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Abstract
Radiofrequency ablation (RFA) has been widely used as an alternative treatment modality for liver tumors. Monitoring the temperature distribution in the tissue during RFA is required to assess the thermal dosage. Ultrasound temperature imaging based on the detection of echo time shifts has received the most attention in the past decade. The coefficient k, connecting the temperature change and the echo time shift, is a medium-dependent parameter used to describe the confounding effects of changes in the speed of sound and thermal expansion as temperature increases. The current algorithm of temperature estimate based on echo time shift detection typically uses a constant k, resulting in estimation errors when ablation temperatures are higher than 50°C. This study proposes an adaptive-k algorithm that enables the automatic adjustment of the coefficient k during ultrasound temperature monitoring of RFA. To verify the proposed algorithm, RFA experiments on in vitro porcine liver samples (total n = 15) were performed using ablation powers of 10, 15, and 20 W. During RFA, a clinical ultrasound system equipped with a 7.5-MHz linear transducer was used to collect backscattered signals for ultrasound temperature imaging using the constant- and adaptive-k algorithms. Concurrently, an infrared imaging system and thermocouples were used to measure surface temperature distribution of the sample and internal ablation temperatures for comparisons with ultrasound estimates. Experimental results demonstrated that the proposed adaptive-k method improved the performance in visualizing the temperature distribution. In particular, the estimation errors were also reduced even when the temperature of the tissue is higher than 50°C. The proposed adaptive-k ultrasound temperature imaging strategy has potential to serve as a thermal dosage evaluation tool for monitoring high-temperature RFA.
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Liu YD, Li Q, Zhou Z, Yeah YW, Chang CC, Lee CY, Tsui PH. Adaptive ultrasound temperature imaging for monitoring radiofrequency ablation. PLoS One 2017; 12:e0182457. [PMID: 28837584 PMCID: PMC5570358 DOI: 10.1371/journal.pone.0182457] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/18/2017] [Indexed: 12/31/2022] Open
Abstract
Radiofrequency ablation (RFA) has been widely used as an alternative treatment modality for liver tumors. Monitoring the temperature distribution in the tissue during RFA is required to assess the thermal dosage. Ultrasound temperature imaging based on the detection of echo time shifts has received the most attention in the past decade. The coefficient k, connecting the temperature change and the echo time shift, is a medium-dependent parameter used to describe the confounding effects of changes in the speed of sound and thermal expansion as temperature increases. The current algorithm of temperature estimate based on echo time shift detection typically uses a constant k, resulting in estimation errors when ablation temperatures are higher than 50°C. This study proposes an adaptive-k algorithm that enables the automatic adjustment of the coefficient k during ultrasound temperature monitoring of RFA. To verify the proposed algorithm, RFA experiments on in vitro porcine liver samples (total n = 15) were performed using ablation powers of 10, 15, and 20 W. During RFA, a clinical ultrasound system equipped with a 7.5-MHz linear transducer was used to collect backscattered signals for ultrasound temperature imaging using the constant- and adaptive-k algorithms. Concurrently, an infrared imaging system and thermocouples were used to measure surface temperature distribution of the sample and internal ablation temperatures for comparisons with ultrasound estimates. Experimental results demonstrated that the proposed adaptive-k method improved the performance in visualizing the temperature distribution. In particular, the estimation errors were also reduced even when the temperature of the tissue is higher than 50°C. The proposed adaptive-k ultrasound temperature imaging strategy has potential to serve as a thermal dosage evaluation tool for monitoring high-temperature RFA.
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Affiliation(s)
- Yi-Da Liu
- School of Electronic Information Engineering, Tianjin University, Tianjin, China
| | - Qiang Li
- School of Electronic Information Engineering, Tianjin University, Tianjin, China
| | - Zhuhuang Zhou
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
- Faculty of Information Technology, Beijing University of Technology, Beijing, China
| | - Yao-Wen Yeah
- Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan
| | - Chien-Cheng Chang
- Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan
- * E-mail: (PHT); (CCC)
| | - Chia-Yen Lee
- Department of Electrical Engineering, National United University, Miao-Li, Taiwan
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- * E-mail: (PHT); (CCC)
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Sato M, Tateishi R, Yasunaga H, Matsui H, Fushimi K, Ikeda H, Yatomi Y, Koike K. Association between hospital volume and in-hospital mortality following radiofrequency ablation for hepatocellular carcinoma. BJS Open 2017; 1:50-54. [PMID: 29951606 PMCID: PMC5989986 DOI: 10.1002/bjs5.9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/30/2017] [Indexed: 12/21/2022] Open
Abstract
Background Radiofrequency ablation (RFA) is a minimally invasive treatment for hepatocellular carcinoma (HCC). There is increasing evidence of an association between increasing hospital volume and lower postoperative mortality for many surgical procedures, but this is difficult to establish with minimally invasive treatments, where postoperative mortality is low. The aim of this study was to investigate the relationship between hospital volume and in-hospital mortality following RFA using a Japanese nationwide database. Methods Data from the Diagnostic Procedure Combination database were analysed from 1 July 2010 to 31 March 2012. Multivariable logistic regression was used to analyse the relationship between hospital volume and in-hospital mortality following RFA, with adjustment for patient background. Results Some 36 675 patients with HCC were identified in the database. The overall in-hospital mortality rate from RFA was 0·31 per cent. In-hospital mortality was significantly higher in low-volume than high-volume hospitals (odds ratio 2·57, 95 per cent c.i. 1·61 to 4·09; P < 0·001). Higher in-hospital mortality was significantly associated with older age and a higher Charlson Co-morbidity Index score. Conclusion RFA for HCC was associated with acceptably low mortality in Japan, but in-hospital mortality following RFA was affected by hospital procedural volume.
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Affiliation(s)
- M Sato
- Department of Clinical Laboratory Medicine University of Tokyo Tokyo Japan.,Department of Gastroenterology, Graduate School of Medicine University of Tokyo Tokyo Japan
| | - R Tateishi
- Department of Gastroenterology, Graduate School of Medicine University of Tokyo Tokyo Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health University of Tokyo Tokyo Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health University of Tokyo Tokyo Japan
| | - K Fushimi
- Department of Health Policy and Informatics Tokyo Medical and Dental University Graduate School of Medicine Tokyo Japan
| | - H Ikeda
- Department of Clinical Laboratory Medicine University of Tokyo Tokyo Japan
| | - Y Yatomi
- Department of Clinical Laboratory Medicine University of Tokyo Tokyo Japan
| | - K Koike
- Department of Gastroenterology, Graduate School of Medicine University of Tokyo Tokyo Japan
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Deng Q, Chen S, Fu C, Jiang J, Zou M, Tan Y, Wang X, Xia F, Feng K, Ma K, Bie P. Long noncoding RNA expression profiles in sub-lethal heat-treated hepatoma carcinoma cells. World J Surg Oncol 2017; 15:136. [PMID: 28732507 PMCID: PMC5521104 DOI: 10.1186/s12957-017-1194-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/22/2017] [Indexed: 02/06/2023] Open
Abstract
Background Sub-lethal heat treatment characterizes a transition zone of radiofrequency ablation (RFA) which explains hepatocellular carcinoma (HCC) residual cancer occurrence in this area after RFA treatment. The biochemistry of residual cancer cell recurrence is poorly understood, but long noncoding RNAs (lncRNAs) may have aberrant expression that is associated with diverse cancers. Thus, we measured lncRNA gene expression in sub-lethally heat-treated HCC cells using microarray. Method Differentially expressed lncRNA and mRNA were measured with an Agilent Human lncRNA + mRNA Array V4.0 (4 × 180 K format) containing 41,000 lncRNAs and 34,000 mRNAs. Bioinformatics analysis was used to assess differentially expressed lncRNA and mRNA. Seven lncRNA and seven mRNA were validated by qRT-PCR analysis in HCC cells. Results Genome-wide lncRNA and mRNA expression data in sub-lethal heat-treated SMMC-7721 HCC cells 558 lncRNA and 250 mRNA were significantly up-regulated and 224 lncRNA and 1031 mRNA down-regulated compared to normal cultured SMMC-7721 cells. We demonstrated for the first time that ENST00000570843.1, ENST00000567668.1, ENST00000582249.1, ENST00000450304.1, TCONS_00015544, ENST00000602478.1, TCONS_00001266 and ARC, IL12RB1, HSPA6 were upregulated, whereas STAT3, PRPSAP1, MCU, URB2 were down-regulated in sub-lethally heat-treated HCC cells. Conclusions lncRNA expression data in sub-lethally heat-treated HCC cells will provide important insights about lncRNAs’ contribution to HCC recurrence after RFA treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12957-017-1194-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Qingsong Deng
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Shihan Chen
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Chunchuan Fu
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Jiayun Jiang
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Mengda Zou
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Yunhua Tan
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Xiaofei Wang
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Feng Xia
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Kai Feng
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
| | - Kuansheng Ma
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
| | - Ping Bie
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
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Guan X, Du H, Li Q, Tsui PH. Combination of Window-Modulated Ultrasound Nakagami Imaging and Gaussian Approximation for Radiofrequency Ablation Monitoring: An In Vitro Study. J Med Biol Eng 2017. [DOI: 10.1007/s40846-017-0310-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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D’Onofrio M, Crosara S, De Robertis R, Butturini G, Salvia R, Paiella S, Bassi C, Mucelli RP. Percutaneous Radiofrequency Ablation of Unresectable Locally Advanced Pancreatic Cancer: Preliminary Results. Technol Cancer Res Treat 2017; 16:285-294. [PMID: 27193941 PMCID: PMC5616042 DOI: 10.1177/1533034616649292] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 03/29/2016] [Accepted: 04/18/2016] [Indexed: 12/19/2022] Open
Abstract
AIM The objective of this study was to evaluate the efficacy of percutaneous radiofrequency ablation of locally advanced pancreatic cancer located in the pancreatic body. MATERIALS AND METHODS Patients with biopsy-proven locally advanced pancreatic adenocarcinoma were considered for percutaneous radiofrequency ablation. Postprocedural computed tomography studies and Ca19.9 tumor marker evaluation were performed at 24 hours and 1 month. At computed tomography, treatment effect was evaluated by excluding the presence of complications. The technical success of the procedure is defined at computed tomography as the achievement of tumoral ablated area. RESULTS Twenty-three patients have been included in the study. Five of the 23 patients were excluded. At computed tomography, the mean size of the intralesional postablation necrotic area was 32 mm (range: 15-65 mm). Technical success of the procedure has been obtained in 16 (93%) of the 18 cases. None of the patients developed postprocedural complications. Mean Ca19.9 serum levels 1 day before, 1 day after, and 1 month after the procedure were 285.8 U/mL (range: 16.6-942.0 U/mL), 635.2 U/mL (range: 17.9-3368.0 U/mL), and 336.0 U/mL (range: 7.0-1400.0 U/mL), respectively. Follow-up duration was less than 6 months for 11 patients and more than 6 months for 7 patients. At the time of the draft of this article, the mean survival of the patients included in the study was 185 days (range: 62-398 days). CONCLUSION Percutaneous radiofrequency ablation of locally advanced adenocarcinoma has a high technical success rate and is effective in cytoreduction both at imaging and laboratory controls.
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Affiliation(s)
- Mirko D’Onofrio
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Stefano Crosara
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Riccardo De Robertis
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Giovanni Butturini
- Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Roberto Salvia
- Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Salvatore Paiella
- Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Claudio Bassi
- Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy
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Yang W, Yan K, Chen MH, Wu JY, Zhang ZY, Lee JC, Wang S, Wu W. Preliminary experience with direct percutaneous arterial embolisation combined with radiofrequency ablation for hypervascular HCC. Int J Hyperthermia 2017; 33:836-845. [DOI: 10.1080/02656736.2017.1305126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Ding H, Su M, Zhu C, Wang L, Zheng Q, Wan Y. CT-guided versus laparoscopic radiofrequency ablation in recurrent small hepatocellular carcinoma against the diaphragmatic dome. Sci Rep 2017; 7:44583. [PMID: 28291254 PMCID: PMC5349557 DOI: 10.1038/srep44583] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 02/10/2017] [Indexed: 12/19/2022] Open
Abstract
Computed tomography-guided radiofrequency ablation (CT-RFA) and laparoscopic RFA (L-RFA) have been used to treat intrahepatic recurrent small hepatocellular carcinoma (HCC) against the diaphragmatic dome. However, the therapeutic safety, efficacy, and hospital fee have never been compared between the two techniques due to scarcity of cases. In this retrospective study, 116 patients were divided into two groups with a total of 151 local recurrent HCC lesions abutting the diaphragm. We compared overall survival (OS), local tumor progression (LTP), postoperative complications, and hospital stay and fee between the two groups. Our findings revealed no significant differences in 5-year OS (36.7% vs. 44.6%, p = 0.4289) or 5-year LTP (73.3% vs. 67.9%, p = 0.8897) between CT-RFA and L-RFA. The overall hospital stay (2.8 days vs. 4.1 days, p < 0.0001) and cost (¥ 19217.6 vs. ¥ 25553.6, p < 0.0001) were significantly lower in the CT-RFA in comparison to that of L-RFA. In addition, we elaborated on the choice of percutaneous puncture paths depending on the locations of the HCC nodules and 11-year experience with CT-RFA. In conclusion, CT-RFA is a relatively easy and economic technique for recurrent small HCC abutting the diaphragm, and both CT-RFA and L-RFA are effective techniques.
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Affiliation(s)
- Huaiyin Ding
- Department of Radiology, The Second Affiliated Hospital of Southeast University, Southeast University, 1-1 Zhongfu Road, Nanjing, Jiangsu, 210003, China
| | - Mu Su
- Department of Oncology, The Second Affiliated Hospital of Southeast University, Southeast University, 1-1 Zhongfu Road, Nanjing, Jiangsu, 210003, China
| | - Chuandong Zhu
- Department of Oncology, The Second Affiliated Hospital of Southeast University, Southeast University, 1-1 Zhongfu Road, Nanjing, Jiangsu, 210003, China
| | - Lixue Wang
- Department of Oncology, The Second Affiliated Hospital of Southeast University, Southeast University, 1-1 Zhongfu Road, Nanjing, Jiangsu, 210003, China
| | - Qin Zheng
- Department of Oncology, The Second Affiliated Hospital of Southeast University, Southeast University, 1-1 Zhongfu Road, Nanjing, Jiangsu, 210003, China
| | - Yuan Wan
- Department of Oncology, The Second Affiliated Hospital of Southeast University, Southeast University, 1-1 Zhongfu Road, Nanjing, Jiangsu, 210003, China.,N250, Millennium Science Complex, Pennsylvania State University, University Park, 16801, PA, USA.,Nanjing Zetect Biomedical Company, Nanjing, 210003, Jiangsu, China
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59
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Niessen C, Thumann S, Beyer L, Pregler B, Kramer J, Lang S, Teufel A, Jung EM, Stroszczynski C, Wiggermann P. Percutaneous Irreversible Electroporation: Long-term survival analysis of 71 patients with inoperable malignant hepatic tumors. Sci Rep 2017; 7:43687. [PMID: 28266600 PMCID: PMC5339813 DOI: 10.1038/srep43687] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/30/2017] [Indexed: 12/18/2022] Open
Abstract
Aim of this retrospective analysis was to evaluate the survival times after percutaneous irreversible electroporation (IRE) in inoperable liver tumors not amenable to thermal ablation. 71 patients (14 females, 57 males, median age 63.5 ± 10.8 years) with 103 liver tumors were treated in 83 interventions using IRE (NanoKnife® system). The median tumor short-axis diameter was 1.9 cm (minimum 0.4 cm, maximum 4.5 cm). 35 patients had primary liver tumors and 36 patients had liver metastases. The Kaplan-Meier method was employed to calculate the survival rates, and the different groups were compared using multivariate log-rank and Wilcoxon tests. The overall median survival time was 26.3 months; the median survival of patients with primary land secondary liver cancer did not significantly differ (26.8 vs. 19.9 months; p = 0.41). Patients with a tumor diameter >3 cm (p < 0.001) or more than 2 lesions (p < 0.005) died significantly earlier than patients with smaller or fewer tumors. Patients with hepatocellular carcinoma and Child-Pugh class B or C cirrhosis died significantly earlier than patients with Child-Pugh class A (p < 0.05). Patients with very early stage HCC survived significantly longer than patients with early stage HCC with a median survival of 22.3 vs. 13.7 months (p < 0.05).
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Affiliation(s)
- C. Niessen
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - S. Thumann
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - L. Beyer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - B. Pregler
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - J. Kramer
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - S. Lang
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - A. Teufel
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - E. M. Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - C. Stroszczynski
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - P. Wiggermann
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Rosengart TK, Mason MC, LeMaire SA, Brandt ML, Coselli JS, Curley SA, Mattox KL, Mills JL, Sugarbaker DJ, Berger DA. The seven attributes of the academic surgeon: Critical aspects of the archetype and contributions to the surgical community. Am J Surg 2017; 214:165-179. [PMID: 28284432 DOI: 10.1016/j.amjsurg.2017.02.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND "Academic surgeon" describes a member of a medical school department of surgery, but this term does not fully define the important role of such physician-scientists in advancing surgical science through translational research and innovation. METHODS The curriculum vitae and self-descriptive vignettes of the records of achievement of seven surgeons possessing documented records of academic leadership, innovation, and dissemination of knowledge were reviewed. RESULTS Out analysis yielded seven attributes of the archetypal academic surgeon: 1) identifies complex clinical problems ignored or thought unsolvable by others, 2) becomes an expert, 3) innovates to advance treatment, 4) observes outcomes to further improve and innovate, 5) disseminates knowledge and expertise, 6) asks important questions to further improve care, and 7) trains the next generation of surgeons and scientists. CONCLUSION Although alternative pathways to innovation and academic contribution also exist, the academic surgeon typically devotes years of careful observation, analysis, and iterative investigation to identify and solve challenging or unexplored clinical problems, ideally leverages resources available in academic medical centers to support these endeavors.
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Affiliation(s)
- Todd K Rosengart
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
| | - Meredith C Mason
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Scott A LeMaire
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Mary L Brandt
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Joseph S Coselli
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Steven A Curley
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Kenneth L Mattox
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Joseph L Mills
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - David J Sugarbaker
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - David A Berger
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Artificial ascites and pneumoperitoneum to facilitate thermal ablation of liver tumors: a pictorial essay. Abdom Radiol (NY) 2017; 42:620-630. [PMID: 27665483 DOI: 10.1007/s00261-016-0910-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Image-guided percutaneous thermal ablation is increasingly utilized in the treatment of hepatic malignancies. Peripherally located hepatic tumors can be difficult to access or located adjacent to critical structures that can be injured. As a result, ablation of peripheral tumors may be avoided or may be performed too cautiously, leading to inadequate ablation coverage. In these cases, separating the tumor from adjacent critical structures can increase the efficacy and safety of procedures. Artificial ascites and artificial pneumoperitoneum are techniques that utilize fluid and gas, respectively, to insulate critical structures from the thermal ablation zone. Induction of artificial ascites and artificial pneumoperitoneum can enable complete ablation of otherwise inaccessible hepatic tumors, improve tumor visualization, minimize unintended thermal injury to surrounding organs, and reduce post-procedural pain. This pictorial essay illustrates and discusses the proper technique and clinical considerations for successful artificial ascites and pneumoperitoneum creation to facilitate safe peripheral hepatic tumor ablation.
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62
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Barat M, Fohlen A, Cassinotto C, Jannot AS, Dautry R, Pelage JP, Boudiaf M, Pocard M, Eveno C, Taouli B, Soyer P, Dohan A. One-month apparent diffusion coefficient correlates with response to radiofrequency ablation of hepatocellular carcinoma. J Magn Reson Imaging 2016; 45:1648-1658. [PMID: 27766709 DOI: 10.1002/jmri.25521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/05/2016] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To assess whether apparent diffusion coefficient (ADC) values at 1 and 3 months after radiofrequency ablation (RFA) may be associated with a favorable response to therapy for hepatocellular carcinoma (HCC) and liver metastases. MATERIALS AND METHODS Fifty-nine patients with HCC (n = 35) or liver metastases (n = 24) who underwent 1.5T diffusion-weighted magnetic resonance imaging (DWMRI) at 1 and 3 months post-RFA were included. ADC values of patients with local tumor recurrence were compared to those without local recurrence. A subgroup analysis was performed for HCC and metastases. RESULTS Thirty-eight HCC and 27 metastases were evaluated. The ADC value of HCC at 1 month after RFA was lower in recurrent tumors (0.957 ± 0.229 [SD] × 10-3 mm2 ) compared to tumors with complete response (1.414 ± 0.322 [SD] × 10-3 mm2 /s, P = 0.006). At multivariate analysis, ADC at 1 month was the single independent variable associated with recurrence for HCC (area under the receiver operating characteristic curve = 0.860). No significant association was observed for liver metastases (P = 0.089). CONCLUSION A low ADC value at 1 month after RFA is associated with an early local recurrence of HCC. This study does not confirm that such association exists for hepatic metastases. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;45:1648-1658.
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Affiliation(s)
- Maxime Barat
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Paris, France
| | - Audrey Fohlen
- CNRS, UMR 6301-ISTCT, CERVOxy, GIP CYCERON, Caen, France.,CEA, DSV/I2BM, UMR6301-ISTCT, Caen, France.,Normandie Université, France.,UNICAEN, UMR6301-ISTCT, Caen, France.,CHU de CAEN, Service d'Imagerie Diagnostique et de Radiologie Thérapeutique, Caen, France
| | - Christophe Cassinotto
- Department of Diagnostic and Interventional Imaging, Hôpîtal Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.,INSERM U1053, Université Bordeaux, Bordeaux, France
| | - Anne Sophie Jannot
- INSERM-UMRS 1138 Team 22, Cordeliers Research Center, Paris, France.,Paris Descartes University, Paris, France.,Department of Medical Informatics and Public Health, European George Pompidou Hospital, Paris, France
| | - Raphael Dautry
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Paris, France
| | - Jean-Pierre Pelage
- CNRS, UMR 6301-ISTCT, CERVOxy, GIP CYCERON, Caen, France.,CEA, DSV/I2BM, UMR6301-ISTCT, Caen, France.,Normandie Université, France.,UNICAEN, UMR6301-ISTCT, Caen, France.,CHU de CAEN, Service d'Imagerie Diagnostique et de Radiologie Thérapeutique, Caen, France
| | - Mourad Boudiaf
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Paris, France
| | - Marc Pocard
- Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France.,UMR CART - INSERM 965, Hôpital Lariboisière, Paris, France.,Department of Digestive Surgery, Hôpital Lariboisière, Paris, France
| | - Clarisse Eveno
- Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France.,UMR CART - INSERM 965, Hôpital Lariboisière, Paris, France.,Department of Digestive Surgery, Hôpital Lariboisière, Paris, France
| | - Bachir Taouli
- Department of Radiology and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Philippe Soyer
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Paris, France.,Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France.,UMR CART - INSERM 965, Hôpital Lariboisière, Paris, France
| | - Anthony Dohan
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Paris, France.,Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France.,UMR CART - INSERM 965, Hôpital Lariboisière, Paris, France.,McGill University Health Center, Department of Radiology, McGill University Health Center, Montreal, QC, Canada
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63
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Navez J, Remue C, Leonard D, Bachmann R, Kartheuser A, Hubert C, Coubeau L, Komuta M, Van den Eynde M, Zech F, Jabbour N. Surgical Treatment of Colorectal Cancer with Peritoneal and Liver Metastases Using Combined Liver and Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Report from a Single-Centre Experience. Ann Surg Oncol 2016; 23:666-673. [PMID: 27646023 DOI: 10.1245/s10434-016-5543-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Chemotherapeutic advances have enabled successful cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) expansion in treating metastatic colorectal cancer. OBJECTIVES The aims of this study were to evaluate the safety of combining liver surgery (LS) with HIPEC and CRS (which remains controversial) and its impact on overall survival (OS) rates. METHODS From 2007 to 2015, a total of 77 patients underwent CRS/HIPEC for peritoneal carcinomatosis (PC) of colorectal cancer. Twenty-five of these patients underwent concomitant LS for suspicion of liver metastases (LM; group 2), and were compared with patients who underwent CRS/HIPEC only (group 1). Demographic and clinical data were reviewed retrospectively. RESULTS Among the group 2 patients, two underwent major hepatectomies, six underwent multiple wedge resections, 16 underwent single wedge resections (one with radiofrequency ablation), and one underwent radiofrequency ablation alone. For groups 1 and 2, median peritoneal cancer index was 6 and 10 (range 0-26; p = 0.08), complication rates were 15.4 and 32.0 % (Dindo-Clavien ≥3; p = 0.15), and median follow-up was 34.2 and 25.5 months (range 0-75 and 3-97), respectively. One group 2 patient died of septic shock after 66 days. Pathology confirmed LM in 21 patients in group 2 (four with benign hepatic lesions were excluded from long-term outcome analysis). Two-year OS rates were 89.5 and 70.2 % (p = 0.04), and 2-year recurrence-free survival rates were 38.3 and 13.4 % (p = 0.01) in groups 1 and 2, respectively. CONCLUSIONS Simultaneous surgery for colorectal LM and PC is both feasible and safe, with low postoperative morbidity. Further longer-term studies would help determine its impact on patient survival.
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Affiliation(s)
- Julie Navez
- Hepatobiliary Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Christophe Remue
- Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Daniel Leonard
- Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Radu Bachmann
- Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Alex Kartheuser
- Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Catherine Hubert
- Hepatobiliary Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Laurent Coubeau
- Hepatobiliary Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Mina Komuta
- Department of Pathology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Marc Van den Eynde
- Department of Medical Oncology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Francis Zech
- Department of Internal Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Nicolas Jabbour
- Hepatobiliary Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
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64
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Min JH, Kim YS, Rhim H, Lee MW, Kang TW, Song KD, Lim HK. Effect of parenchymal uptake of perfluorobutane microbubbles (Sonazoid(®) ) on radiofrequency ablation of the liver: in vivo experimental study. Liver Int 2016; 36:1187-95. [PMID: 26835608 DOI: 10.1111/liv.13081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/22/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS To investigate the differences in mechanical effects and ablation zone between radiofrequency (RF) ablation with and without Sonazoid uptake in an in vivo rabbit liver model. METHODS Our study was approved by the Institutional Animal Care and Use Committee. Twenty-five rabbits were randomly allotted to one of five ablation durations (i.e., 1, 2, 3, 6 and 12 min). For each rabbit, RF ablation was performed twice, before and 10 min after Sonazoid administration (i.e. control group vs. Sonazoid group), using a 1-cm internally cooled electrode (40W) equipped with a parallelly fixed pressure-monitoring device. During ablation, a 'popping' sound was perceived and recorded along with tissue pressure changes and RF ablation parameters. Then, the ablation volume and microscopic changes were compared. RESULTS Popping sounds were more frequently perceived in the control group (21/25 vs. 1/25, P < 0.001). The time to first pressure peak was shorter in the Sonazoid group (22.3 ± 1.1 s vs. 46.3 ± 4.4 s, P < 0.001) with similar pressures (39.8 ± 4.2 mmHg vs. 35.6 ± 4.1 mmHg, P = 0.350). Time to first roll-off and mean power output were significantly less in the Sonazoid group (17.6 ± 1.2 s vs. 71.2 ± 8.2 s, P < 0.001; 9.4 ± 0.3 W vs. 12.8 ± 0.5 W, P < 0.001). Consequently, the Sonazoid group had lower total energy and ablation volumes for all durations. Microscopically, the control group showed larger conflu-ent disruptions, whereas the Sonazoid group showed many smaller disruptions scattered throughout the ablation zones. CONCLUSIONS Radiofrequency ablation after Sonazoid uptake induces a smaller ablation zone than conventional RF ablation. However, it appears to ablate the liver tissue with less mechanical effects.
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Affiliation(s)
- Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Sun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Keun Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Science and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, Seoul, Korea
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65
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Abstract
Pulmonary metastases are common in patients with cancer for which surgery is considered a standard approach in appropriately selected patients. A number of patients are not candidates for surgery due to a medical comorbidities or the extent of surgery required. For these patients, noninvasive or minimally invasive approaches to ablate pulmonary metastases are potential treatment strategies. This article summarizes the rationale and outcomes for non-surgical treatment approaches, including radiotherapy, radiofrequency and microwave ablation, for pulmonary metastases.
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Affiliation(s)
- Matthew J Boyer
- Department of Radiation Oncology, Duke University, Box 3085 DUMC, Durham, NC 27710, USA
| | - Umberto Ricardi
- Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - David Ball
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 2 St Andrews Pl, Melbourne, Victoria 3002, Australia; The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University, Box 3085 DUMC, Durham, NC 27710, USA.
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66
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Kaur G, Willsmore T, Gulati K, Zinonos I, Wang Y, Kurian M, Hay S, Losic D, Evdokiou A. Titanium wire implants with nanotube arrays: A study model for localized cancer treatment. Biomaterials 2016; 101:176-88. [PMID: 27289379 DOI: 10.1016/j.biomaterials.2016.05.048] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 03/21/2016] [Accepted: 05/27/2016] [Indexed: 12/11/2022]
Abstract
Adverse complications associated with systemic administration of anti-cancer drugs are a major problem in cancer therapy in current clinical practice. To increase effectiveness and reduce side effects, localized drug delivery to tumour sites requiring therapy is essential. Direct delivery of potent anti-cancer drugs locally to the cancer site based on nanotechnology has been recognised as a promising alternative approach. Previously, we reported the design and fabrication of nano-engineered 3D titanium wire based implants with titania (TiO2) nanotube arrays (Ti-TNTs) for applications such as bone integration by using in-vitro culture systems. The aim of present study is to demonstrate the feasibility of using such Ti-TNTs loaded with anti-cancer agent for localized cancer therapy using pre-clinical cancer models and to test local drug delivery efficiency and anti-tumour efficacy within the tumour environment. TNF-related apoptosis-inducing ligand (TRAIL) which has proven anti-cancer properties was selected as the model drug for therapeutic delivery by Ti-TNTs. Our in-vitro 2D and 3D cell culture studies demonstrated a significant decrease in breast cancer cell viability upon incubation with TRAIL loaded Ti-TNT implants (TRAIL-TNTs). Subcutaneous tumour xenografts were established to test TRAIL-TNTs implant performance in the tumour environment by monitoring the changes in tumour burden over a selected time course. TRAIL-TNTs showed a significant regression in tumour burden within the first three days of implant insertion at the tumour site. Based on current experimental findings these Ti-TNTs wire implants have shown promising capacity to load and deliver anti-cancer agents maintaining their efficacy for cancer treatment.
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Affiliation(s)
- Gagandeep Kaur
- School of Chemical Engineering, The University of Adelaide, Adelaide, SA, 5005, Australia; School of Medicine, Discipline of Surgery, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Tamsyn Willsmore
- School of Medicine, Discipline of Surgery, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Karan Gulati
- School of Chemical Engineering, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Irene Zinonos
- School of Medicine, Discipline of Surgery, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Ye Wang
- School of Chemical Engineering, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Mima Kurian
- School of Chemical Engineering, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Shelley Hay
- School of Medicine, Discipline of Surgery, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Dusan Losic
- School of Chemical Engineering, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Andreas Evdokiou
- School of Medicine, Discipline of Surgery, The University of Adelaide, Adelaide, SA, 5005, Australia.
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67
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Xie J, Zhang X, Teng M, Yu B, Yang S, Lee RJ, Teng L. Synthesis, characterization, and evaluation of mPEG-SN38 and mPEG-PLA-SN38 micelles for cancer therapy. Int J Nanomedicine 2016; 11:1677-86. [PMID: 27217746 PMCID: PMC4853016 DOI: 10.2147/ijn.s103110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
7-Ethyl-10-hydroxy camptothecin (SN38) is a potent topoisomerase inhibitor and a metabolite of irinotecan. Its clinical development has been hampered by its poor solubility. To address this problem, methoxy poly(ethylene glycol)-2000 (mPEG2K)-SN38 and mPEG2K-poly(lactide) (PLA1.5K)-SN38 conjugates were prepared and then dispersed into an aqueous medium to form micelles. Physicochemical characteristics of SN38-polymer conjugate micelles, for example, micelle diameter, zeta potential, morphology, and drug content, were then evaluated. The results showed that the mean diameters of mPEG2K-SN38 and mPEG2K-PLA1.5K-SN38 micelles were ~130 and 20 nm, respectively. These two micelles had similar drug contents. mPEG2K-PLA1.5K-SN38 micelles were more homogeneous than mPEG2K-SN38 micelles. Moreover, in vitro drug release behavior of the micelles was studied by high performance liquid chromatography. SN38 release from mPEG2K-SN38 micelles was much faster than from mPEG2K-PLA1.5K-SN38 micelles. In vitro cytotoxicity, cellular uptake, and apoptosis assays of the SN38-polymer conjugate micelles were carried out on BEL-7402 human liver cancer cells. In vivo biodistribution and antitumor tumor efficacy studies were carried out in a nude mouse xenograft model derived from BEL-7402 cells. The results showed that mPEG2K-PLA1.5K-SN38 micelles were significantly more effective than mPEG2K-SN38 micelles in tumor inhibition, and the inhibitory effect of mPEG2K-PLA1.5K-SN38 micelles on tumor growth was significantly greater than that of mPEG2K-SN38 micelles (1,042 vs 1,837 mm) at 30 days. In conclusion, mPEG-PLA-SN38 is a promising anticancer agent that warrants further investigation.
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Affiliation(s)
- Jing Xie
- College of Life Sciences, Jilin University, Changchun, People's Republic of China
| | - Xiaomin Zhang
- Hangzhou PushiKang Biotechnology Co., Ltd, Hangzhou, People's Republic of China
| | - Meiyu Teng
- College of Life Sciences, Jilin University, Changchun, People's Republic of China
| | - Bo Yu
- Hangzhou PushiKang Biotechnology Co., Ltd, Hangzhou, People's Republic of China
| | - Shuang Yang
- College of Life Sciences, Jilin University, Changchun, People's Republic of China
| | - Robert J Lee
- College of Life Sciences, Jilin University, Changchun, People's Republic of China; Division of Pharmaceutics, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Lesheng Teng
- College of Life Sciences, Jilin University, Changchun, People's Republic of China
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68
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Kojcev R, Fuerst B, Zettinig O, Fotouhi J, Lee SC, Frisch B, Taylor R, Sinibaldi E, Navab N. Dual-robot ultrasound-guided needle placement: closing the planning-imaging-action loop. Int J Comput Assist Radiol Surg 2016; 11:1173-81. [DOI: 10.1007/s11548-016-1408-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/31/2016] [Indexed: 10/21/2022]
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69
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Chen JY, Luo YK, Cai SW, Ji WB, Yao M, Jiang K, Dong JH. Ultrasound-guided radiofrequency ablation of the segmental Glissonian pedicle: A new technique for anatomic liver resection. Surgery 2016; 159:802-9. [DOI: 10.1016/j.surg.2015.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 12/22/2022]
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70
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CT Appearance of Hepatocellular Carcinoma after Locoregional Treatments: A Comprehensive Review. Gastroenterol Res Pract 2015; 2015:670965. [PMID: 26798332 PMCID: PMC4700180 DOI: 10.1155/2015/670965] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/09/2015] [Accepted: 09/14/2015] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a major health problem worldwide, affecting more than 600,000 new patients per year. Curative treatments are available in a small percentage of patients, while most of them present in stages requiring locoregional treatments such as thermoablation, transarterial chemoembolization, and/or radioembolization. These therapies
result in specific imaging features that the general radiologist has to be aware of in order to assess the response to treatment and to correctly manage the follow-up of treated patients. Multiphasic helical computed tomography has become a popular imaging modality for detecting hypervascular tumors and characterizing liver lesions. On this basis, many staging and diagnostic systems have been proposed for evaluating response to all different existing strategies. Radiofrequencies and microwaves generate thermoablation of tumors, and transarterial chemoembolization exploits the double effect of the locoregional administration of drugs and embolizing particles. Eventually radioembolization uses a beta-emitting isotope to induce necrosis. Therefore, the aim of this comprehensive review is to analyze and compare CT imaging appearance of HCC after various locoregional treatments, with regard to specific indications for all possible procedures.
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71
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Silviu UB, Daniel P, Claudiu M, Săndulescu L, Simona F, Ştefan P, Valeriu Ş, Adrian S. Endoscopic ultrasound-guided radiofrequency ablation of the pancreas: An experimental study with pathological correlation. Endosc Ultrasound 2015; 4:330-5. [PMID: 26643702 PMCID: PMC4672592 DOI: 10.4103/2303-9027.170426] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: The treatment of pancreatic cancer represents a major objective in clinical research, as it still remains the fourth leading cause of cancer deaths among men and women, with approximately 6% of all cancer-related deaths. Materials and Methods: We studied the assessment of an endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) probe through a 19G needle in order to achieve a desirable necrosis area in the pancreas. Radiofrequency ablation of the head of the pancreas was performed on 10 Yorkshire pigs with a weight between 25 kg and 35 kg and a length of 40-70 cm. Using an EUS-guided RFA experimental probe, we ablated an area of 2-3 cm width. The biological samples were harvested after 3 days and 5 days and necropsy was performed 1 week after the procedure. Results: All pigs showed no significant change regarding their behavior and no signs of complication was encountered. Blood analysis revealed increased values of amylase, alkaline phosphatase, and gamma-glutamyl transpeptidase on the 3rd day but a decrease on the 5th day. After necropsy and isolation of the pancreas, the ablated area was easily found, describing a solid necrosis. The pathological examination revealed a coagulative necrosis area with minimal invasion and inflammatory tissue at about 2 cm surrounding the lesion. Conclusion: EUS-RFA is a feasible technique and might represent a promising therapy for the future treatment of pancreatic cancer. However, further studies are necessary to investigate EUS-guided RFA as an option for palliation in pancreatic cancer until it can be successfully used in human patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Săftoiu Adrian
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania; Department of Endoscopy, Gastrointestinal Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark,
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72
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Kim WW, Kim KH, Kim SH, Kim JS, Park SJ, Kim KH, Choi CS, Choi YK. Comparison of Hepatic Resection and Radiofrequency Ablation for the Treatment of Colorectal Liver Metastasis. Indian J Surg 2015; 77:1126-30. [PMID: 27011523 PMCID: PMC4775611 DOI: 10.1007/s12262-015-1211-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 01/05/2015] [Indexed: 12/11/2022] Open
Abstract
The liver is the major site of metastasis of primary colorectal cancer. Hepatic resection (HR) is considered the standard treatment for colorectal liver metastasis. In high-risk cases, radiofrequency ablation (RFA) can be attempted as an alternative treatment. This study compared the clinical profiles and overall and disease-free survival rates of patients with colorectal liver metastasis undergoing HR and RFA. From 1995 to 2009, we retrospectively analyzed clinical experiences of 43 and 17 patients who had undergone HR and RFA for primary colorectal cancer, respectively. To compare outcomes, we investigated the 3-year overall and disease-free survival rates. The 3-year overall survival rates of patients treated with HR and RFA were 53.5 and 47.1 %, respectively (p = 0.285); the disease-free survival rates were 35.0 and 26.9 %, respectively (p = 0.211). In the HR and RFA groups, 30 (60.2 %) and 13 (76.5 %) patients developed recurrence, respectively (p = 0.604). In the HR group, 1 patient died from postoperative liver failure, and 9 (20.9 %) developed postoperative complications, including wound infection, biliary leakage, intra-abdominal abscess, and pneumonia. In the RFA group, 1 patient (5.9 %) required prolonged inpatient care because of a procedure-related liver abscess. Although HR should be considered the first option for colorectal liver metastasis, RFA can be regarded as a primary treatment modality depending on the patient's characteristics, especially when a patient refuses surgery or has comorbidities.
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Affiliation(s)
- Woon-Won Kim
- />Department of Surgery, Haeundae Paik Hospital, University of Inje College of Medicine, 1435, Jwa-dong, Haeundae-gu, Busan, 612-030 South Korea
| | - Ki Hoon Kim
- />Department of Surgery, Haeundae Paik Hospital, University of Inje College of Medicine, 1435, Jwa-dong, Haeundae-gu, Busan, 612-030 South Korea
| | - Sam Hee Kim
- />Department of Surgery, Haeundae Paik Hospital, University of Inje College of Medicine, 1435, Jwa-dong, Haeundae-gu, Busan, 612-030 South Korea
| | - Jin Soo Kim
- />Department of Surgery, Haeundae Paik Hospital, University of Inje College of Medicine, 1435, Jwa-dong, Haeundae-gu, Busan, 612-030 South Korea
| | - Sung Jin Park
- />Department of Surgery, Haeundae Paik Hospital, University of Inje College of Medicine, 1435, Jwa-dong, Haeundae-gu, Busan, 612-030 South Korea
| | - Kwang Hee Kim
- />Busan Paik Hospital, University of Inje College of Medicine, Busan, South Korea
| | - Chang Su Choi
- />Busan Paik Hospital, University of Inje College of Medicine, Busan, South Korea
| | - Young Kil Choi
- />Busan Paik Hospital, University of Inje College of Medicine, Busan, South Korea
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73
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Wu S, Hou J, Ding Y, Wu F, Hu Y, Jiang Q, Mao P, Yang Y. Cryoablation Versus Radiofrequency Ablation for Hepatic Malignancies: A Systematic Review and Literature-Based Analysis. Medicine (Baltimore) 2015; 94:e2252. [PMID: 26656371 PMCID: PMC5008516 DOI: 10.1097/md.0000000000002252] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The aim of this study is to summarize and quantify the current evidence on the therapeutic efficacy of cryoablation compared with radiofrequency ablation (RFA) in patients with hepatic malignancies in a meta-analysis.Data were collected by searching PubMed, Scopus, and Cochrane databases for reports published up to May 26, 2015. Studies that reported data on comparisons of therapeutic efficacy of cryoablation and RFA were included. The random effects model was used to estimate the pooled relative risks of events comparing cryoablation to RFA for therapy of hepatic malignancies.Seven articles met the inclusion criteria and were included in the meta-analysis. The meta-analysis showed that there was no statistically significant difference in mortality of at least 6 months (odds ratio [OR] = 1.00, 95% confidence interval [CI]: 0.68-1.49) and local tumor progression according to both patients (OR = 1.64, 95% CI: 0.57-4.74) and tumors (OR = 1.81, 95% CI: 0.74-4.38) between cryoablation group and RFA group. However, the risk of complications was significantly higher in the cryoablation group than that in the RFA group (OR = 2.93, 95% CI: 1.15-7.46). When considering the specific complications, only thrombocytopenia (OR = 51.13, 95% CI: 2.92-894.21) and renal impairment (OR = 4.19, 95% CI: 1.34-13.11) but not other complications were significantly higher in the cryoablation group.In conclusion, the 2 methods had almost equal mortality and nonsignificant difference in local tumor progression, with higher risk of complications in cryoablation. Further large-scale, well-designed randomized controlled trials are needed to identify the current findings and investigate the long-term effects of cryoablation compared with RFA for therapy of hepatic malignancies.
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Affiliation(s)
- Shunquan Wu
- From the Research Center for Clinical and Translational Medicine, the 302nd Hospital of PLA, Beijing, China (SW, JH, YH, QJ, PM); Department of Medical Microbiology and Parasitology, Second Military Medical University, Shanghai, China (YD); Department of General Surgery, the 309th Hospital of PLA, Beijing, China (FW); Center of Therapeutic Research of Hepatocellular Carcinoma, the 302nd Hospital of PLA, Beijing, China (YY)
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74
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Misra SK, Ghoshal G, Gartia MR, Wu Z, De AK, Ye M, Bromfield CR, Williams EM, Singh K, Tangella KV, Rund L, Schulten K, Schook LB, Ray PS, Burdette EC, Pan D. Trimodal Therapy: Combining Hyperthermia with Repurposed Bexarotene and Ultrasound for Treating Liver Cancer. ACS NANO 2015; 9:10695-10718. [PMID: 26435333 PMCID: PMC4820022 DOI: 10.1021/acsnano.5b05974] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Repurposing of existing cancer drugs to overcome their physical limitations, such as insolubility, represents an attractive strategy to achieve enhanced therapeutic efficacy and broaden the range of clinical applications. Such an approach also promises to offer substantial cost savings in drug development efforts. Here we repurposed FDA-approved topical agent bexarotene (Targretin), currently in limited use for cutaneous manifestations of T-cell lymphomas, and re-engineer it for use in solid tumor applications by forming self-assembling nanobubbles. Physico-chemical characterization studies of the novel prodrug nanobubbles demonstrated their stability, enhanced target cell internalization capability, and highly controlled release profile in response to application of focused ultrasound energy. Using an in vitro model of hepatocellular carcinoma and an in vivo large animal model of liver ablation, we demonstrate the effectiveness of bexarotene prodrug nanobubbles when used in conjunction with catheter-based ultrasound, thereby highlighting the therapeutic promise of this trimodal approach.
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Affiliation(s)
- Santosh K. Misra
- Department of Bioengineering University of Illinois at Urbana-Champaign, USA
| | - Goutam Ghoshal
- Acoustic Med System, 208 Burwash Ave, Savoy, Illinois, USA
| | - Manas R. Gartia
- Department of Bioengineering University of Illinois at Urbana-Champaign, USA
| | - Zhe Wu
- Center for the Physics of Living Cells, Department of Physics, University of Illinois at Urbana-Champaign, Illinois, USA
| | - Arun K. De
- Department of Animal Sciences, University of Illinois, Champaign-Urbana, Illinois, USA
| | - Mao Ye
- Department of Bioengineering University of Illinois at Urbana-Champaign, USA
| | - Corinne R. Bromfield
- Agricultural Animal Care and Use Program, University of Illinois at Urbana-Champaign, Illinois, USA
| | | | - Kuldeep Singh
- Veterinary Diagnostic Laboratory, University of Illinois, Champaign-Urbana, Illinois, USA
| | | | - Laurie Rund
- Department of Animal Sciences, University of Illinois, Champaign-Urbana, Illinois, USA
| | - Klaus Schulten
- Beckman Institute of Advanced Science and Technology, University of Illinois at Urbana-Champaign, Illinois, USA
| | - Lawrence B. Schook
- Department of Bioengineering University of Illinois at Urbana-Champaign, USA
- Department of Animal Sciences, University of Illinois, Champaign-Urbana, Illinois, USA
| | - Partha S. Ray
- Department of Bioengineering University of Illinois at Urbana-Champaign, USA
- Beckman Institute of Advanced Science and Technology, University of Illinois at Urbana-Champaign, Illinois, USA
| | | | - Dipanjan Pan
- Department of Bioengineering University of Illinois at Urbana-Champaign, USA
- Beckman Institute of Advanced Science and Technology, University of Illinois at Urbana-Champaign, Illinois, USA
- Mills Breast Cancer Institute, Carle Foundation Hospital, 502 N. Busey, Urbana, Illinois, USA
- Department of Materials Science and Engineering, University of Illinois-Urbana Champaign, Illinois, USA
- Corresponding author: (UIUC) and (AMS)
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Morishita A, Sakamoto T, Kobara H, Tadokoro T, Ohura K, Fujita K, Tani J, Miyoshi H, Yoneyama H, Himoto T, Masaki T. Evaluation of in vivo efficacy of radiofrequency ablation with D-sorbitol in animal liver. Mol Clin Oncol 2015; 4:183-186. [PMID: 26893857 DOI: 10.3892/mco.2015.680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/12/2015] [Indexed: 11/06/2022] Open
Abstract
Percutaneous radiofrequency ablation (RFA) enables cauterization of liver cancer in a limited number of sessions without major complications. In contrast to the efficacy of this technique, the size of coagulation necrosis is limited due to increased impedance. D-sorbitol has been used as an irrigating fluid during transurethral resection of the prostate, since it is considered to be a dielectric fluid. In order to determine whether D-sorbitol enhances the effect of RFA, RFA was performed by slowly injecting 3% D-sorbitol near the tip of the RFA needle. The maximum of the total injected volume of D-sorbitol was 20 ml and RFA was terminated if the threshold of impedance was exceeded. RFA and D-sorbitol RFA were performed in 5 different parts of pig livers and dog livers in vivo. The total volumes of coagulation necrosis in the D-sorbitol RFA group were significantly higher compared with those in the RFA group. The total delivered energy in the D-sorbitol RFA group was also higher compared with that in the RFA group, due to the suppression of impedance elevation. No significant complications, such as bleeding or damage, were observed during the D-sorbitol RFA procedure in the in vivo model. In conclusion, RFA combined with D-sorbitol increases the total volume of coagulation necrosis through controlling impedance in the ablated liver and, therefore, D-sorbitol may be useful for the treatment of liver cancers.
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Affiliation(s)
- Asahiro Morishita
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, P.R. China
| | - Teppei Sakamoto
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, P.R. China
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, P.R. China
| | - Tomoko Tadokoro
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, P.R. China
| | - Kyoko Ohura
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, P.R. China
| | - Koji Fujita
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, P.R. China
| | - Joji Tani
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, P.R. China
| | - Hisaaki Miyoshi
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, P.R. China
| | - Hirohito Yoneyama
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, P.R. China
| | - Takashi Himoto
- Department of Medical Technology, Kagawa Prefectual University of Health Sciences, Takamatsu, Kagawa 761-0123, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, P.R. China
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Harari CM, Magagna M, Bedoya M, Lee FT, Lubner MG, Hinshaw JL, Ziemlewicz T, Brace CL. Microwave Ablation: Comparison of Simultaneous and Sequential Activation of Multiple Antennas in Liver Model Systems. Radiology 2015; 278:95-103. [PMID: 26133361 DOI: 10.1148/radiol.2015142151] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare microwave ablation zones created by using sequential or simultaneous power delivery in ex vivo and in vivo liver tissue. MATERIALS AND METHODS All procedures were approved by the institutional animal care and use committee. Microwave ablations were performed in both ex vivo and in vivo liver models with a 2.45-GHz system capable of powering up to three antennas simultaneously. Two- and three-antenna arrays were evaluated in each model. Sequential and simultaneous ablations were created by delivering power (50 W ex vivo, 65 W in vivo) for 5 minutes per antenna (10 and 15 minutes total ablation time for sequential ablations, 5 minutes for simultaneous ablations). Thirty-two ablations were performed in ex vivo bovine livers (eight per group) and 28 in the livers of eight swine in vivo (seven per group). Ablation zone size and circularity metrics were determined from ablations excised postmortem. Mixed effects modeling was used to evaluate the influence of power delivery, number of antennas, and tissue type. RESULTS On average, ablations created by using the simultaneous power delivery technique were larger than those with the sequential technique (P < .05). Simultaneous ablations were also more circular than sequential ablations (P = .0001). Larger and more circular ablations were achieved with three antennas compared with two antennas (P < .05). Ablations were generally smaller in vivo compared with ex vivo. CONCLUSION The use of multiple antennas and simultaneous power delivery creates larger, more confluent ablations with greater temperatures than those created with sequential power delivery.
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Affiliation(s)
- Colin M Harari
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - Michelle Magagna
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - Mariajose Bedoya
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - Fred T Lee
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - Meghan G Lubner
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - J Louis Hinshaw
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - Timothy Ziemlewicz
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - Christopher L Brace
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
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Intraductal Cooling via a Nasobiliary Tube During Radiofrequency Ablation of Central Liver Tumors Reduces Biliary Injuries. AJR Am J Roentgenol 2015; 204:1329-35. [DOI: 10.2214/ajr.14.13788] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
OPINION STATEMENT When possible, surgical resection remains the "gold standard" for the treatment of hepatic colorectal metastases. Liver resection should be considered when complete removal of all macroscopic disease can be achieved safely. For those patients with unresectable metastases, or when a patient may not be a candidate for liver resection, many choices are available to the clinician in an attempt to achieve locoregional control, including tumor ablation, intra-arterial therapies, and radiation therapy. Whereas with surgical resection, durable local control can be considered potentially curable, other liver-directed approaches currently are mostly palliative. Ongoing trials are being undertaken to evaluate the role of such cytoreductive therapies. During the initial evaluation of any patient who might be a candidate for liver-directed therapy, particularly when the intent may be curative, complete assessment with high-quality imaging should be done before any therapy to determine the full extent of disease. Most importantly, the establishment of a multidisciplinary team upon initial diagnosis can optimize the choice and sequencing of the various systemic and locoregional choices available to the colorectal cancer patient.
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Affiliation(s)
- Michael A Choti
- Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9031, USA,
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Naya Y, Nakamura T, Oishi M, Ueda T, Nakanishi H, Naitoh Y, Hongo F, Kamoi K, Okihara K, Tanaka O, Yamagami T, Yamada K, Miki T. The efficacy of radio-frequency ablation for metastatic lung or liver tumors of male germ cell tumors as an alternative minimally invasive therapy after salvage chemotherapy. Int J Clin Oncol 2015; 20:1192-7. [PMID: 25924698 DOI: 10.1007/s10147-015-0824-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/20/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to assess the efficacy of radio-frequency ablation (RFA) for metastatic lung or liver tumors of germ cell tumors (GCTs) after chemotherapy. METHODS RFA with computed tomography guidance and monitoring was performed in 24 patients with 48 metastatic lung or liver tumors of GCTs. Group A consisted of 9 patients with tumor marker normalization after salvage chemotherapy and group B consisted of 15 patients without tumor marker normalization in spite ofintensive treatment. RESULTS Out of 48 tumors, 41 tumors in 21 patients were evaluated for the efficacy of the RFA treatment. Of the 41 tumors, successful ablation was achieved in 34 (82.9 %). The patients in group A had significantly better survival than the patients in group B (p = 0.0003). In group A, all 9 patients are still alive with no evidence of disease (NED). Patients with a solitary tumor had significantly better survival than those with multiple tumors (p = 0.0247). In group B, 2 patients are alive with NED, 1 patient is alive with disease, and the remaining 12 patients have died a tumor-related death. Three cases of pneumothorax requiring intubation were observed. CONCLUSIONS RFA is less invasive than surgery and is an effective treatment option for curative and palliative therapy as an alternative to invasive salvage surgery for post-chemotherapeutic metastatic lung or liver lesions from GCT.
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Affiliation(s)
- Yoshio Naya
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Terukazu Nakamura
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Masakatsu Oishi
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takashi Ueda
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hiroyuki Nakanishi
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yasuyuki Naitoh
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Fumiya Hongo
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazumi Kamoi
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Koji Okihara
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Tanaka
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuji Yamagami
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kei Yamada
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsuneharu Miki
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Kamat S, Chawla S, Rajendram P, Pastores SM, Kostelecky N, Halpern NA. An analysis of patients transferred to a tertiary oncological intensive care unit for defined procedures. Am J Crit Care 2015; 24:241-7. [PMID: 25934721 DOI: 10.4037/ajcc2015174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Up to 50 000 intensive care unit interhospital transfers occur annually in the United States. OBJECTIVE To determine the prevalence, characteristics, and outcomes of cancer patients transferred from an intensive care unit in one hospital to another intensive care unit at an oncological center and to evaluate whether interventions planned before transfer were performed. METHODS Data on transfers for planned interventions from January 2008 through December 2012 were identified retrospectively. Demographic and clinical variables, receipt of planned interventions, and outcome data were analyzed. RESULTS Of 4625 admissions to an intensive care unit at the oncological center, 143 (3%) were transfers from intensive care units of other hospitals. Of these, 47 (33%) were transfers for planned interventions. Patients' mean age was 57 years, and 68% were men. At the time of intensive care unit transfer, 20 (43%) were receiving mechanical ventilation. Interventions included management of airway (n = 19) or gastrointestinal (n = 2) obstruction, treatment of tumor bleeding (n = 12), chemotherapy (n = 10), and other (n = 4). A total of 37 patients (79%) received the planned interventions within 48 hours of intensive care unit arrival; 10 (21%) did not because their signs and symptoms abated. Median intensive care unit and hospital lengths of stay at the oncological center were 4 and 13 days, respectively. Intensive care unit and hospital mortality rates were 11% and 19%, respectively. Deaths occurred only in patients who received interventions. CONCLUSIONS Interhospital transfers of cancer patients to an intensive care unit at an oncological center are infrequent but are most commonly done for direct interventional care. Most patients received planned interventions soon after transfer.
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Affiliation(s)
- Sunil Kamat
- At the time of this study Sunil Kamat and Prabalini Rajendram were fellows, Sanjay Chawla is an assistant attending physician, Stephen M. Pastores is the critical care fellowship program director, Natalie Kostelecky is a research nurse, and Neil A. Halpern is the chief, Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sanjay Chawla
- At the time of this study Sunil Kamat and Prabalini Rajendram were fellows, Sanjay Chawla is an assistant attending physician, Stephen M. Pastores is the critical care fellowship program director, Natalie Kostelecky is a research nurse, and Neil A. Halpern is the chief, Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Prabalini Rajendram
- At the time of this study Sunil Kamat and Prabalini Rajendram were fellows, Sanjay Chawla is an assistant attending physician, Stephen M. Pastores is the critical care fellowship program director, Natalie Kostelecky is a research nurse, and Neil A. Halpern is the chief, Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen M. Pastores
- At the time of this study Sunil Kamat and Prabalini Rajendram were fellows, Sanjay Chawla is an assistant attending physician, Stephen M. Pastores is the critical care fellowship program director, Natalie Kostelecky is a research nurse, and Neil A. Halpern is the chief, Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Natalie Kostelecky
- At the time of this study Sunil Kamat and Prabalini Rajendram were fellows, Sanjay Chawla is an assistant attending physician, Stephen M. Pastores is the critical care fellowship program director, Natalie Kostelecky is a research nurse, and Neil A. Halpern is the chief, Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Neil A. Halpern
- At the time of this study Sunil Kamat and Prabalini Rajendram were fellows, Sanjay Chawla is an assistant attending physician, Stephen M. Pastores is the critical care fellowship program director, Natalie Kostelecky is a research nurse, and Neil A. Halpern is the chief, Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Ramalho M, AlObaidy M, Burke LM, Dale BM, Gerber DA, Wong TZ, Semelka RC. MR-PET evaluation of 1-month post-ablation therapy for hepatocellular carcinoma: preliminary observations. ACTA ACUST UNITED AC 2015; 40:1405-14. [PMID: 25906343 DOI: 10.1007/s00261-015-0436-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the feasibility and protocol optimization of whole-body hybrid MR-PET system performed 1-month after post-locoregional thermoablative procedures for hepatocellular carcinomas (HCCs). MATERIALS AND METHODS Eight patients (6 men and 2 women; mean age, 56.6 ± 5.5 years) with 9 ablated HCCs constituted our study population. Three readers interpreted the studies to determine the presence or absence of residual malignancy. Two readers independently assessed the fused MR-PET images to compare registration accuracy of two types of T2-weighted (triggered T2 half-Fourier acquisition single-shot turbo spin-echo and turbo spin-echo) and T1-weighted [Cartesian and radial 3D gradient echo (GRE)]. Image quality evaluation of both 3D-GRE T1-weighted sequences was evaluated. Kappa statistics were used to measure inter-observer agreement. Non-parametric Kruskal-Wallis and Wilcoxon signed-rank tests were used for qualitative data analysis. RESULTS Definite residual tumor was observed in 3/9 ablations; two were PET positive. All residual tumors were isovascular on MRI. Radial 3D-GRE demonstrated significantly superior MR-PET subjective co-registration in comparison with the remaining sequences and showed a non-significant trend toward higher image quality scores than Cartesian GRE. CONCLUSION Whole-body hybrid MR-PET is feasible as a part of 1-month follow-up post-locoregional thermoablative treatment for HCC. Radial 3D-GRE offers improved co-registration with PET data, with overall good image quality.
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Affiliation(s)
- Miguel Ramalho
- Department of Radiology, University Of North Carolina at Chapel Hill, CB 7510, 2001 Old Clinic Bldg., Chapel Hill, NC, 7599-7510, USA
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Shin SW, Jeong WK, Lim S, Kim Y, Kim J. Alteration of laboratory findings after radiofrequency ablation of hepatocellular carcinoma: relationship to severity of the underlying liver disease and the ablation volume. Clin Mol Hepatol 2015; 21:71-9. [PMID: 25834804 PMCID: PMC4379200 DOI: 10.3350/cmh.2015.21.1.71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND/AIMS To investigate sequential changes in laboratory markers after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) and the relationship of these changes to the severity of the underlying liver disease. METHODS This retrospective analysis included 65 patients (44 males, 21 females) who underwent RFA of HCC. Hematologic and biochemical markers were assessed at the pre-RFA period and 1 day, 2-3 days, and 1-2 weeks after RFA. We classified the subjects into two groups: Child-Pugh A (n=41) and Child-Pugh B (n=24). The ablative margin volume (AMV) of each patient was measured. We analyzed the changes in laboratory profiles from the baseline, and investigated whether these laboratory changes were correlated with the AMV and the Child-Pugh classification. RESULTS Most of the laboratory values peaked at 2-3 days after RFA. AMV was significantly correlated with changes in WBC count, hemoglobin level, and serum total bilirubin level (Pearson's correlation coefficient, 0.324-0.453; P<0.05). The alanine aminotransferase (ALT) level varied significantly over time (P=0.023). CONCLUSIONS Most of the measured laboratory markers changed from baseline, peaking at 2-3 days. The ALT level was the only parameter for which there was a significant difference after RFA between Child-Pugh A and B patients: it increased significantly more in the Child-Pugh A patients.
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Affiliation(s)
- Sang-Wook Shin
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Woo Kyoung Jeong
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea. ; Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Sanghyeok Lim
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Yongsoo Kim
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Jinoo Kim
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea. ; Department of Radiology, Ajou University Hospital, Ajou University College of Medicine, Suwon, Korea
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Multipolar radiofrequency ablation for colorectal liver metastases close to major hepatic vessels. Surgeon 2015; 13:77-82. [DOI: 10.1016/j.surge.2013.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/27/2013] [Accepted: 11/06/2013] [Indexed: 01/23/2023]
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Huang H, Liang P, Yu XL, Cheng ZG, Han ZY, Yu J, Liu FY. Safety assessment and therapeutic efficacy of percutaneous microwave ablation therapy combined with percutaneous ethanol injection for hepatocellular carcinoma adjacent to the gallbladder. Int J Hyperthermia 2015; 31:40-7. [PMID: 25766386 DOI: 10.3109/02656736.2014.999017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE This study sought to evaluate the safety and efficacy of ultrasound-guided (US-guided) percutaneous microwave (MW) ablation combined with percutaneous ethanol injection (PEI) to treat liver tumours adjacent to the gallbladder. MATERIALS AND METHODS A total of 136 patients with hepatocellular carcinoma (HCC) adjacent to the gallbladder, who underwent ultra-sonographically-guided percutaneous MW ablation, which was combined with PEI in 132 patients, were retrospectively assessed. The patient population characteristics, tumour features, local tumour progression and treatment were compared and analysed. The safety and efficacy of the therapy were assessed by clinical data and imaging in follow-up examinations. RESULTS All patients were completely treated with two sessions; 120 patients underwent one session, 16 patients underwent two sessions. The primary technique was effective in 95.6% of the cases, according to the computed tomography (CT) or magnetic resonance imaging (MRI) in the one-month follow-up (132 of 138 sessions). PEI and other therapies were performed in the patients who had been incompletely treated (all six patients underwent PEI, and some underwent other therapies, including one transcatheter arterial chemoembolisation (TACE), one liver transplantation and two liver resections). There was a median follow-up period of 30.1 months and a range of 4 to 68 months. None of the patients had major complications. There were no treatment-related deaths. Twenty-six patients died of primary disease progression that was not directly attributable to MW ablation (19.1%, 26/136). Local tumour progression was noted in five patients (3.7%, 5/136), who had completely ablated tumours at follow-up. The patients with locally progressing tumours underwent additional therapy (three patients underwent PEI, one patient TACE, and one liver resection). CONCLUSION Ultrasound-guided percutaneous MW ablation, in combination with percutaneous ethanol injection and thermal monitoring, is a safe and effective treatment for HCC adjacent to the gallbladder.
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Affiliation(s)
- Hui Huang
- Department of Interventional Ultrasound, Chinese PLA General Hospital , Beijing , China
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Bimonte S, Barbieri A, Palaia R, Leongito M, Albino V, Piccirillo M, Arra C, Izzo F. An overview of loco-regional treatments in patients and mouse models for hepatocellular carcinoma. Infect Agent Cancer 2015; 10:9. [PMID: 25755676 PMCID: PMC4353675 DOI: 10.1186/s13027-015-0004-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 02/20/2015] [Indexed: 12/20/2022] Open
Abstract
Hepatocellular carcinoma is a highly aggressive malignancy and is the third leading cause of cancer-related deaths worldwide. Although surgery is currently considered the most effective curative treatment for this type of cancer, it is note that most of patients have a poor prognosis due to chemioresistence and tumor recurrence. Loco-regional therapies, including radiofrequency ablation, surgical resection and transcatheter arterial chemoembolization play a major role in the clinical management of hepatocellular carcinoma. In order to improve the treatment outcome of patients diagnosed with this disease, several in vivo studies by using different techniques on cancer mouse models have been performed. This review will focus on the latest papers on the efficacy of loco-regional therapy and combined treatments in patients and mouse models of hepatocellular carcinoma.
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Affiliation(s)
- Sabrina Bimonte
- Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Antonio Barbieri
- INT Facility, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Raffaele Palaia
- Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Maddalena Leongito
- Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Vittorio Albino
- Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Mauro Piccirillo
- Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Claudio Arra
- INT Facility, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Francesco Izzo
- Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
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Zhou Z, Wu S, Wang CY, Ma HY, Lin CC, Tsui PH. Monitoring radiofrequency ablation using real-time ultrasound Nakagami imaging combined with frequency and temporal compounding techniques. PLoS One 2015; 10:e0118030. [PMID: 25658424 PMCID: PMC4320093 DOI: 10.1371/journal.pone.0118030] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 12/29/2014] [Indexed: 01/01/2023] Open
Abstract
Gas bubbles induced during the radiofrequency ablation (RFA) of tissues can affect the detection of ablation zones (necrosis zone or thermal lesion) during ultrasound elastography. To resolve this problem, our previous study proposed ultrasound Nakagami imaging for detecting thermal-induced bubble formation to evaluate ablation zones. To prepare for future applications, this study (i) created a novel algorithmic scheme based on the frequency and temporal compounding of Nakagami imaging for enhanced ablation zone visualization, (ii) integrated the proposed algorithm into a clinical scanner to develop a real-time Nakagami imaging system for monitoring RFA, and (iii) investigated the applicability of Nakagami imaging to various types of tissues. The performance of the real-time Nakagami imaging system in visualizing RFA-induced ablation zones was validated by measuring porcine liver (n = 18) and muscle tissues (n = 6). The experimental results showed that the proposed algorithm can operate on a standard clinical ultrasound scanner to monitor RFA in real time. The Nakagami imaging system effectively monitors RFA-induced ablation zones in liver tissues. However, because tissue properties differ, the system cannot visualize ablation zones in muscle fibers. In the future, real-time Nakagami imaging should be focused on the RFA of the liver and is suggested as an alternative monitoring tool when advanced elastography is unavailable or substantial bubbles exist in the ablation zone.
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Affiliation(s)
- Zhuhuang Zhou
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Shuicai Wu
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
- * E-mail: (PHT); (SW)
| | - Chiao-Yin Wang
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiang-Yang Ma
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Chih Lin
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- * E-mail: (PHT); (SW)
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88
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Characterization of the biliary tract by virtual ultrasonography constructed by gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging. J Med Ultrason (2001) 2014; 42:185-93. [DOI: 10.1007/s10396-014-0598-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/13/2014] [Indexed: 11/27/2022]
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89
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Desolneux G, Vara J, Razafindratsira T, Isambert M, Brouste V, McKelvie-Sebileau P, Evrard S. Patterns of complications following intraoperative radiofrequency ablation for liver metastases. HPB (Oxford) 2014; 16:1002-8. [PMID: 24830798 PMCID: PMC4487751 DOI: 10.1111/hpb.12274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/07/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intraoperative radiofrequency ablation (IRFA) is added to surgery to obtain hepatic clearance of liver metastases. Complications occurring in IRFA should differ from those associated with wedge or anatomic liver resection. METHODS Patients with liver metastases treated with IRFA from 2000 to 2010 were retrospectively analysed. Postoperative outcomes are reported according to the Clavien-Dindo system of classification. RESULTS A total of 151 patients underwent 173 procedures for 430 metastases. Of these, 97 procedures involved IRFA plus liver resection and 76 involved IRFA only. The median number of lesions treated by IRFA was two (range: 1-11). A total of 123 (71.1%) procedures were carried out in patients who had received preoperative chemotherapy. The mortality rate was 1.2%. Thirty (39.5%) IRFA-only patients and 45 (46.4%) IRFA-plus-resection patients presented complications. Immediate complications (n = 4) were associated with IRFA plus resection. American Society of Anesthesiologists (ASA) class, previous abdominal surgery or hepatic resection, body mass index, number of IRFA procedures, portal pedicle clamping, total vascular exclusion and preoperative chemotherapy were not associated with a greater number of complications of Grade III or higher severity. Length of surgery >4 h [odds ratio (OR) 2.67, 95% confidence interval (CI) 1.1-6.3; P < 0.05] and an associated contaminating procedure (OR 3.72, 95% CI 1.53-9.06; P < 0.005) led to a greater frequency of complications of Grade III or higher. CONCLUSIONS Mortality and morbidity after IRFA, with or without resection, are low. Nevertheless, long interventions and concurrent bowel operations increase the risk for septic complications.
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Affiliation(s)
| | - Jeremy Vara
- Digestive Tumour Unit, Institut BergoniéBordeaux, France
| | | | | | - Véronique Brouste
- Clinical and Epidemiological Research Unit, Institut BergoniéBordeaux, France
| | | | - Serge Evrard
- Digestive Tumour Unit, Institut BergoniéBordeaux, France,University of BordeauxBordeaux, France,Correspondence, Serge Evrard, Digestive Tumour Unit, Institut Bergonié, 229 Cours de l’Argonne, 33076 Bordeaux, France. Tel: + 33 5 56 33 32 61. Fax: + 33 5 56 33 33 83. E-mail:
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90
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Zhou Z, Wu W, Wu S, Xia J, Wang CY, Yang C, Lin CC, Tsui PH. A survey of ultrasound elastography approaches to percutaneous ablation monitoring. Proc Inst Mech Eng H 2014; 228:1069-82. [DOI: 10.1177/0954411914554438] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Percutaneous thermal ablation has been widely used as a minimally invasive treatment for tumors. Treatment monitoring is essential for preventing complications while ensuring treatment efficacy. Mechanical testing measurements on tissue reveal that tissue stiffness increases with temperature and ablation duration. Different types of imaging methods can be used to monitor ablation procedures, including temperature or thermal strain imaging, strain imaging, modulus imaging, and shear modulus imaging. Ultrasound elastography demonstrates the potential to become the primary imaging modality for monitoring percutaneous ablation. This review briefly presented the state-of-the-art ultrasound elastography approaches for monitoring radiofrequency ablation and microwave ablation. These techniques were divided into four groups: quasi-static elastography, acoustic radiation force elastography, sonoelastography, and applicator motion elastography. Their advantages and limitations were compared and discussed. Future developments were proposed with respect to heat-induced bubbles, tissue inhomogeneities, respiratory motion, three-dimensional monitoring, multi-parametric monitoring, real-time monitoring, experimental data center for percutaneous ablation, and microwave ablation monitoring.
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Affiliation(s)
- Zhuhuang Zhou
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Weiwei Wu
- College of Electronic Information and Control Engineering, Beijing University of Technology, Beijing, China
| | - Shuicai Wu
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Jingjing Xia
- School of Electronic Information Engineering, Tianjin University, Tianjin, China
| | - Chiao-Yin Wang
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chunlan Yang
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Chung-Chih Lin
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Medical Image Research Center, Institute for Radiological Research, Chang Gung University, Taoyuan, Taiwan
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Narayanan G, Bhatia S, Echenique A, Suthar R, Barbery K, Yrizarry J. Vessel patency post irreversible electroporation. Cardiovasc Intervent Radiol 2014; 37:1523-9. [PMID: 25212418 DOI: 10.1007/s00270-014-0988-9] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 07/26/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of the study was to evaluate the effect of Irreversible Electroporation (IRE) on vessel patency in close proximity to the ablation zone. MATERIALS AND METHODS Between January 2010 and November 2013, 101 patients underwent percutaneous IRE procedures using the NanoKnife for primary and metastatic tumors in different organs. Age ranged from 24 to 83 years. A total of 129 lesions were treated. [liver (100), pancreas (18), kidney (3), pelvis (1), aorto-caval lymph nodes (2), adrenal (2), lung (1), retroperitoneal (1), surgical bed of a prior Whipple procedure (1)]. Post treatment contrast-enhanced CT and MRI scans were reviewed to evaluate caliber, patency, and flow defects of vessels in close proximity to the ablation zone (defined as vessels within 0-1 cm from the treatment zone). RESULTS A total of 158 vessels were examined for patency on follow-up. The mean distance of the vessel from the treatment zone was 2.3 ± 2.5 mm. Ten vessels within the treatment zone were encased by tumor. Mean tumor size was 2.7 + 1.5 cm. Overall mean follow-up was 10.3 months. Abnormal vascular changes were noted in 7 of 158 (4.4%) vessels. No significant association was found between distances from the treatment zone and presence of narrowing/thrombosis at the follow-up imaging. (Mann-Whitney U, p = 0.772; logistic regression: p = 0.593; odds ratio: 0.908; CI 0.637-1.294). CONCLUSION This study demonstrates safety of IRE for the treatment of tumors near the large blood vessels and tumors already encasing the vessels. Further studies to substantiate these findings are essential to validate this crucial advantage of IRE.
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Affiliation(s)
- Govindarajan Narayanan
- Department of Radiology, University of Miami-Miller School of Medicine, 1475 N.W. 12 Avenue, Miami, FL, 33136, USA,
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Hamza A, Elrefaey S. Non-surgical treatment of early breast cancer: techniques on the way. Gland Surg 2014; 3:149-50. [PMID: 25207205 DOI: 10.3978/j.issn.2227-684x.2013.10.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 10/28/2013] [Indexed: 11/14/2022]
Abstract
Trials are still on the way to evaluate different non-surgical techniques to treat early breast cancer with achieving maximum oncological control and aesthetic outcome. Also these techniques can help old patients to bypass surgical and radiation complications and facilitate the treatment of early breast cancer with minimum side effects.
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Affiliation(s)
- Alaa Hamza
- 1 General Surgery Department, Medical Research Institute, Alexandria University, Egypt ; 2 Division of Plastic Surgery, European Institute of Oncology, 435-20141 Milano, Italy ; 3 Faculity of medicine, Alexandria University, Egypt
| | - Shymaa Elrefaey
- 1 General Surgery Department, Medical Research Institute, Alexandria University, Egypt ; 2 Division of Plastic Surgery, European Institute of Oncology, 435-20141 Milano, Italy ; 3 Faculity of medicine, Alexandria University, Egypt
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Spliethoff JW, Tanis E, Evers DJ, Hendriks BHW, Prevoo W, Ruers TJM. Monitoring of tumor radio frequency ablation using derivative spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:97004. [PMID: 25239499 DOI: 10.1117/1.jbo.19.9.097004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/22/2014] [Indexed: 05/15/2023]
Abstract
Despite the widespread use of radio frequency (RF) ablation, an effective way to assess thermal tissue damage during and after the procedure is still lacking. We present a method for monitoring RF ablation efficacy based on thermally induced methemoglobin as a marker for full tissue ablation. Diffuse reflectance (DR) spectra were measured from human blood samples during gradual heating of the samples from 37 to 60, 70, and 85°C. Additionally, reflectance spectra were recorded real-time during RF ablation of human liver tissue ex vivo and in vivo. Specific spectral characteristics of methemoglobin were extracted from the spectral slopes using a custom optical ablation ratio. Thermal coagulation of blood caused significant changes in the spectral slopes, which is thought to be caused by the formation of methemoglobin. The time course of these changes was clearly dependent on the heating temperature. RF ablation of liver tissue essentially led to similar spectral alterations. In vivo DR measurements confirmed that the method could be used to assess the degree of thermal damage during RF ablation and long after the tissue cooled.
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Affiliation(s)
- Jarich W Spliethoff
- The Netherlands Cancer Institute, Department of Surgery, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands
| | - Erik Tanis
- The Netherlands Cancer Institute, Department of Surgery, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands
| | - Daniel J Evers
- The Netherlands Cancer Institute, Department of Surgery, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands
| | - Benno H W Hendriks
- Minimally Invasive Healthcare, Philips Research, High Tech Campus 34, Eindhoven 5656 AE, The Netherlands
| | - Warner Prevoo
- The Netherlands Cancer Institute, Department of Radiology, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands
| | - Theo J M Ruers
- The Netherlands Cancer Institute, Department of Surgery, Plesmanlaan 121, Amsterdam 1066CX, The NetherlandsdUniversity of Twente, MIRA Institute, Building Zuidhorst P.O. Box 217, Enschede 7500 AE, The Netherlands
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Xu RH, Gao W, Wang C, Guo DK, Tang L, Zhang H, Wang CJ. Systematic evaluation of percutaneous radiofrequency ablation versus percutaneous ethanol injection for the treatment of small hepatocellular carcinoma: a meta-analysis. Eur J Med Res 2014; 19:39. [PMID: 25141776 PMCID: PMC4237813 DOI: 10.1186/2047-783x-19-39] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/24/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) have been used for patients with hepatocellular carcinoma (HCC). However, which therapy is superior remains to be further elucidated. We aimed to conduct a systematic review to assess survival and local tumor recurrence rate with RFA compared with PEI therapy for HCC. METHODS We conducted systematic review and meta-analysis of randomized controlled trials (RCTs) published up to 2014 in PubMed, MEDLINE, EMBASE, EBSCO, Springer, Ovid and the Cochrane library. Only RCTs that evaluated survival rate and occurrence of HCC between RFA and PEI therapy were included. The OR (odds ratio) with a 95% confidence interval (CI) was calculated by the Revman 5.0 software. RESULTS A total of six studies including 983 HCC patients were eligible for this analysis. The survival rate showed a significant benefit under RFA therapy over PEI at 1-year (P = 0.02, OR = 1.88, 95% CI: 1.09 to 3.22), 2-years (P = 0.0003, OR = 2.06, 95% CI: 1.39 to 3.05) and 3-years (P = 0.0007, OR = 1.68, 95% CI: 1.25 to 2.27). Likewise, RFA achieved significantly lower rates of local tumor recurrence over PEI at 1-year (P = 0.002, OR = 0.43, 95% CI: 0.26 to 0.73), 2-year (P = 0.03, OR = 0.33, 95% CI: 0.12 to 0.88) and 3-year (P = 0.003, OR = 0.61, 95% CI: 0.43 to 0.84). CONCLUSIONS The current evidence suggests that RFA is superior to PEI in better survival and local disease control for small HCCs <5 cm in diameter and that RFA is worthy of promotion in clinical applications.
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Affiliation(s)
| | | | | | | | | | - Hui Zhang
- Department of Hepatobiliary and Pancreatic Diseases, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Pudong New District, Shanghai 200120, China.
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Shimonov M, Ezri T, Blecher M, Cherniak A, Azamfirei L. Hemodynamic effects of sevoflurane versus propofol anesthesia for laparoscopic radiofrequency ablation of liver tumors. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2006.10872456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wang KF, Pan W, Wang F, Wang GF, Madhava P, Pan HM, Kong DX, Liu XG. Geometric optimization of a mathematical model of radiofrequency ablation in hepatic carcinoma. Asian Pac J Cancer Prev 2014; 14:6151-8. [PMID: 24289641 DOI: 10.7314/apjcp.2013.14.10.6151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Radio frequency ablation (RFA) is an effective means of achieving local control of liver cancer. It is a particularly suitable mode of therapy for small and favorably located tumors. However, local progression rates are substantially higher for large tumors (>3.0 cm). In the current study, we report on a mathematical model based on geometric optimization to treat large liver tumors. A database of mathematical models relevant to the configuration of liver cancer was also established. The specific placement of electrodes and the frequency of ablation were also optimized. In addition, three types of liver cancer lesion were simulated by computer guidance incorporating mathematical models. This approach can be expected to provide a more effective and rationale mechanism for employing RFA in the therapy of hepatic carcinoma.
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Affiliation(s)
- Kai-Feng Wang
- Department of Oncology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China E-mail : ,
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Thandassery RB, Goenka U, Goenka MK. Role of local ablative therapy for hepatocellular carcinoma. J Clin Exp Hepatol 2014; 4:S104-11. [PMID: 25755601 PMCID: PMC4284241 DOI: 10.1016/j.jceh.2014.03.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 03/03/2014] [Indexed: 02/08/2023] Open
Abstract
Percutaneous local ablation (PLA) techniques are currently considered as the best treatment option for patients with early-stage hepatocellular carcinoma (HCC) who are not candidates for surgical resection. They are safe, minimally invasive, efficacious and cost-effective. Radiofrequency ablation (RFA) is considered as the first line treatment in some centers, though most of the guidelines recommend it for small HCCs, where surgical resection is not feasible. In developing countries percutaneous ethanol injection (PEI) and percutaneous acetic acid injection (PAI) may be used instead of RFA. For large HCCs, advances in electrode designs and newer techniques of ablation, including microwave ablation, are increasingly been used. Combination treatment modalities have shown promising results as compared to single modality for large tumors. The selection of the most appropriate modality depends on the size, number of lesions, the liver function status, patient's financial resources, availability of a particular technique and the expertise available.
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Affiliation(s)
| | | | - Mahesh K. Goenka
- Address for correspondence: Mahesh Kumar Goenka, Institute of Gastroscience, Apollo Gleneagles Hospital, Kolkata, West Bengal, India. Tel.: +91 9830040599 (mobile).
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98
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Lee HY, Ko HK, Kim SH, Lee KS, Ro J, Park IH. Percutaneous radiofrequency ablation for liver metastases in breast cancer patients. Breast J 2014; 19:563-5. [PMID: 24073730 DOI: 10.1111/tbj.12170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Ha Yeon Lee
- Department of Hematology and Oncology, KyungHee University Hospital at Gandong
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Forauer AR, Dewey BJ, Seigne JD. Cancer-free survival and local tumor control after impendence-based radiofrequency ablation of biopsy-proven renal cell carcinomas with a minimum of 1-year follow-up. Urol Oncol 2014; 32:869-76. [PMID: 24946958 DOI: 10.1016/j.urolonc.2014.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 02/20/2014] [Accepted: 03/19/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVES There are numerous reports describing the use of radiofrequency ablation (RFA) to treat renal cell carcinoma. Many series, however, describe heterogeneous populations, lack histologic descriptions, use various RFA systems, and indicate tumor destruction by different ablation end points. This study examined the outcomes of computed tomography-guided, impedance-based RFA of biopsy-proven renal cell carcinoma clinically staged as T1a with a minimum of 1 year of postablation follow-up. METHODS AND MATERIALS This retrospective study identified all consecutive patients who had undergone renal RFA since May 2005 at our institution. Patients without biopsy-proven renal cell carcinoma (RCCa) were excluded. Of the patients who met these criteria, evaluation was limited to patients with a minimum of 12 months of follow-up. Data collected from the patients' electronic medical and radiologic records included demographic data, tumor-related data, procedural details, and clinical follow-up visits. RESULTS A total of 39 patients (46 lesions) met the inclusion criteria. The mean tumor diameter was 2.6 cm (range: 1.2-4.0 cm). The most common histologies were clear cell (n = 27) and papillary (n = 16) renal cancer. The lesion location was equally divided between upper pole (n = 16), middle pole (n = 16), and lower pole (n = 14). Overall, 83% of the tumors were exophytic. No residual or recurrent enhancing mass was identified in the ablation bed on post-RFA imaging during the mean follow-up period of 35.3 months (range: 12-83). All patients were treated in a single encounter and no lesion required a second ablation; technical success (absence of residual tumor) on the initial post-RFA imaging study was 46 of 46 (100%). Clinical success was achieved in 45 of 46 lesions (98%); residual, viable tumor was found in a pretransplant nephrectomy specimen on postprocedure day 127. The mean cancer-free survival was 36.2 months. Comparison of preablation and postablation renal function found no statistically significant change. CONCLUSIONS The consistent outcomes in our post-RFA imaging and clinical surveillance allow us to offer image-guided ablation to patients with T1a RCCa as a valid treatment option offering long-term cancer-free survival. Impedance-based RFA in a carefully selected patient population with T1a RCCa is a reliable treatment option, with disease-free survival rates that are comparable to partial nephrectomy.
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Affiliation(s)
- Andrew R Forauer
- Division of Interventional Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | - Benjamin J Dewey
- Geisel School of Medicine at Dartmouth College, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - John D Seigne
- Division of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Fong ZV, Tanabe KK. The clinical management of hepatocellular carcinoma in the United States, Europe, and Asia: A comprehensive and evidence-based comparison and review. Cancer 2014; 120:2824-38. [DOI: 10.1002/cncr.28730] [Citation(s) in RCA: 188] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 02/18/2014] [Accepted: 03/21/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Zhi Ven Fong
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
| | - Kenneth K. Tanabe
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
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