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Campbell WA, Makary MS. Advances in Image-Guided Ablation Therapies for Solid Tumors. Cancers (Basel) 2024; 16:2560. [PMID: 39061199 PMCID: PMC11274819 DOI: 10.3390/cancers16142560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/26/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Image-guided solid tumor ablation methods have significantly advanced in their capability to target primary and metastatic tumors. These techniques involve noninvasive or percutaneous insertion of applicators to induce thermal, electrochemical, or mechanical stress on malignant tissue to cause tissue destruction and apoptosis of the tumor margins. Ablation offers substantially lower risks compared to traditional methods. Benefits include shorter recovery periods, reduced bleeding, and greater preservation of organ parenchyma compared to surgical intervention. Due to the reduced morbidity and mortality, image-guided tumor ablation offers new opportunities for treatment in cancer patients who are not candidates for resection. Currently, image-guided ablation techniques are utilized for treating primary and metastatic tumors in various organs with both curative and palliative intent, including the liver, pancreas, kidneys, thyroid, parathyroid, prostate, lung, breast, bone, and soft tissue. The invention of new equipment and techniques is expanding the criteria of eligible patients for therapy, as now larger and more high-risk tumors near critical structures can be ablated. This article provides an overview of the different imaging modalities, noninvasive, and percutaneous ablation techniques available and discusses their applications and associated complications across various organs.
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Affiliation(s)
- Warren A. Campbell
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Virginia, Charlottesville, VA 22903, USA
| | - Mina S. Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Wimper Y, Overduin CG, Sedelaar JPM, Veltman J, Jenniskens SFM, Bomers JGR, Fütterer JJ. MRI-Guided Salvage Focal Cryoablation: A 10-Year Single-Center Experience in 114 Patients with Localized Recurrent Prostate Cancer. Cancers (Basel) 2023; 15:4093. [PMID: 37627122 PMCID: PMC10452144 DOI: 10.3390/cancers15164093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Patients with localized recurrent prostate cancer (PCa) are eligible for androgen-deprivation therapy, salvage radical prostatectomy (RP) or radiation therapy. These treatments are associated with serious side-effects, illustrating the need for alternative local treatment options with lower morbidity rates. All patients who underwent magnetic resonance imaging (MRI)-guided salvage focal cryoablation (SFC) with localized recurrent PCa between 2011-2021 (n = 114) were included. Two subgroups were formed: patients without (n = 99) and with prior RP (n = 15). We assessed the recurrence- (RFS) and treatment-free survival (TFS), measured from date of treatment to date of recurrence or initiation of additional salvage treatment, using Kaplan-Meier plots. Complications were reported using the Clavien-Dindo (CD) scale. Overall 1-year and 5-year RFS were 76.0% and 25.1%, and overall 1-year and 5-year TFS were 91.5% and 58.2%, respectively. Patients without prior RP showed a significantly higher 1-year (78.5% vs. 52.5%) and 5-year RFS (28.1% vs. 0.0%; p = 0.03), and a trend towards a higher 1-year (92.6% vs. 79.0%) and 5-year TFS (60.2% vs. 23.0%; p = 0.10) compared to those with prior RP. A total of 46 complications occurred in 37 patients, and the overall complication rate was 32.4% (37/114 patients). The majority (41/46; 89.1%) of complications were minor (CD 1-2). Overall (31.3 vs. 40.0%) and major (3.0 vs. 13.3%) complication rates were lower in patients without compared to those with prior RP, respectively. MRI-guided SFC is an effective and safe therapy for patients with recurrent PCa, and has proved to delay and potentially prevent the initiation of salvage treatments. Patients with locally recurrent PCa after prior RP had an increased risk of recurrence, a shortened time to additional treatment, and more complications compared to those without prior RP, which should be considered when selecting patients for SFC.
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Affiliation(s)
- Yvonne Wimper
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (C.G.O.); (S.F.M.J.); (J.G.R.B.); (J.J.F.)
| | - Christiaan G. Overduin
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (C.G.O.); (S.F.M.J.); (J.G.R.B.); (J.J.F.)
| | - J. P. Michiel Sedelaar
- Department of Urology, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Jeroen Veltman
- Department of Radiology, Ziekenhuisgroep Twente, 7609 PP Almelo, The Netherlands;
| | - Sjoerd F. M. Jenniskens
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (C.G.O.); (S.F.M.J.); (J.G.R.B.); (J.J.F.)
| | - Joyce G. R. Bomers
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (C.G.O.); (S.F.M.J.); (J.G.R.B.); (J.J.F.)
| | - Jurgen J. Fütterer
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (C.G.O.); (S.F.M.J.); (J.G.R.B.); (J.J.F.)
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Wang N, Zhao DW, Chen D, Wu ZM, Wang YJ, Yang ZY, Zhao JL, Zhou FJ, Li YH. Clinical value of normal saline injection for expansion of the anterior perirectal space during prostate cryoablation. Eur J Surg Oncol 2023; 49:252-256. [PMID: 35817633 DOI: 10.1016/j.ejso.2022.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/27/2022] [Accepted: 06/23/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The objective of this study is to describe the technique and evaluate the clinical value of normal saline (NS) injection for expanding the anterior perirectal space during prostate cryoablation for prostate cancer (PCa) patients. METHODS PCa patients who received cryoablation between August 2014 and December 2019 were enrolled, and the technique of NS injection was adopted. The complications were evaluated. The prostate-specific antigen (PSA) nadir and biochemical progression-free survival (bPFS) were measured in localized PCa patients who received cryoablation as the primary treatment. RESULTS A total of 159 PCa patients were included. Among 147 patients with the data of anterior perirectal space, the median (interquartile range [IQR]) distance of estimated iceball edge beyond the prostatic capsule was 8.3 (7.0-10.0) mm. No cases of urethrorectal fistula were reported; 29 patients developed urinary retention and 25 patients presented scrotal edema. All complications below Clavien-Dindo grade IIIb disappeared within 7 weeks after surgery. Urinary incontinence was reported in 6 patients. Among localized PCa patients, the median (IQR) follow-up time was 56.5 (36.0-73.5) months. The estimated 5-year bPFS was 82.3% overall, 82.8% for low-to intermediate-risk PCa patients, and 82.1% for high-risk PCa patients. For 52 patients received cryoablation alone, the median (IQR) PSA nadir was 0.147 (0.027-0.381) ng/mL. CONCLUSIONS The technique of NS injection for expanding the anterior perirectal space during cryoablation surgery could avoid urethrorectal fistula and might benefit localized PCa patients with lower PSA nadir and longer bPFS.
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Affiliation(s)
- Ning Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
| | - Di-Wei Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
| | - Dong Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
| | - Zhi-Ming Wu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
| | - Yan-Jun Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
| | - Zhen-Yu Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
| | - Jun-Liang Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
| | - Fang-Jian Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China.
| | - Yong-Hong Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China.
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MR Imaging in Real Time Guiding of Therapies in Prostate Cancer. Life (Basel) 2022; 12:life12020302. [PMID: 35207589 PMCID: PMC8878909 DOI: 10.3390/life12020302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 11/22/2022] Open
Abstract
Magnetic resonance imaging (MRI)-guided therapy for prostate cancer (PCa) aims to reduce the treatment-associated comorbidity of existing radical treatment, including radical prostatectomy and radiotherapy. Although active surveillance has been used as a conservative method to reduce overtreatment, there is a growing demand for less morbidity and personalized (focal) treatment. The development of multiparametric MRI was of real importance in improving the detection, localization and staging of PCa. Moreover, MRI has been useful for lesion targeting within the prostate, as it is used in the guidance of prostate biopsies, by means of cognitive registration, MRI-ultrasound fusion guidance or direct in-bore MRI-guidance. With regard to PCa therapies, MRI is used for precise probe placement into the lesion and to accurately monitor the treatment in real-time. Moreover, advances in MR-compatible thermal ablation allow for noninvasive real-time temperature mapping during treatment. In this review, we present an overview of the current status of MRI-guided therapies in PCa, focusing on cryoablation, focal laser ablation, high intensity focused ultrasound and transurethral ultrasound ablation. We explain the important role of MRI in the evaluation of the completeness of the ablation and during follow-up. Finally, we will discuss the challenges and future development inherent to these new technologies.
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Thompson SM, Gorny KR, Koepsel EMK, Welch BT, Mynderse L, Lu A, Favazza CP, Felmlee JP, Woodrum DA. Body Interventional MRI for Diagnostic and Interventional Radiologists: Current Practice and Future Prospects. Radiographics 2021; 41:1785-1801. [PMID: 34597216 DOI: 10.1148/rg.2021210040] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinical use of MRI for guidance during interventional procedures emerged shortly after the introduction of clinical diagnostic MRI in the late 1980s. However, early applications of interventional MRI (iMRI) were limited owing to the lack of dedicated iMRI magnets, pulse sequences, and equipment. During the 3 decades that followed, technologic advancements in iMRI magnets that balance bore access and field strength, combined with the development of rapid MRI pulse sequences, surface coils, and commercially available MR-conditional devices, led to the rapid expansion of clinical iMRI applications, particularly in the field of body iMRI. iMRI offers several advantages, including superior soft-tissue resolution, ease of multiplanar imaging, lack of ionizing radiation, and capability to re-image the same section. Disadvantages include longer examination times, lack of MR-conditional equipment, less operator familiarity, and increased cost. Nonetheless, MRI guidance is particularly advantageous when the disease is best visualized with MRI and/or when superior soft-tissue contrast is needed for treatment monitoring. Safety in the iMRI environment is paramount and requires close collaboration among interventional radiologists, MR physicists, and all other iMRI team members. The implementation of risk-limiting measures for personnel and equipment in MR zones III and IV is key. Various commercially available MR-conditional needles, wires, and biopsy and ablation devices are now available throughout the world, depending on the local regulatory status. As such, there has been tremendous growth in the clinical applications of body iMRI, including localization of difficult lesions, biopsy, sclerotherapy, and cryoablation and thermal ablation of malignant and nonmalignant soft-tissue neoplasms. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Scott M Thompson
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Krzysztof R Gorny
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Erica M Knavel Koepsel
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Brian T Welch
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Lance Mynderse
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Aiming Lu
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Christopher P Favazza
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Joel P Felmlee
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - David A Woodrum
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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Abstract
PURPOSE OF REVIEW This review aims to summarize the latest evidence for the use of salvage ablation of localized prostate cancer recurrences after primary therapy radiotherapy or prostatectomy. RECENT FINDINGS Savage ablation represents a treatment option in select patients with localized recurrences following primary therapy of prostate cancer. Following radiotherapy, salvage cryotherapy and high-intensity focused ultrasound (HIFU) demonstrate encouraging oncologic outcomes. Biochemical recurrence-free survival ranged from 71% at 2 years to 44.2% at 10 years for cryotherapy and from 51% at 5 years to 28.7% at 10 years for HIFU. Rates of adverse effects appear to be more favorable with ablation compared to salvage surgery. Focal salvage ablation may offer a further balance between oncologic control and adverse effects. Following radical prostatectomy, recent data on the use of salvage ablation of local recurrences are less robust with only a few small studies published in the last 2 years. SUMMARY Salvage ablation is an option for localized disease recurrences following primary treatment. Its role is most established for postradiation recurrence. It can also be utilized in postprostatectomy recurrence, although published data is more limited. Future studies are needed to further explore the role of ablation in both cohorts.
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Woodrum DA, Kawashima A, Gorny KR, Mynderse LA. Magnetic Resonance-Guided Prostate Ablation. Semin Intervent Radiol 2019; 36:351-366. [PMID: 31798208 PMCID: PMC6887527 DOI: 10.1055/s-0039-1697001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In 2019, the American Cancer Society (ACS) estimates that 174,650 new cases of prostate cancer will be diagnosed and 31,620 will die due to the prostate cancer in the United States. Prostate cancer is often managed with aggressive curative intent standard therapies including radiotherapy or surgery. Regardless of how expertly done, these standard therapies often bring significant risk and morbidity to the patient's quality of life with potential impact on sexual, urinary, and bowel functions. Additionally, improved screening programs, using prostatic-specific antigen and transrectal ultrasound-guided systematic biopsy, have identified increasing numbers of low-risk, low-grade "localized" prostate cancer. The potential, localized, and indolent nature of many prostate cancers presents a difficult decision of when to intervene, especially within the context of the possible comorbidities of aggressive standard treatments. Active surveillance has been increasingly instituted to balance cancer control versus treatment side effects; however, many patients are not comfortable with this option. Although active debate continues on the suitability of either focal or regional therapy for the low- or intermediate-risk prostate cancer patients, no large consensus has been achieved on the adequate management approach. Some of the largest unresolved issues are prostate cancer multifocality, limitations of current biopsy strategies, suboptimal staging by accepted imaging modalities, less than robust prediction models for indolent prostate cancers, and safety and efficiency of the established curative therapies following focal therapy for prostate cancer. In spite of these restrictions, focal therapy continues to confront the current paradigm of therapy for low- and even intermediate-risk disease. It has been proposed that early detection and proper characterization may play a role in preventing the development of metastatic disease. There is level-1 evidence supporting detection and subsequent aggressive treatment of intermediate- and high-risk prostate cancer. Therefore, accurate assessment of cancer risk (i.e., grade and stage) using imaging and targeted biopsy is critical. Advances in prostate imaging with MRI and PET are changing the workup for these patients, and advances in MR-guided biopsy and therapy are propelling prostate treatment solutions forward faster than ever.
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