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Xu G, Zhao Z, Xu K, Zhu J, Roe AW, Xu B, Zhang X, Li J, Xu D. Magnetic resonance temperature imaging of laser-induced thermotherapy using proton resonance frequency shift: evaluation of different sequences in phantom and porcine brain at 7 T. Jpn J Radiol 2022; 40:768-780. [DOI: 10.1007/s11604-022-01263-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
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Ierardi AM, Carnevale A, Angileri SA, Pellegrino F, Renzulli M, Golfieri R, Zhang D, Sun H, Giganti M, Dionigi G, Carrafiello G. Outcomes following minimally invasive imagine-guided percutaneous ablation of adrenal glands. Gland Surg 2020; 9:859-866. [PMID: 32775281 DOI: 10.21037/gs.2020.03.32] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Whilst surgery represents the gold standard for the treatment of adrenal primary malignant tumors, metastatic involvement of the adrenal glands is generally approached conservatively; however, surgery for local control has been controversial, and several reports have described the utility of surgical removal in terms of prolonged survival in selected patients. Different techniques, including radiofrequency ablation (RFA), microwave ablation (MWA), laser induced thermal therapy (LITT), cryoablation (CRA), and chemical ablation, are employed in percutaneous image-guided ablation for primary and metastatic malignancies of the adrenal glands, in case of patients with multiple comorbidities or who refuse surgery. Technical success, clinical success and safety were analysed and discussed in this systematic review. Tumor size was found a significant determinant for local disease control; histology of the primary malignancy and coexistence of tumor elsewhere were correlated with prognosis. These procedures resulted to be feasible and safe, with hypertensive crisis representing the most common complication. Although there is lack of evidence in the literature concerning outcomes compared with surgery, percutaneous ablation may represent a useful therapeutic option for controlling unresectable adrenal metastases, offering patients opportunities for improved survival.
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Affiliation(s)
- Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, Via A di Rudinì 8, 20142 Milan, Italy
| | - Aldo Carnevale
- Department of Radiology, University Hospital of Ferrara, via A. Moro 8, 44124 Ferrara, Italy
| | - Salvatore Alessio Angileri
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, Via A di Rudinì 8, 20142 Milan, Italy
| | - Fabio Pellegrino
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, via L. Ariosto 35, 44121 Ferrara, Italy
| | - Matteo Renzulli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Daqi Zhang
- Division of thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, 126 Xiantai Blvd, Changchun, China
| | - Hui Sun
- Division of thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, 126 Xiantai Blvd, Changchun, China
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, via L. Ariosto 35, 44121 Ferrara, Italy
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Gianpaolo Carrafiello
- Unità Operativa di Radiologia, Fondazione I.R.C.C.S. Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Hypertensive Crisis during Microwave Ablation of Adrenal Neoplasms: A Retrospective Analysis of Predictive Factors. J Vasc Interv Radiol 2019; 30:1343-1350. [DOI: 10.1016/j.jvir.2019.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/29/2018] [Accepted: 01/12/2019] [Indexed: 12/11/2022] Open
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Zhao Q, Tian G, Chen F, Zhong L, Jiang T. CT-guided percutaneous laser ablation of metastatic lung cancer: three cases report and literature review. Oncotarget 2018; 8:2187-2196. [PMID: 27974695 PMCID: PMC5356791 DOI: 10.18632/oncotarget.13901] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/22/2016] [Indexed: 01/06/2023] Open
Abstract
Objective To report the efficacy and safety of CT-guided percutaneous laser ablation (PLA) for metastatic lung tumors. Methods Three cases of metastatic lung cancer underwent CT-guided PLA, and we searched for previously published articles on the minimally invasive CT-guided RFA or MWA for lung tumors in recent five years. Results With the guidance of CT, all lesions had good prognosis under laser ablation. Case 1 suffering from severe pulmonary dysfunction and diffuse pulmonary bullae, had small pneumothorax. CT scan obtained four months following the ablation showed two lesions had complete responses and one partial response. Case 2 had successful complete response with absent lung mass, and also had a good postoperative condition without any discomfort in the two-month follow-up. Case 3 showed partial response and improved greatly after five months. 962 cases (mean age of 45.7 years, 62.2% male) of 1297 lung tumors with detailed information were identified from 27 articles. Of these cases, the minority manifested complications such as pneumothorax, hemoptysis, hemothorax, pneumonia, pain and fever. Conclusions Percutaneous CT-guided PLA could be a safe and promising minimally invasive treatment for patients with primary lung cancer or unresectable pulmonary metastases, especially multineedle PLA in large tumors, which still needs more large-scale prospective studies to convince this method in the future.
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Affiliation(s)
- Qiyu Zhao
- Department of Ultrasonography, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guo Tian
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fen Chen
- Department of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liyun Zhong
- Department of Ultrasonography, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian'an Jiang
- Department of Ultrasonography, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Parisi AJ, Sundararajan SH, Garg R, Hargreaves EL, Patel NV, Danish SF. Assessment of Optimal Imaging Protocol Sequences After Laser-Induced Thermal Therapy for Intracranial Tumors. Neurosurgery 2017; 83:471-479. [DOI: 10.1093/neuros/nyx439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 07/15/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anthony J Parisi
- Department of Neurosurgery, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Sri Hari Sundararajan
- Department of Radiology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Rahul Garg
- Department of Radiology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Eric L Hargreaves
- Department of Neurosurgery, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Nitesh V Patel
- Department of Neurosurgery, Rutgers, New Jersey Medical School, Newark, New Jersey
- Section of Neurosurgery, Rutgers, Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Shabbar F Danish
- Section of Neurosurgery, Rutgers, Cancer Institute of New Jersey, New Brunswick, New Jersey
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叶 欣, 范 卫, 王 徽, 王 俊, 古 善, 冯 威, 庄 一, 刘 宝, 李 晓, 李 玉, 杨 坡, 杨 霞, 杨 武, 陈 俊, 张 嵘, 林 征, 孟 志, 胡 凯, 柳 晨, 彭 忠, 韩 玥, 靳 勇, 雷 光, 翟 博, 黄 广, 中国抗癌协会肿瘤微创治疗专业委员会肺癌微创治疗分会. [Expert Consensus for Thermal Ablation of Primary and Metastatic Lung Tumors
(2017 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:433-445. [PMID: 28738958 PMCID: PMC5972946 DOI: 10.3779/j.issn.1009-3419.2017.07.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- 欣 叶
- 250014 济南, 山东大学附属省立医院肿瘤科Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
| | - 卫君 范
- 510060 广州, 中山大学肿瘤医院影像与微创介入中心Imaging and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - 徽 王
- 130012 长春, 吉林省肿瘤医院介入治疗中心Interventional Treatment Center, Jilin Provincial Tumor Hospital, Changchun 130012, China
| | - 俊杰 王
- 100191 北京, 北京大学第三医院放射治疗科Department of Radiation Oncology, Peking University 3rd Hospital, Beijing 100191, China
| | - 善智 古
- 410013 长沙, 湖南省肿瘤医院放射介入科Department of Interventional Therapy, Hunan Provincial Tumor Hospital, Changsha 410013, China
| | - 威健 冯
- 100045 北京, 首都医科大学附属复兴医院肿瘤科Department of Oncology, Fuxing Hospital Affiliated to the Capital University of Medical Sciences, Beijing 100045, China
| | - 一平 庄
- 210009 南京, 江苏省肿瘤医院介入科Department of Interventional Therapy, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - 宝东 刘
- 100053 北京, 首都医科大学宣武医院胸外科Department of Thoracic Surgery, Xuanwu Hospital Affiliated to the Capital University of Medical Sciences, Beijing 100053, China
| | - 晓光 李
- 100005 北京, 北京医院肿瘤微创中心Department of Tumor Minimally Invasive Therapy, Beijing Hospital, Beijing 100005, China
| | - 玉亮 李
- 250033 济南, 山东大学第二医院介入治疗中心Interventional Treatment Center, Shandong University Second Hospital, Ji'nan 250033, China
| | - 坡 杨
- 150001 哈尔滨, 哈尔滨医科大学第四人民医院介入放射科Department of Interventional Radiology, The Fourth Hospital of Harbin Medical University, Harbin 150001, China
| | - 霞 杨
- 250014 济南, 山东大学附属省立医院肿瘤科Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
| | - 武威 杨
- 100071 北京, 解放军307医院肿瘤微创治疗科Department of Tumor Minimally Invasive Therapy, 307 Hospital, Beijing 100071, China
| | - 俊辉 陈
- 510060 广州, 中山大学肿瘤医院影像与微创介入中心Imaging and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - 嵘 张
- 518036 深圳, 北京大学深圳医院微创介入科Department of Minimally Invasive Interventional Therapy, Shenzhen Hospital of Beijing University, Shenzhen 518036, China
| | - 征宇 林
- 350005 福州, 福建医科大学附属第一医院介入科Department of Interventional Therapy, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - 志强 孟
- 200032 上海, 复旦大学肿瘤医院微创治疗科Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - 凯文 胡
- 100078 北京, 北京中医药大学东方医院肿瘤科Department of Oncology, Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100078, China
| | - 晨 柳
- 100083 北京, 北京肿瘤医院介入治疗科Department of Interventional Therapy, Beijing Cancer Hospital, Beijing 100083, China
| | - 忠民 彭
- 250014 济南, 山东省立医院胸外科Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
| | - 玥 韩
- 100021 北京, 中国医学科学院肿瘤医院介入治疗科Department of Interventional Therapy, Tumor Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China
| | - 勇 靳
- 215004 苏州, 苏州大学第二附属医院介入治疗科Department of Interventional Therapy, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - 光焰 雷
- 710061 西安, 陕西省肿瘤医院胸外科Department of Thoracic Surgery, Shanxi Provincial Tumor Hospital, Xi'an 710061, China
| | - 博 翟
- 200127 上海, 上海交通大学仁济医院肿瘤介入治疗科Tumor Interventional Therapy Center, Shanghai Renji Hospital, Shanghai 200127, China
| | - 广慧 黄
- 250014 济南, 山东大学附属省立医院肿瘤科Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
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New Techniques in MRI-Fluid-attenuated Inversion Recovery (FLAIR) Imaging, Diffusion Tensor Imaging (DTI), and MRI-guided Laser-induced Thermotherapy (LITT) for Brain Lesions. Int Anesthesiol Clin 2015; 54:94-108. [PMID: 26655511 DOI: 10.1097/aia.0000000000000085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lin Y, Lin WC, Fwu PT, Shih TC, Yeh LR, Su MY, Chen JH. Investigation of factors affecting hypothermic pelvic tissue cooling using bio-heat simulation based on MRI-segmented anatomic models. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2015; 122:76-88. [PMID: 26198131 PMCID: PMC4549219 DOI: 10.1016/j.cmpb.2015.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/08/2015] [Accepted: 07/03/2015] [Indexed: 06/11/2023]
Abstract
This study applied a simulation method to map the temperature distribution based on magnetic resonance imaging (MRI) of individual patients, and investigated the influence of different pelvic tissue types as well as the choice of thermal property parameters on the efficiency of endorectal cooling balloon (ECB). MR images of four subjects with different prostate sizes and pelvic tissue compositions, including fatty tissue and venous plexus, were analyzed. The MR images acquired using endorectal coil provided a realistic geometry of deformed prostate that resembled the anatomy in the presence of ECB. A single slice with the largest two-dimensional (2D) cross-sectional area of the prostate gland was selected for analysis. The rectal wall, prostate gland, peri-rectal fatty tissue, peri-prostatic fatty tissue, peri-prostatic venous plexus, and urinary bladder were manually segmented. Pennes' bioheat thermal model was used to simulate the temperature distribution dynamics, by using an in-house finite element mesh based solver written in MATLAB. The results showed that prostate size and periprostatic venous plexus were two major factors affecting ECB cooling efficiency. For cases with negligible amount of venous plexus and small prostate, the average temperature in the prostate and neurovascular bundles could be cooled down to 25 °C within 30 min. For cases with abundant venous plexus and large prostate, the temperature could not reach 25 °C at the end of 3 h cooling. Large prostate made the cooling difficult to propagate through. The impact of fatty tissue on cooling effect was small. The filling of bladder with warm urine during the ECB cooling procedure did not affect the temperature in the prostate or NVB. In addition to the 2D simulation, in one case a 3D pelvic model was constructed for volumetric simulation. It was found that the 2D slice with the largest cross-sectional area of prostate had the most abundant venous plexus, and was the most difficult slice to cool, thus it may provide a conservative prediction of the cooling effect. This feasibility study demonstrated that the simulation tool could potentially be used for adjusting the setting of ECB for individual patients during hypothermic radical prostatectomy. Further studies using MR thermometry are required to validate the in silico results obtained using simulation.
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Affiliation(s)
- Yuting Lin
- Tu and Yuen Center for Functional Onco-Imaging of Department of Radiological Sciences, University of California, Irvine, CA 92697, USA
| | - Wei-Ching Lin
- Department of Radiology, China Medical University Hospital, Taichung 40402, Taiwan
| | - Peter T Fwu
- Tu and Yuen Center for Functional Onco-Imaging of Department of Radiological Sciences, University of California, Irvine, CA 92697, USA
| | - Tzu-Ching Shih
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung 40402, Taiwan
| | - Lee-Ren Yeh
- Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung 82445, Taiwan
| | - Min-Ying Su
- Tu and Yuen Center for Functional Onco-Imaging of Department of Radiological Sciences, University of California, Irvine, CA 92697, USA
| | - Jeon-Hor Chen
- Tu and Yuen Center for Functional Onco-Imaging of Department of Radiological Sciences, University of California, Irvine, CA 92697, USA; Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung 82445, Taiwan.
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Allegretti G, Saccomandi P, Giurazza F, Caponero M, Frauenfelder G, Di Matteo F, Beomonte Zobel B, Silvestri S, Schena E. Magnetic resonance-based thermometry during laser ablation on ex-vivo swine pancreas and liver. Med Eng Phys 2015; 37:631-41. [DOI: 10.1016/j.medengphy.2015.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 04/02/2015] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
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Diddens-Tschoeke HC, Hüttmann G, Gruber AD, Pottier RH, Hanken H. Localized thermal tumor destruction using dye-enhanced photothermal tumor therapy. Lasers Surg Med 2015; 47:452-61. [PMID: 26052931 DOI: 10.1002/lsm.22356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE In an attempt to develop a new therapeutic approach for highly localized thermal destruction of tissue targets that lack natural pigmentation, the potential of in-vivo dye-enhanced photothermal therapy (PTT) was investigated. PTT involves the application of an exogenous absorber, which accumulates in metabolically active tissues, followed by non-invasive light irradiation, using appropriate wavelengths, exposure durations, and irradiances. The chromophore used, palladium(II) octabutoxynaphthalocyanine (PdNc(OBu)8 ), strongly absorbs in the near infrared wavelength range which thus permits good penetration depth of the exciting light. The predominant de-excitation routes of the chromophore are radiationless thermal processes. MATERIALS AND METHODS Using a BALB/c mouse model with a subcutaneously implanted syngeneic EMT6 adenocarcinoma, 96-100 hours after intraperitoneal application of PdNc(OBu)8 , tumor, and surrounding tissue were irradiated with a 830 nm continuous wave diode laser applying 30 Wcm(-2) for 10-20 seconds. Treatment parameters were based on theoretical calculations. RESULTS Histological evaluation of thermal effects on tumor and normal tissue showed that after PdNc(OBu)8 -enhanced photothermal treatment, highly localized and selective thermal damage of the tumors was achieved. The necrotic tumor area was invaded by inflammatory cells, including neutrophils, macrophages, mast cells, and lymphocytes, thus reflecting a prominent host immune response. In tumors treated with PTT for 15 or 20 seconds, respectively, only few surviving tumor cells were detected underneath the epidermis. Adjacent peripheral normal tissue including skin and muscle remained completely unaffected. CONCLUSION This study highlights the potential of achieving irreversible thermal tissue damage closely localized to the target tissue when PdNc(OBu)8 is used in combination with continuous-wave light.
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Affiliation(s)
| | - Gereon Hüttmann
- Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
| | - Achim D Gruber
- Department of Veterinary Pathology, College of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Roy H Pottier
- Department of Chemistry and Chemical Engineering, Royal Military College of Canada, Kingston, Ontario, Canada
| | - Henning Hanken
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Banerjee C, Snelling B, Berger MH, Shah A, Ivan ME, Komotar RJ. The role of magnetic resonance-guided laser ablation in neurooncology. Br J Neurosurg 2015; 29:192-6. [DOI: 10.3109/02688697.2014.996527] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vallo S, Eichler K, Kelly K, Schulz B, Bartsch G, Haferkamp A, Vogl TJ, Zangos S. MR-guided laser-induced thermotherapy in ex vivo porcine kidney: comparison of four different imaging sequences. Lasers Surg Med 2014; 46:558-62. [PMID: 24902949 DOI: 10.1002/lsm.22262] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2014] [Indexed: 11/10/2022]
Abstract
PURPOSE To evaluate the clinical value of different magnetic resonance imaging (MRI) sequences for a real-time thermo-monitoring during laser-induced thermotherapy (LITT) in kidneys. METHODS Twenty-eight ex vivo pig kidneys were treated with laser ablation under MR guidance in a high-field MR scanner (Magnetom Espree or Avanto Fit, Siemens, Germany). For the thermal ablation of the kidney, a neodymium yttrium-aluminum-garnet (Nd:YAG) laser was used in combination with a special protective catheter (length 43 cm, 4 French) which is sealed at the distal end. First, ablation was performed for 7, 10, and 13 minutes using FLASH sequences for investigation of time-dependent growth of lesion size. In the second step, we evaluated the optimal imaging sequence during a 7 minutes ablation of the kidney and after cooling using four different MR sequences (Haste, FLASH, radial VIBE, and Caipirinha DIXON). RESULTS Macroscopic lesion volume increased from 3,784 ± 1,525 mm(3) to 7,683 ± 5,756 mm(3) after the ablation from 7 to 13 minutes and MR volume ranged from 2,107 ± 1,674 mm(3) to 2,934 ± 1,549 mm(3) after the ablation from 7 to 13 minutes. During ablation, FLASH (132 ± 34%) and radial VIBE (120 ± 43%) sequences displayed lesion volumes most efficiently with a trend to overestimation. The Caipirinha DIXON (323 ± 24%) sequence overestimated the volumes significantly during real-time monitoring. The volumes measured by MRI with FLASH (61 ± 30%), Haste (67 ± 28%), or radial VIBE (48 ± 14%) sequences after cooling of the kidney after ablation were always underestimated. The Caipirinha DIXON (142 ± 2%) sequence still overestimated the lesion volume after cooling of the kidney. CONCLUSION LITT is a feasible ablation modality in kidney tissue. Moreover, macroscopic and MR lesion volume increases time-dependently. For online monitoring, radial VIBE and FLASH sequences seem to be most efficient.
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Affiliation(s)
- Stefan Vallo
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
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Di Costanzo GG, D'Adamo G, Tortora R, Zanfardino F, Mattera S, Francica G, Pacella CM. A novel needle guide system to perform percutaneous laser ablation of liver tumors using the multifiber technique. Acta Radiol 2013; 54:876-81. [PMID: 23761559 DOI: 10.1177/0284185113489825] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Previous studies have shown that laser ablation with the multifiber technique is effective in the treatment of liver tumors. However, the correct positioning of multiple needles may be challenging. PURPOSE To investigate the use of a novel needle guide system that was developed to perform percutaneous laser ablation of liver tumors with the multifiber technique under ultrasonographic guidance. MATERIAL AND METHODS Between February 2009 and June 2011, 116 patients (104 hepatocellular carcinomas and 12 metastases) with 127 liver nodules (median diameter, 3.0 cm; range, 1.5-6.0) were treated. Nineteen nodules were in high-risk locations. A needle guide with separate channels to insert two needles in a parallel position and at a prefixed distance was used. RESULTS Needles were positioned inside the target nodule easily and quickly, and correct spacing (1.5-1.8 cm) between light sources was immediately achieved. Complete tumor ablation was achieved in a single session in 112 (88.2%) lesions. In nodules ≤3.0 cm and >3.0 cm in size, ablation was complete in 93.6% and 79.6% of cases, respectively. Of note, complete ablation was achieved in 91.7% of nodules up to 5.0 cm. CONCLUSION With the new guidance system, needles could be inserted in parallel fashion, which facilitated positioning the needles in geometrical configurations to maximize the ablative effect. Worthy of note, the complete ablation rate in nodules >3.0 cm using the new guide system was higher than what has been reported in the literature so far.
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Affiliation(s)
| | | | | | | | | | - Giampiero Francica
- Diagnostic and Interventional Ultrasound Unit, Camilliani Hospital, Naples
| | - Claudio Maurizio Pacella
- Regina Apostolorum Hospital, Diagnostic Imaging and Interventional Radiology, Albano Laziale, Italy
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Bazrafshan B, Hübner F, Farshid P, Paul J, Hammerstingl R, Vogel V, Mäntele W, Vogl TJ. Magnetic resonance temperature imaging of laser-induced thermotherapy: assessment of fast sequences in ex vivo porcine liver. Future Oncol 2013; 9:1039-50. [DOI: 10.2217/fon.13.54] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Aim: To evaluate magnetic resonance sequences for T1 and proton resonance frequency (PRF) thermometry during laser-induced thermotherapy (LITT) in liver tissue. Materials & methods: During LITT (1064 nm; 30 W; 3-cm diffuser; 2–3 min) in ex vivo porcine liver, temperature was measured (25–70°C) utilizing a fiberoptic thermometer and MRI was performed with a 1.5-T scanner through the following sequences: segmented echo planar imaging (seg-EPI) for the PRF method; fast low-angle shot (FLASH), inversion-recovery turbo FLASH (IRTF), saturation-recovery turbo FLASH (SRTF) and true-fast imaging (TRUFI) for the T1 method. Phase angle and signal amplitude (regarding PRF/T1) was recorded in regions of interest, on images under fiberoptic probe tips. Sequences’ thermal coefficients were determined by calibrating phase angle and signal amplitude against temperature and subsequently validated. Results: Coefficients of -0.0089 ± 0.0003 ppm °C-1 (seg-EPI) and -0.917 ± 0.046, -1.166 ± 0.058, -1.038 ± 0.054 and -1.443 ± 0.118°C-1 (FLASH, IRTF, SRTF and TRUFI, respectively) were obtained. Precisions of 0.71, 1.34, 2.07, 2.44 and 3.21°C and, through Bland–Altman analysis, accuracies of -0.67, 0.79, 1.65, 1.57 and 2.13°C (seg-EPI, FLASH, IRTF, SRTF and TRUFI, respectively) were determined. Conclusion: The PRF method with seg-EPI sequence is preferred for thermometry during LITT owing to higher precision and accuracy. Among T1-method sequences, FLASH showed higher accuracy and robustness.
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Affiliation(s)
- Babak Bazrafshan
- Institute for Diagnostic & Interventional Radiology, Johann Wolfgang Goethe-University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
| | - Frank Hübner
- Institute for Diagnostic & Interventional Radiology, Johann Wolfgang Goethe-University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Parviz Farshid
- Institute for Diagnostic & Interventional Radiology, Johann Wolfgang Goethe-University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Jijo Paul
- Institute for Diagnostic & Interventional Radiology, Johann Wolfgang Goethe-University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Renate Hammerstingl
- Institute for Diagnostic & Interventional Radiology, Johann Wolfgang Goethe-University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Vitali Vogel
- Institute for Biophysics, Department of Physics, Johann Wolfgang Goethe-University, Max-von-Laue-Straße 1, 60438 Frankfurt am Main, Germany
| | - Werner Mäntele
- Institute for Biophysics, Department of Physics, Johann Wolfgang Goethe-University, Max-von-Laue-Straße 1, 60438 Frankfurt am Main, Germany
| | - Thomas J Vogl
- Institute for Diagnostic & Interventional Radiology, Johann Wolfgang Goethe-University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Patel NV, Jethwa PR, Barrese JC, Hargreaves EL, Danish SF. Volumetric trends associated with MRI-guided laser-induced thermal therapy (LITT) for intracranial tumors. Lasers Surg Med 2013; 45:362-9. [DOI: 10.1002/lsm.22151] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Nitesh V. Patel
- Division of Neurosurgery; UMDNJ-Robert Wood Johnson Medical School; New Brunswick New Jersey
| | - Pinakin R. Jethwa
- Department of Neurological Surgery; UMDNJ-New Jersey Medical School; Newark New Jersey
| | - James C. Barrese
- Department of Neurological Surgery; UMDNJ-New Jersey Medical School; Newark New Jersey
| | - Eric L. Hargreaves
- Division of Neurosurgery; UMDNJ-Robert Wood Johnson Medical School; New Brunswick New Jersey
| | - Shabbar F. Danish
- Division of Neurosurgery; UMDNJ-Robert Wood Johnson Medical School; New Brunswick New Jersey
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Temperature imaging of laser-induced thermotherapy (LITT) by MRI: evaluation of different sequences in phantom. Lasers Med Sci 2013; 29:173-83. [DOI: 10.1007/s10103-013-1306-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 03/11/2013] [Indexed: 12/11/2022]
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17
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Pacella CM, Papini E. Image-guided percutaneous ablation therapies for local recurrences of thyroid tumors. J Endocrinol Invest 2013; 36:61-70. [PMID: 23391859 DOI: 10.1007/bf03346744] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The incidence of thyroid carcinoma has increased steadily over the last few decades. Most differentiated thyroid carcinomas (DTC) are cured thanks to the initial treatment with surgery and radioiodine therapy. Nevertheless, neck lymph node metastases are found in a few of these patients during their long-term clinical and ultrasound follow-up. In some of these cases radioiodine treatment may not be effective in eradicating nodal metastases due to scant 131-I uptake. Additionally, a few of these patients undergo repeated neck explorations and/or resections. Based on these considerations and on the frequently indolent course of DTC neck metastases, a non-surgical therapeutic approach should be considered to control small local foci of DTC. There is increasing interest in mini-invasive image-guided procedures that can be performed under local anesthesia which do not affect the performance status of the patient. Image-guided minimally invasive ablative therapies delivered by using needle-like applicators include both thermal and non-thermal source techniques. Over the past 25 years, these therapies have gained widespread attention and, in many cases, broad clinical acceptance as methods for treating focal malignancies. In an attempt to overcome the limitations of treating certain unresectable tumor types not amenable to a further surgical treatment, a few investigators have reported successfully combining percutaneous therapies with other oncologic treatment strategies (combined treatments). In this review, we reported mini-invasive techniques more commonly employed in selected cases to ameliorate local compressive symptoms, control hormonal production, and reduce the volume of neoplastic tissue prior to traditional palliative treatment.
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Affiliation(s)
- C M Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Via San Francesco 50, Albano Laziale - Rome, Italy.
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Jethwa PR, Barrese JC, Gowda A, Shetty A, Danish SF. Magnetic Resonance Thermometry-Guided Laser-Induced Thermal Therapy for Intracranial Neoplasms. Oper Neurosurg (Hagerstown) 2012; 71:133-44; 144-5. [DOI: 10.1227/neu.0b013e31826101d4] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Laser-induced thermal therapy is a promising tool in the neurosurgeon's armamentarium. This methodology has seen a resurgence in application as a result of advances in technology.
OBJECTIVE:
To report our initial experience with the procedure after treating 20 consecutive patients, the largest series to date.
METHODS:
Patients were selected for laser therapy if they had failed conventional therapies, were unable to tolerate an open cranial procedure, or the tumor was deemed otherwise inoperable. In this series, 980-nm diode laser catheters were placed stereotactically in the operating room. The patients were then transferred to the magnetic resonance imaging suite for thermal ablation.
RESULTS:
A total of 31 laser applicators were placed in 20 patients with intracranial neoplasms. The majority of patients (17 of 20) had prior treatment for their tumors. The overall accuracy of laser insertion was 83.9%, improving with increased experience. The average lesion volume treated was 7.0 ± 9.0 cm3. With the use of damage estimates from the software provided, the treatment continued until the entire tumor had been irreversibly ablated. The average length of hospitalization was 2.27 days, with the majority of patients going home on postoperative day 1. Complications occurred in 4 patients, typically in those who were in poor health preoperatively.
CONCLUSION:
Laser-induced thermal therapy is an intuitive procedure for treating difficult intracranial neoplasms. As with any other procedure, patient selection and lesion selection are important factors in determining outcome.
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Affiliation(s)
- Pinakin R. Jethwa
- Department of Neurosurgery, UMDNJ--New Jersey Medical School, Newark, New Jersey
| | - James C. Barrese
- Department of Neurosurgery, UMDNJ--New Jersey Medical School, Newark, New Jersey
| | | | | | - Shabbar F. Danish
- Division of Neurosurgery, UMDNJ-- Robert Wood Johnson Medical School, New Brunswick, New Jersey
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19
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The influence of Nd:YAG laser irradiation on Fluoroptic® temperature measurement: an experimental evaluation. Lasers Med Sci 2012; 28:487-96. [DOI: 10.1007/s10103-012-1090-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 03/22/2012] [Indexed: 10/28/2022]
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20
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Sancho JJ, Triponez F, Montet X, Sitges-Serra A. Surgical management of adrenal metastases. Langenbecks Arch Surg 2011; 397:179-94. [DOI: 10.1007/s00423-011-0889-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 11/30/2011] [Indexed: 10/14/2022]
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Jethwa PR, Lee JH, Assina R, Keller IA, Danish SF. Treatment of a supratentorial primitive neuroectodermal tumor using magnetic resonance-guided laser-induced thermal therapy. J Neurosurg Pediatr 2011; 8:468-75. [PMID: 22044371 DOI: 10.3171/2011.8.peds11148] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Supratentorial primitive neuroectodermal tumors (PNETs) are rare tumors that carry a poorer prognosis than those arising from the infratentorial compartment (such as medulloblastoma). The overall prognosis for these patients depends on several factors including the extent of resection, age at diagnosis, CSF dissemination, and site in the supratentorial space. The authors present the first case of a patient with a newly diagnosed supratentorial PNET in which cytoreduction was achieved with MR-guided laser-induced thermal therapy. A 10-year-old girl presented with left-sided facial weakness and a large right thalamic mass extending into the right midbrain. The diagnosis of supratentorial PNET was made after stereotactic biopsy. Therapeutic options for this lesion were limited because of the risks of postoperative neurological deficits with resection. The patient underwent MR-guided laser-induced thermal ablation of her tumor. Under real-time MR thermometry, thermal energy was delivered to the tumor at a core temperature of 90°C for a total of 960 seconds. The patient underwent follow-up MR imaging at regular intervals to evaluate the tumor response to the thermal ablation procedure. Initial postoperative scans showed an increase in the size of the lesion as well as the amount of the associated edema. Both the size of the lesion and the edema stabilized by 1 week and then decreased below preablation levels at the 3-month postsurgical follow-up. There was a slight increase in the size of the lesion and associated edema at the 6-month follow-up scan, presumably due to concomitant radiation she received as part of her postoperative care. The patient tolerated the procedure well and has had resolution of her symptoms since surgery. Further study is needed to assess the role of laser-induced thermal therapy for the treatment of intracranial tumors. As such, it is a promising tool in the neurosurgical armamentarium. Postoperative imaging has shown no evidence of definitive recurrence at the 6-month follow-up period, but longer-term follow-up is required to assess for late recurrence.
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Affiliation(s)
- Pinakin R Jethwa
- Department of Neurosurgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ, USA
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Bazrafshan B, Hübner F, Farshid P, Larson MC, Vogel V, Mäntele W, Vogl TJ. A liver-mimicking MRI phantom for thermal ablation experiments. Med Phys 2011; 38:2674-84. [PMID: 21776804 DOI: 10.1118/1.3570577] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To develop a liver-mimicking MRI gel phantom for use in the development of temperature mapping and coagulation progress visualization tools needed for the thermal tumor ablation methods, including laser-induced interstitial thermotherapy (LITT) and radiofrequency ablation (RFA). METHODS A base solution with an acrylamide concentration of 30 vol. % was prepared. Different components were added to the solution; among them are bovine hemoglobin and MR signal-enhancing contrast agents (Magnevist as T1 and Lumirem as T2 contrast agent) for adjustment of the optical absorption and MR relaxation times, respectively. The absorption was measured in samples with various hemoglobin concentrations (0%-7.5%) at different temperatures (25-80 degrees C) using the near-infrared spectroscopy, measuring the transmitted radiation through the sample. The relaxation times were measured in samples with various concentrations of T1 (0.025%-0.325%) and T2 (0.4%-1.6%) contrast agents at different temperatures (25-75 degrees C), through the MRI technique, acquiring images with specific sequences. The concentrations of the hemoglobin and contrast agents of the gel were adjusted so that its absorption coefficient and relaxation times are equivalent to those of liver. To this end, the absorption and relaxation times of the gel samples were compared to reference values, measured in an ex vivo porcine liver at different temperatures through the same methods used for the gel. For validation of the constructed phantom, the absorption and relaxation times were measured in samples containing the determined amounts of the hemoglobin and contrast agents and compared with the corresponding liver values. To qualitatively test the heat resistance of the phantom, it was heated with the LITT method up to approximately 120 degrees C and then was cut to find out if it has been melted. RESULTS In contrast to liver, where the absorption change with temperature showed a sigmoidal form with a jump at T approximately equal 45 degrees C, the absorption of the gel varied slightly over the whole temperature range. However, the gel absorption presented a linear increase from approximately 1.8 to approximately 2.2 mm(-1) with the rising hemoglobin concentration. The gel relaxation times showed a linear decrease with the rising concentrations of the respective contrast agents. Conversely, with the rising temperature, both T1 and T2 increased linearly and showed almost the same trends as in liver. The concentrations of hemoglobin and T1 and T2 contrast agents were determined as 3.92 +/- 0.42 vol. %, 0.098 +/- 0.023 vol. %, and 2.980 +/- 0.067 vol. %, respectively. The measured ex vivo liver T1 value increased from approximately 300 to approximately 530 ms and T2 value from approximately 45 to approximately 52 ms over the temperature range. The phantom validation experiments resulted in absorption coefficients of 2.0-2.1 mm(-1) with variations of 1.5%-2.95% compared to liver below 50 degrees C, T1 of 246.6-597.2 ms and T2 of 40.8-67.1 ms over the temperature range of 25-75 degrees C. Using the Bland-Altman analysis, a difference mean of -6.1/1.9 ms was obtained for T1/T2 between the relaxation times of the phantom and liver. After heating the phantom with LITT, no evidence of melting was observed. CONCLUSIONS The constructed phantom is heat-resistant and MR-compatible and can be used as an alternative to liver tissue in the MR-guided thermal ablation experiments with laser to develop clinical tools for real-time monitoring and controlling the thermal ablation progress in liver.
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Affiliation(s)
- Babak Bazrafshan
- Department of Diagnostic and Interventional Radiology, Hospital of the J. W. Goethe University of Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Mclean K, Lilienfeld H, Caracciolo JT, Hoffe S, Tourtelot JB, Carter WB. Management of Isolated Adrenal Lesions in Cancer Patients. Cancer Control 2011; 18:113-26. [DOI: 10.1177/107327481101800206] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Kelly Mclean
- Endocrine Tumor Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Howard Lilienfeld
- Endocrine Tumor Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | | | - Sarah Hoffe
- Radiation Oncology Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - John B. Tourtelot
- Endocrine Tumor Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - W. Bradford Carter
- Endocrine Tumor Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Ahrar K, Gowda A, Javadi S, Borne A, Fox M, McNichols R, Ahrar JU, Stephens C, Stafford RJ. Preclinical assessment of a 980-nm diode laser ablation system in a large animal tumor model. J Vasc Interv Radiol 2010; 21:555-61. [PMID: 20346883 DOI: 10.1016/j.jvir.2010.01.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 11/29/2009] [Accepted: 01/02/2010] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To characterize the performance of a 980-nm diode laser ablation system in an in vivo tumor model. MATERIALS AND METHODS This study was approved by the institutional animal care and use committee. The ablation system consisted of a 15-W, 980-nm diode laser, flexible diffusing-tipped fiber optic, and 17-gauge internally cooled catheter. Ten immunosuppressed dogs were inoculated subcutaneously with canine-transmissible venereal tumor fragments in eight dorsal locations. Laser ablations were performed at 79 sites where inoculations were successful (99%) at powers of 10 W, 12.5 W, and 15 W, with exposure times between 60 and 180 seconds. In 20 cases, multiple overlapping ablations were performed. After the dogs were euthanized, the tumors were harvested, sectioned along the applicator tract, measured, and photographed. Measurements of ablation zone were performed on gross specimen. Histopathology and viability staining was performed with hematoxylin and eosin and nicotinamide adenine dinucleotide hydrogen staining. RESULTS Gross pathologic examination confirmed a well circumscribed ablation zone with sharp boundaries between thermally ablated tumor in the center surrounded by viable tumor tissue. When a single applicator was used, the greatest ablation diameters ranged from 12 mm at the lowest dose (10 W, 60 seconds) to 26 mm at the highest dose (15 W, 180 seconds). Multiple applicators created ablation zones as large as 42 mm in greatest diameter (with the lasers operating at 15 W for 120 seconds). CONCLUSIONS The new 980-nm diode laser and internally cooled applicator effectively create large ellipsoid thermal ablations in less than 3 minutes.
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Affiliation(s)
- Kamran Ahrar
- Department of Radiology, Section of Interventional Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
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Streitparth F, Knobloch G, Balmert D, Chopra S, Rump J, Wonneberger U, Philipp C, Hamm B, Teichgräber U. Laser-induced thermotherapy (LITT)--evaluation of a miniaturised applicator and implementation in a 1.0-T high-field open MRI applying a porcine liver model. Eur Radiol 2010; 20:2671-8. [PMID: 20526885 DOI: 10.1007/s00330-010-1831-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 04/23/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the feasibility and safety of a novel LITT applicator for thermal ablation of liver malignancies in 1.0-T high-field open MRI. METHODS A miniaturised 6-F double-tubed protective catheter with a closed cooling circuit was used with a flexible laser fibre, connected to a 1,064-nm Nd:YAG laser and evaluated in non-perfused porcine livers (18-30 W for 10-20 min, 2-W and 2-min increments; n = 210/applicator) in reference to an established 9-F system. As a proof of concept, MR-guided LITT was performed in two healthy domestic pigs in high-field open MRI. RESULTS Ex-vivo, the coagulation volumes induced by the 6-F system with maximum applicable power of 24 W for 20 min (33.0 ± 4.4 cm(3)) did not differ significantly from those set with the 9-F system at 30 W for 20 min (35.8 ± 4.9 cm(3)) (p = 0.73). A flow-rate of 15 ml/min of the cooling saline solution was sufficient. MR navigation and thermometry were feasible. CONCLUSION The miniaturised 6-F applicator can create comparable coagulation sizes to those of the 9-F system. Applicator guidance and online-thermometry in high-field open MRI are feasible.
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Affiliation(s)
- Florian Streitparth
- Department of Radiology, Charité, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Abstract
Needlescopic adrenal ablative therapy is an attractive therapeutic option for the management of small adrenal masses. The spectrum of neoplasms that can be ablated includes isolated solid organ metastases (lung, kidney, liver), nonisolated but symptomatic (painful) adrenal metastasis, and small, nonmetastatic, hormonally active adrenal tumors. Moreover, needlescopic ablation offers an effective minimally morbid intervention for patients who are poor surgical candidates either due to advanced age and/or significant comorbid conditions. Ablative techniques described to date include radiofrequency ablation (RFA), cryoablation, and chemical ablation. Most procedures can be performed under percutaneous radiographic guidance on an outpatient basis. By and large, the bulk of clinical experience with adrenal ablation pertains to RFA. Successful ablation is usually dependent upon lesion size, with tumors 5 cm or smaller demonstrating the highest successful ablation rates. The most frequently described adverse sequelae of adrenal ablation are local tumor recurrences. However, many of these local recurrences can be managed by repeat ablation, with patients demonstrating durable oncologic outcomes.
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Affiliation(s)
- Eric Lauer
- Penn State Milton S. Hershey Medical Center, Division of Urology, 500 University Drive, C4830B, Hershey, PA 17033, USA
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27
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Bibliography. Current world literature. Obesity and nutrition. Curr Opin Endocrinol Diabetes Obes 2008; 15:470-5. [PMID: 18769222 DOI: 10.1097/med.0b013e328311f3cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Papini E, Bizzarri G, Pacella CM. Percutaneous laser ablation of benign and malignant thyroid nodules. Curr Opin Endocrinol Diabetes Obes 2008; 15:434-9. [PMID: 18769216 DOI: 10.1097/med.0b013e32830eb89a] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Percutaneous image-guided procedures, largely based on thermal ablation, are at present under investigation for achieving a nonsurgical targeted cytoreduction in benign and malignant thyroid lesions. RECENT FINDINGS In several uncontrolled clinical trials and in two randomized clinical trials, laser ablation has demonstrated a good efficacy and safety for the shrinkage of benign cold thyroid nodules. In hyperfunctioning nodules, laser ablation induced a nearly 50% volume reduction with a variable frequency of normalization of thyroid-stimulating hormone levels. Laser ablation has been tested for the palliative treatment of poorly differentiated thyroid carcinomas, local recurrences or distant metastases. SUMMARY Laser ablation therapy is indicated for the shrinkage of benign cold nodules in patients with local pressure symptoms who are at high surgical risk. The treatment should be performed only by well trained operators and after a careful cytological evaluation. Laser ablation does not seem to be consistently effective in the long-term control of hyperfunctioning thyroid nodules and is not an alternative treatment to 131I therapy. Laser ablation may be considered for the cytoreduction of tumor tissue prior to external radiation therapy or chemotherapy of local or distant recurrences of thyroid malignancy that are not amenable to surgical or radioiodine treatment.
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Affiliation(s)
- Enrico Papini
- Department of Endocrinology, Regina Apostolorum Hospital, Albano, Rome, Italy.
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Mahnken AH, Bruners P, Günther RW. Techniques of interventional tumor therapy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:646-53. [PMID: 19471636 DOI: 10.3238/arztebl.2008.0646] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 05/26/2008] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The last few years have seen the rapid development of new image-guided interventions for the local treatment of malignant tumors. The goal of this article is to provide an overview of the techniques that are most commonly used today in interventional oncology. METHODS Selective literature review on the current state of image-guided interventional techniques for local tumor therapy. RESULTS While surgery, radiation oncology, and systemic chemotherapy are still the three main pillars of tumor therapy, a broad range of minimally invasive, image-guided techniques for local tumor treatment is now available. These may be categorized as percutaneous injection of a toxic substance, transarterial embolization, thermal ablation, and internal radiotherapy. The choice of treatment depends on the type, location, and size of tumor. The greatest amount of clinical experience to date has been gathered in the treatment of primary and secondary hepatic malignancy, but there are interventional treatment options for virtually all regions of the body. At present, the utility of this form of treatment is limited for very large or multiple tumors; novel therapeutic options for these situations are now being studied. DISCUSSION The outcome of treatment depends on a judicious determination of the indication for it. The indication should be established by interdisciplinary consensus after all treatment options have been considered.
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Affiliation(s)
- Andreas H Mahnken
- Klinik für radiologische Diagnostik, Universitätsklinikum der RWTH Aachen.
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Pacella CM, Stasi R, Bizzarri G, Pacella S, Graziano FM, Guglielmi R, Papini E. Percutaneous laser ablation of unresectable primary and metastatic adrenocortical carcinoma. Eur J Radiol 2007; 66:88-94. [PMID: 17498906 DOI: 10.1016/j.ejrad.2007.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2006] [Revised: 04/04/2007] [Accepted: 04/05/2007] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the feasibility, safety, and clinical benefits of percutaneous laser ablation (PLA) in patients with unresectable primary and metastatic adrenocortical carcinoma (ACC). PATIENTS AND METHODS Four patients with hepatic metastases from ACC and a Cushing's syndrome underwent ultrasound-guided PLA. In one case the procedure was performed also on the primary tumor. RESULTS After three sessions of PLA, the primary tumor of 15 cm was ablated by 75%. After 1-4 (median 1) sessions of PLA, five liver metastases ranging from 2 to 5 cm were completely ablated, while the sixth tumor of 12 cm was ablated by 75%. There were no major complications. Treatment resulted in an improvement of performance status and a reduction of the daily dosage of mitotane in all patients. The three patients with liver metastases presented a marked decrease of 24-h urine cortisol levels, an improved control of hypertension and a mean weight loss of 2.8 kg. After a median follow-up after PLA of 27.0 months (range, 9-48 months), two patients have died of tumor progression, while two other patients remain alive and free of disease. CONCLUSIONS Percutaneous laser ablation is a feasible, safe and well tolerated procedure for the palliative treatment of unresectable primary and metastatic ACC. Further study is required to evaluate the impact of PLA on survival.
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Affiliation(s)
- Claudio M Pacella
- Regina Apostolorum Hospital, Department of Diagnostic Imaging and Interventional Radiology, Via San Francesco 50, Albano Laziale, Rome 00041, Italy.
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