of 18 months — a meaningful outcome in a disease setting where median survival without intervention is typically measured in weeks to months.
Case 5 — Stage IV Invasive Lobular Breast Carcinoma with Bone and Liver Metastases
An 84-year-old female patient presented with Stage IV invasive lobular carcinoma of the right breast (CT: 95×45 mm lesion) with bone and liver metastases. Prior systemic treatments included capecitabine, exemestane, and anastrozole. Pathological profile: ER(+), PR(+), Her-2(+), P53(+), Ki-67 >5%. Given the patient's age and metastatic disease status, Co-Ablation® CT-guided percutaneous cryoablation was performed using two cryoprobes. Two complete freeze-heat cycles were carried out — the first consisting of 11 minutes of freezing followed by 5 minutes of rewarming, and the second of 16 minutes of freezing followed by 5 minutes of rewarming — and the needles were then withdrawn. The procedure was completed without complication, demonstrating the applicability of Co-Ablation® even in elderly patients with advanced, multi-metastatic disease.
Why Choose BIOOCUS for Co-Ablation® Access
BIOOCUS Medical Group connects international patients with China's most experienced oncology teams performing Co-Ablation® — a network spanning over 200 top hospitals, with a collective case volume exceeding 20,000 patients treated.
Our medical coordination services include:
- Review of your medical records and imaging to assess eligibility for Co-Ablation®
- Connection to the most appropriate specialist center and MDT team for your tumor type
- End-to-end in-hospital care coordination during your time in China
- Assistance with travel, accommodation, and logistics for patients and accompanying family members
- Remote follow-up coordination after you return home, including imaging review and ongoing communication with your treating team
- Multilingual consultation support
Our pre-treatment medical evaluation is provided free of charge. There is no obligation to proceed.
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