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Richards HS, Cousins S, Scroggie DL, Elliott D, Macefield R, Hudson E, Mutanga IR, Shah M, Alford N, Blencowe NS, Blazeby J. Examining the application of the IDEAL framework in the reporting and evaluation of innovative invasive procedures: secondary qualitative analysis of a systematic review. BMJ Open 2024; 14:e079654. [PMID: 38803251 PMCID: PMC11129025 DOI: 10.1136/bmjopen-2023-079654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES The development of new surgical procedures is fundamental to advancing patient care. The Idea, Developments, Exploration, Assessment and Long-term (IDEAL) framework describes study designs for stages of innovation. It can be difficult to apply due to challenges in defining and identifying innovative procedures. This study examined how the IDEAL framework is operationalised in real-world settings; specifically, the types of innovations evaluated using the framework and how authors justify their choice of IDEAL study design. DESIGN Secondary qualitative analysis of a systematic review. DATA SOURCES Citation searches (Web of Science and Scopus) identified studies following the IDEAL framework and citing any of the ten key IDEAL/IDEAL_D papers. ELIGIBILITY CRITERIA Studies of invasive procedures/devices of any design citing any of the ten key IDEAL/IDEAL_D papers. DATA EXTRACTION AND SYNTHESIS All relevant text was extracted. Three frameworks were developed, namely: (1) type of innovation under evaluation; (2) terminology used to describe stage of innovation and (3) reported rationale for IDEAL stage. RESULTS 48 articles were included. 19/48 described entirely new procedures, including those used for the first time in a different clinical context (n=15/48), reported as IDEAL stage 2a (n=8, 53%). Terminology describing stage of innovation was varied, inconsistent and ambiguous and was not defined. Authors justified their choice of IDEAL study design based on limitations in published evidence (n=36) and unknown feasibility and safety (n=32) outcomes. CONCLUSION Identifying stage of innovation is crucial to inform appropriate study design and governance decisions. Authors' rationale for choice of IDEAL stage related to the existing evidence base or lack of sufficient outcome data for procedures. Stage of innovation was poorly defined with inconsistent descriptions. Further work is needed to develop methods to identify innovation to inform practical application of the IDEAL framework. Defining the concept of innovation in terms of uncertainty, risk and degree of evidence may help to inform decision-making.
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Affiliation(s)
- Hollie Sarah Richards
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Sian Cousins
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Darren L Scroggie
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Daisy Elliott
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Rhiannon Macefield
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Elizabeth Hudson
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Ian Rodney Mutanga
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Maximilian Shah
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Natasha Alford
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Natalie S Blencowe
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Jane Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
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Effects of different applied voltages of irreversible electroporation on prostate cancer in a mouse model. Sci Rep 2022; 12:22336. [PMID: 36572706 PMCID: PMC9792528 DOI: 10.1038/s41598-022-25258-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/28/2022] [Indexed: 12/28/2022] Open
Abstract
As a non-thermal ablation method, irreversible electroporation (IRE) has been widely investigated in the treatment of prostate cancer. However, no consensus has been achieved on the optimal parameters of IRE for prostate cancer. Since high voltage is known to carry risks of muscle contraction and patient discomfort, it is crucial to identify the minimum but effective and safer applied voltage to inhibit tumor growth. In this study, the effect of different applied voltages of IRE on prostate cancer was evaluated in BALB/c nude mice. Mathematical simulation and measurement of the actual ablation area revealed a larger ablation area at a higher voltage. In in vivo experiment, except for the three different voltages applied, all groups received identical electrical conditions: pulse number, 180 (20 groups × 9 pulses/group); pulse width, 100 µs; pulse interval, 2 ms; distance between the electrodes, 5 mm; and electrode exposure length, 15 mm. Whilst the tumor volume initially decreased in the 500 V (1000 V/cm) and 700 V (1400 V/cm) groups and subsequently increased, only a transient increase followed by a continuous decrease until the sacrifice was observed in the 900 V (1800 V/cm) group. This result demonstrated a lasting effect of a higher applied voltage on tumor growth inhibition. The histological, immunohistochemical, and western blot findings all confirmed IRE-induced apoptosis in the treatment groups. Taken together, 900 V seemed to be the minimum applied voltage required to reduce tumor growth, though subsequent studies are anticipated to further narrow the voltage intervals and lower the minimum voltage required for tumor inhibition.
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High-Frequency Pulsed Electric Field Ablation in Beagle Model for Treatment of Prostate Cancer. Cancers (Basel) 2022; 14:cancers14204987. [PMID: 36291771 PMCID: PMC9599345 DOI: 10.3390/cancers14204987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Around 248,530 newly diagnosed in 2021, prostate cancer has been the most frequently diagnosed cancer in the USA. Rapid decellularization preserving acellular tissues is essential for accurate treatment and regeneration in affected areas. Our study aimed to assess the safety and efficacy of high-frequency pulsed electric field (HF-PEF) in a beagle model for the treatment of prostate cancer. We confirmed that HF-PEF of 1800 V/cm, 100 μs width, 2 ms interval successfully decellularized the prostate tissue after 4 hours, and the tissues were almost regenerated in 28 days. IRE with HF-PEF has therapeutic potential to treat prostate cancer while minimizing damage to the surrounding tissues. Abstract Conventional irreversible electroporation (IRE) with low-frequency pulsed electric field (LF-PEF) is used to induce cell death; however, it has several disadvantages including a long procedure time and severe muscle contraction due to high-voltage electric field. This study investigates a novel IRE protocol with high-frequency pulsed electric field (HF-PEF) of 500 Hz repetition to ablate the prostate tissue in beagles for treatment of prostate cancer. A finite element analysis was performed to validate optimal electrical field strength for the procedure. In total, 12 beagles received HF-PEF of 500 Hz and were sacrificed at 4 h, 4 days, and 28 days (3 each). The remaining three beagles underwent sham procedure. The outcomes of HF-PEF were assessed by histological responses. HF-PEF successfully decellularized the prostate tissues 4 h after the treatment. The prostate glands, duct, and urethra were well preserved after IRE with HF-PEF. The ablated prostatic tissues were gradually regenerated and appeared similar to the original tissues 28 d after IRE with HF-PEF. Moreover, electrocardiography and hematology demonstrated that IRE with HF-PEF did not seriously affect the cardiac tissue. HF-PEF was effective and safe in the beagle prostate and effectively induced the ablation and gradually recovered with cellular regeneration.
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Macefield RC, Wilson N, Hoffmann C, Blazeby JM, McNair AGK, Avery KNL, Potter S. Outcome selection, measurement and reporting for new surgical procedures and devices: a systematic review of IDEAL/IDEAL-D studies to inform development of a core outcome set. BJS Open 2020; 4:1072-1083. [PMID: 33016009 PMCID: PMC8444278 DOI: 10.1002/bjs5.50358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/20/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Outcome selection, measurement and reporting for the evaluation of new surgical procedures and devices is inconsistent and lacks standardization. A core outcome set may promote the safe and transparent evaluation of surgical innovations. This systematic review examined outcome selection, measurement and reporting in studies conducted within the IDEAL (Idea, Development, Exploration, Assessment and Long-term monitoring) framework to examine current practice and inform the development of a core outcome set for early-phase studies of surgical procedures/devices. METHODS Web of Science and Scopus citation searches were performed to identify author-reported IDEAL/IDEAL-D studies for any surgical procedure/device. Outcomes were extracted verbatim, including contextual information regarding outcome selection and measurement. Outcomes were categorized to inform a conceptual framework of outcome domains relevant to evaluating innovation. RESULTS Some 48 studies were identified. Outcome selection, measurement and reporting varied widely across studies in different IDEAL stages. From 1737 outcomes extracted, 22 domains specific to evaluating innovation were conceptualized under seven broad categories: procedure completion success/failure; modifications; unanticipated events; surgeons' experiences; patients' experiences; resource use specific to the innovative procedure/device; and other innovation-specific outcomes. Most innovation-specific outcomes were measured and reported in only a small number of studies. CONCLUSION This review highlighted the need for guidance and standardization in outcome selection and reporting in the evaluation of new surgical procedures/devices. Novel outcome domains specific to innovation have been identified to establish a core outcome set for future evaluations of surgical innovations.
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Affiliation(s)
- R. C. Macefield
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical SchoolUniversity of BristolBristolUK
| | - N. Wilson
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical SchoolUniversity of BristolBristolUK
| | - C. Hoffmann
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical SchoolUniversity of BristolBristolUK
| | - J. M. Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical SchoolUniversity of BristolBristolUK
| | - A. G. K. McNair
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical SchoolUniversity of BristolBristolUK
- Department of Gastrointestinal SurgeryBristolUK
| | - K. N. L. Avery
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical SchoolUniversity of BristolBristolUK
| | - S. Potter
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical SchoolUniversity of BristolBristolUK
- Bristol Breast Care CentreNorth Bristol NHS TrustBristolUK
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Westhoff N, Ritter M, Maros M, Rassweiler-Seyfried MC, Michel MS, Honeck P, von Hardenberg J. Prospective Feasibility Study of Single-Shot Antibiotic Prophylaxis in Transrectal Focal Ablation of Prostate Cancer. Urol Int 2020; 104:378-385. [PMID: 32396911 DOI: 10.1159/000507123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/10/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Urinary tract infections (UTI) represent the most frequent complications after transrectal focal ablation of prostate cancer. Single-shot antibiotic prophylaxis for prevention has not yet been described. METHODS In this cohort study of patients who received a high-intensity focused ultrasound (HIFU) ablation of prostate cancer within a registered prospective single-arm trial, we analyzed posttreatment UTI (≤30 days after HIFU) related to perioperative antibiotic management in an exploratory analysis: single-shot prophylaxis or targeted treatment for bacteriuria. Potential risk factors associated with UTI were evaluated by uni- and multivariate regression analyses. RESULTS In total, 55 patients were eligible for analysis. Of these, 76.4% received antibiotic single-shot prophylaxis. UTI occurred in 10.7% of all patients, 5.4% developed fever, 3.6% required hospitalization. An antibiotic single-shot prophylaxis helped to protect 90.5% of men from infectious complications. Estimated effects indicate that a longer posttreatment catheterization (OR 3.38, 95% CI 0.47-27.08) and larger ablation volume (OR 4.85, 95% CI 0.61-107.49) might be associated with the highest risk for UTI after treatment. CONCLUSION Single-shot antibiotic prophylaxis compared to a targeted antibiotic treatment showed a similar effectivity to prevent patients from infectious complications and should be considered as an element of antibiotic stewardship. Further research on risk factors and antibiotic strategies is required.
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Affiliation(s)
- Niklas Westhoff
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany,
| | - Manuel Ritter
- Department of Urology and Pediatric Urology, University Hospital of Bonn, Bonn, Germany
| | - Máté Maros
- Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marie-Claire Rassweiler-Seyfried
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Maurice-Stephan Michel
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Patrick Honeck
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jost von Hardenberg
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Quality of life assessment for patients undergoing irreversible electroporation (IRE) for treatment of locally advanced pancreatic cancer (LAPC). Am J Surg 2019; 218:571-578. [DOI: 10.1016/j.amjsurg.2019.03.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/24/2019] [Accepted: 03/27/2019] [Indexed: 12/25/2022]
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Scheltema MJ, O'Brien TJ, van den Bos W, de Bruin DM, Davalos RV, van den Geld CWM, Laguna MP, Neal RE, Varkarakis IM, Skolarikos A, Stricker PD, de Reijke TM, Arena CB, de la Rosette J. Numerical simulation modeling of the irreversible electroporation treatment zone for focal therapy of prostate cancer, correlation with whole-mount pathology and T2-weighted MRI sequences. Ther Adv Urol 2019; 11:1756287219852305. [PMID: 31217820 PMCID: PMC6557022 DOI: 10.1177/1756287219852305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/29/2019] [Indexed: 12/14/2022] Open
Abstract
Background: At present, it is not possible to predict the ablation zone volume following irreversible electroporation (IRE) for prostate cancer (PCa). This study aimed to determine the necessary electrical field threshold to ablate human prostate tissue in vivo with IRE. Methods: In this prospective multicenter trial, patients with localized PCa were treated with IRE 4 weeks before their scheduled radical prostatectomy. In 13 patients, numerical models of the electrical field were generated and compared with the ablation zone volume on whole-mount pathology and T2-weighted magnetic resonance imaging (MRI) sequences. Volume-generating software was used to calculate the ablation zone volumes on histology and MRI. The electric field threshold to ablate prostate tissue was determined for each patient. Results: A total of 13 patients were included for histological and simulation analysis. The median electrical field threshold was 550 V/cm (interquartile range 383–750 V/cm) for the software-generated histology volumes. The median electrical field threshold was 500 V/cm (interquartile range 386–580 V/cm) when the ablation zone volumes were used from the follow-up MRI. Conclusions: The electrical field threshold to ablate human prostate tissue in vivo was determined using whole-mount pathology and MRI. These thresholds may be used to develop treatment planning or monitoring software for IRE prostate ablation; however, further optimization of simulation methods are required to decrease the variance that was observed between patients.
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Affiliation(s)
- Matthijs J Scheltema
- Department of Urology, Amsterdam UMC, Meibergdreef 9, Room G4-249, Amsterdam, 1105 AZ, The Netherlands
| | - Tim J O'Brien
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | | | | | - Rafael V Davalos
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Cees W M van den Geld
- Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Maria P Laguna
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey Amsterdam UMC, Amsterdam, the Netherlands
| | - Robert E Neal
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Ioannis M Varkarakis
- Second Urology Department, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Andreas Skolarikos
- Second Urology Department, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Phillip D Stricker
- Department of Urology, St. Vincent's Prostate Cancer Centre, Sydney, Australia
| | - Theo M de Reijke
- Department of Urology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Christopher B Arena
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Jean de la Rosette
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey Amsterdam UMC, Amsterdam, the Netherlands
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Giganti F, Stabile A, Giona S, Marenco J, Orczyk C, Moore CM, Allen C, Kirkham A, Emberton M, Punwani S. Prostate cancer treated with irreversible electroporation: MRI-based volumetric analysis and oncological outcome. Magn Reson Imaging 2019; 58:143-147. [PMID: 30768957 DOI: 10.1016/j.mri.2019.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/21/2019] [Accepted: 02/10/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND To assess multiparametric magnetic resonance imaging (mpMRI) characteristics in prostate cancer (PCa) before and after irreversible electroporation (IRE) and to investigate their correlation with the presence of post-operative recurrence of PCa. METHODS MpMRI was performed in 30 men with PCa prior to treatment, after 10 days and at 6 months. An additional scan at 1 year was available for 18 men. Two radiologists assessed retrospectively the following parameters by planimetry: tumour volume, necrotic volume (early post-treatment scan) and residual fibrosis. Residual tumour/recurrence were defined as a suspicious area within the treatment field scored ≥ 4 on a 1-to-5 scale. Oncological outcome was also assessed. RESULTS The median follow-up of the entire study was 16 months. Six men were undertreated and showed mpMRI recurrence after 6 months. At 1-year, three additional men had recurrence. Overall, four of these 9 men (44%) were retreated. The other five men did not receive any further treatment. Median time to re-treatment was 15 months. Median pre-treatment lesion volume was 0.65 cc, 0.66 cc and 0.43 cc on the different mpMRI sequences (T2-weighted, diffusion-weighted and dynamic contrast enhanced imaging). Median necrotic volume was 10.77 cc. Median overall residual fibrosis volumes were 0.84 cc and 0.95 cc at 6-month and 1-year mpMRI. Pre-treatment, necrotic and residual fibrosis volumes were significantly different (p < 0.001). Pre-treatment tumour volumes on diffusion-weighted imaging and necrotic volumes were correlated (r = 0.18; p = 0.02). CONCLUSIONS MpMRI is able to visualise the IRE ablation effects in men with PCa. MpMRI-derived parameters - such as tumour, necrotic and fibrosis volumes - can be measured and are potentially useful for assessing efficacy in the medium term, as with other ablative techniques.
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Affiliation(s)
- Francesco Giganti
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.
| | - Armando Stabile
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Simone Giona
- Department of Urology, Frimley Park Hospital, Frimley, Camberley, UK
| | - José Marenco
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clement Orczyk
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Centre for Medical Imaging, University College London, London, UK
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White SB, Zhang Z, Chen J, Gogineni VR, Larson AC. Early Immunologic Response of Irreversible Electroporation versus Cryoablation in a Rodent Model of Pancreatic Cancer. J Vasc Interv Radiol 2018; 29:1764-1769. [DOI: 10.1016/j.jvir.2018.07.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 12/25/2022] Open
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Sugimoto K, Moriyasu F, Tsuchiya T, Nagakawa Y, Hosokawa Y, Saito K, Tsuchida A, Itoi T. Irreversible Electroporation for Nonthermal Tumor Ablation in Patients with Locally Advanced Pancreatic Cancer: Initial Clinical Experience in Japan. Intern Med 2018; 57:3225-3231. [PMID: 29984761 PMCID: PMC6287993 DOI: 10.2169/internalmedicine.0861-18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective To evaluate irreversible electroporation (IRE) for locally advanced pancreatic cancer (LAPC). Methods This study was approved by our local review board. Eight patients with histologically proven LAPC ≤5 cm were prospectively enrolled to undergo ultrasound-guided IRE. The primary endpoint was complications within 90 days. Secondary outcomes were the overall survival (OS) and time to local progression. Safety was assessed using Common Terminology Criteria for Adverse Events Version 4.0. Results All patients were treated successfully. The median procedure time was 150 min. The median largest tumor diameter was 29.5 mm (20.0-48.0 mm) in the pancreatic head (n=5) and body (n=3). Open (n=4) and percutaneous (n=4) approaches were used. No patients died within 90 days after IRE. There were 5 minor complications in 3 patients and 4 major complications in 3 patients. The incidence rates of major complications did not differ significantly between the approaches. The median time to local progression after IRE was 12.0 months, and the median OS was 17.5 months from IRE and 24.0 months from the diagnosis, with no significant differences between the approaches. Conclusions Percutaneous and open IRE may be acceptable for patients with LAPC (despite some major adverse events) and may represent a useful new therapeutic option.
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Affiliation(s)
- Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Fuminori Moriyasu
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Japan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal Surgery, Tokyo Medical University, Japan
| | - Yuichi Hosokawa
- Department of Gastrointestinal Surgery, Tokyo Medical University, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, Japan
| | - Akihiko Tsuchida
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
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Parchur AK, Sharma G, Jagtap JM, Gogineni VR, LaViolette PS, Flister MJ, White SB, Joshi A. Vascular Interventional Radiology-Guided Photothermal Therapy of Colorectal Cancer Liver Metastasis with Theranostic Gold Nanorods. ACS NANO 2018; 12:6597-6611. [PMID: 29969226 PMCID: PMC9272590 DOI: 10.1021/acsnano.8b01424] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We report sub-100 nm optical/magnetic resonance (MR)/X-ray contrast-bearing theranostic nanoparticles (TNPs) for interventional image-guided photothermal therapy (PTT) of solid tumors. TNPs were composed of Au@Gd2O3:Ln (Ln = Yb/Er) with X-ray contrast (∼486 HU; 1014 NPs/mL, 0.167 nM) and MR contrast (∼1.1 × 108 mM-1 S-1 at 9.4 T field strength). Although TNPs are deposited in tumors following systemic administration via enhanced permeation and retention effect, the delivered dose to tumors is typically low; this can adversely impact the efficacy of PTT. To overcome this limitation, we investigated the feasibility of site-selective hepatic image-guided delivery of TNPs in rats bearing colorectal liver metastasis (CRLM). The mesenteric vein of tumor-bearing rats was catheterized, and TNPs were infused into the liver by accessing the portal vein for site-selective delivery. The uptake of TNPs with hepatic delivery was compared with systemic administration. MR imaging confirmed that delivery via the hepatic portal vein can double the CRLM tumor-to-liver contrast compared with systemic administration. Photothermal ablation was performed by inserting a 100 μm fiber-optic carrying 808 nm light via a JB1, 3-French catheter for 3 min under DynaCT image guidance. Histological analysis revealed that the thermal damage was largely confined to the tumor region with minimal damage to the adjacent liver tissue. Transmission electron microscopy imaging validated the stability of core-shell structure of TNPs in vivo pre- and post-PTT. TNPs comprising Gd-shell-coated Au nanorods can be effectively employed for the site-directed PTT of CRLM by leveraging interventional radiology methods.
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Affiliation(s)
- Abdul Kareem Parchur
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | - Gayatri Sharma
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | - Jaidip M. Jagtap
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | | | - Peter S. LaViolette
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | - Michael J. Flister
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | - Sarah Beth White
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | - Amit Joshi
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
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Pesapane F, Patella F, Fumarola EM, Zanchetta E, Floridi C, Carrafiello G, Standaert C. The prostate cancer focal therapy. Gland Surg 2018; 7:89-102. [PMID: 29770305 PMCID: PMC5938267 DOI: 10.21037/gs.2017.11.08] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 10/31/2017] [Indexed: 12/21/2022]
Abstract
Despite prostate cancer (PCa) is the leading form of non-cutaneous cancer in men, most patients with PCa die with disease rather than of the disease. Therefore, the risk of overtreatment should be considered by clinicians who have to distinguish between patients with high risk PCa (who would benefit from radical treatment) and patients who may be managed more conservatively, such as through active surveillance or emerging focal therapy (FT). The aim of FT is to eradicate clinically significant disease while protecting key genito-urinary structures and function from injury. While effectiveness studies comparing FT with conventional care options are still lacking, the rationale supporting FT relies on evidence-based advances such as the understanding of the index lesion's central role in the natural history of the PCa and the improvement of multiparametric magnetic resonance imaging (mpMRI) in the detection and risk stratification of PCa. In this literature review, we want to highlight the rationale for FT in PCa management and the current evidence on patient eligibility. Furthermore, we summarize the best imaging modalities to localize the target lesion, describe the current FT techniques in PCa, provide an update on their oncological outcomes and highlight trends for future research.
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Affiliation(s)
- Filippo Pesapane
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Francesca Patella
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Enrico Maria Fumarola
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Edoardo Zanchetta
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Chiara Floridi
- Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Health Sciences, Diagnostic and Interventional Radiology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Chloë Standaert
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
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13
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Sun JH, Zhu TY, Chen XH, Nie CH, Ren ZG, Zhou GH, Zhou TY, Yin SY, Peng ZY, Wu LM, Zhang XX, Wang WL, Zheng SS. In vivo evaluation of bronchial injury of irreversible electroporation in a porcine lung ablation model by using laboratory, pathological, and CT findings. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:1273-1280. [PMID: 31938222 PMCID: PMC6958169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/12/2018] [Indexed: 06/10/2023]
Abstract
Irreversible electroporation (IRE) creates permanent pores in the cell membrane, leading to irreversible cell death. In this study, the impact of IRE on bronchial injury was comprehensively examined in a timed series study. Altogether, 8 Bama miniature pigs were included in this study and were randomly assigned to experimental and control groups. The experimental group underwent IRE that was guided and monitored by spiral computed tomography (CT). The monopole probe of the IRE was positioned at the right pulmonary hilum. Specimens were collected at 0 h, 2 h, 2 d, 7 d, and 14 d after the IRE procedure for a pathological examination. A small amount of needle-tract bleeding occurred in two animals, and mild pneumothorax occurred in another. IRE can elicit acute bronchial inflammation, bleeding, and mucosal injury, but severe complications were not found. Pathological examinations and transmission electron microscopy (TEM) showed dead vascular epithelium cells in the region of the ablation, while the bronchioli and the vascular extracellular matrix were preserved. At 2 hours post-IRE, there were marked increases in bronchoalveolar macrophages (P<0.001), but the inflammation could recover after 14 days and showed no statistical significance when compared with the control group at the same time. In conclusion, CT-guided IRE ablation can elicit acute but recoverable bronchial inflammation, bleeding, and mucosal injury in porcine lung tissues. However, longer follow-up is still required to establish an evaluation of the long-term safety.
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Affiliation(s)
- Jun-Hui Sun
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang ProvinceHangzhou, China
- Clinical Medical Research Center for Hepatobiliary and Pancreatic Disease of Zhejiang ProvinceHangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public HealthHangzhou, China
| | - Tong-Yin Zhu
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang ProvinceHangzhou, China
- Clinical Medical Research Center for Hepatobiliary and Pancreatic Disease of Zhejiang ProvinceHangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public HealthHangzhou, China
| | - Xin-Hua Chen
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang ProvinceHangzhou, China
- Clinical Medical Research Center for Hepatobiliary and Pancreatic Disease of Zhejiang ProvinceHangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public HealthHangzhou, China
| | - Chun-Hui Nie
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang ProvinceHangzhou, China
- Clinical Medical Research Center for Hepatobiliary and Pancreatic Disease of Zhejiang ProvinceHangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public HealthHangzhou, China
| | - Zhi-Gang Ren
- Department of Infectious Diseases; Precision Medicine Center, The First Affiliated Hospital of Zhengzhou UniversityZhengzhou, China
| | - Guan-Hui Zhou
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang ProvinceHangzhou, China
- Clinical Medical Research Center for Hepatobiliary and Pancreatic Disease of Zhejiang ProvinceHangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public HealthHangzhou, China
| | - Tan-Yang Zhou
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang ProvinceHangzhou, China
- Clinical Medical Research Center for Hepatobiliary and Pancreatic Disease of Zhejiang ProvinceHangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public HealthHangzhou, China
| | - Sheng-Yong Yin
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang ProvinceHangzhou, China
- Clinical Medical Research Center for Hepatobiliary and Pancreatic Disease of Zhejiang ProvinceHangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public HealthHangzhou, China
| | - Zhi-Yi Peng
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang ProvinceHangzhou, China
- Clinical Medical Research Center for Hepatobiliary and Pancreatic Disease of Zhejiang ProvinceHangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public HealthHangzhou, China
| | - Li-Ming Wu
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang ProvinceHangzhou, China
- Clinical Medical Research Center for Hepatobiliary and Pancreatic Disease of Zhejiang ProvinceHangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public HealthHangzhou, China
| | - Xiong-Xin Zhang
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang ProvinceHangzhou, China
- Clinical Medical Research Center for Hepatobiliary and Pancreatic Disease of Zhejiang ProvinceHangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public HealthHangzhou, China
| | - Wei-Lin Wang
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang ProvinceHangzhou, China
- Clinical Medical Research Center for Hepatobiliary and Pancreatic Disease of Zhejiang ProvinceHangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public HealthHangzhou, China
| | - Shu-Sen Zheng
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public HealthHangzhou, China
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Baur ADJ, Collettini F, Enders J, Maxeiner A, Schreiter V, Stephan C, Gebauer B, Hamm B, Fischer T. MRI-TRUS fusion for electrode positioning during irreversible electroporation for treatment of prostate cancer. Diagn Interv Radiol 2018; 23:321-325. [PMID: 28508759 DOI: 10.5152/dir.2017.16276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We aimed to introduce an approach for image-guided positioning of electrodes for irreversible electroporation (IRE) in patients with prostate cancer using a magnetic resonance imaging-transrectal ultrasonography (MRI-TRUS) fusion technique. In 10 consecutive patients with biopsy-proven Gleason score ≤3+4 prostate cancer, 19 G electrodes were inserted into the prostate using a transperineal access. Magnetic resonance images of the prostate acquired before IRE were fused with transrectal ultrasound images acquired during IRE. The position of the ultrasound probe was tracked via a sensor and corresponding magnetic resonance images were calculated in real-time. While MRI allowed delineation of the target volume, the position of the electrodes could be visualized on ultrasound images; the distance between individual electrode pairs was measured. Based on these measurements the software installed on the IRE unit was able to calculate the voltage necessary to generate the electric field for ablation. Using contrast-enhanced ultrasound, changes in perfusion within the ablation zone after IRE were documented. This technique allowed positioning of the electrodes around the target volume under image guidance in all patients treated with IRE. The target lesion and a safety margin were covered within the estimated ablation zone. MRI-TRUS guidance for IRE combines the advantages of good visualization of the target lesion on MRI with the ability of ultrasound to acquire imaging in real-time with a mobile device.
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Affiliation(s)
- Alexander D J Baur
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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15
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Graff P, Portalez D, Lusque A, Brun T, Aziza R, Khalifa J, Roumiguié M, Quintyn Ranty ML, Filleron T, Bachaud JM, Malavaud B. IDEAL 2a Phase II Study of Ultrafocal Brachytherapy for Low- and Intermediate-risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2018; 102:903-911. [PMID: 29510957 DOI: 10.1016/j.ijrobp.2018.01.066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/11/2018] [Accepted: 01/22/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Focal therapy of prostate cancer requires precise positioning of therapeutic agents within well-characterized index tumors (ITs). We assessed the feasibility of low-dose-rate ultrafocal brachytherapy. METHODS AND MATERIALS The present study was an institutional review board-approved European Clinical Trials Database-registered phase II protocol. Patients referred (October 2013 to August 2016) for active surveillance (prostate-specific antigen <10 ng/mL, cT1c-cT2a, Gleason score on referring biopsy specimens ≤6 (3+3), ≤3 positive biopsy cores, ≤50% of cancer) were preselected. Inclusion was confirmed when complementary image-guided biopsy findings informed a single Prostate Imaging Reporting and Data System (PI-RADS) ≥3, Gleason score ≤7a (3+4) lesion. A ultrasound-visible ancillary marker was positioned within the IT using a magnetic resonance imaging (MRI)/3-dimensional transrectal ultrasound (TRUS) elastic fusion-guided system (Koelis). Ultrafocal transperineal delivery of 125I seeds used classic 2-dimensional TRUS (Bard-FlexFocus) and dose optimization (Variseed Treatment Planning System). Following Simon's optimal design, 17 patients were required to assess the feasibility of delivering ≥95% of the prescribed dose (160 Gy) to the IT (primary objective). Adverse events (Common Terminology Criteria for Adverse Events) and quality of life (5-item International Index of Erectile Function, International Prostate Symptom Score) were recorded. One-year control biopsy specimens were obtained from the IT and untreated segments. RESULTS Of the 44 preselected patients, 27 did not meet the inclusion criteria. Of the 17 ultrafocal brachytherapy-treated patients, 16 met the primary objective (per protocol success). The prescription dose was delivered to 14.5% ± 6.4% of the prostate volume, resulting in negligible urethral and rectal irradiation and toxicity. No recurrence was evidenced on the 1-year follow-up MRI studies or IT biopsy specimens. Seven nonclinically significant cancers and one Gleason score 7a (3+4) cancer (salvage prostatectomy) were observed in the untreated parenchyma. CONCLUSIONS Recent technology has allowed for selective and effective brachytherapy of small MRI targets.
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Affiliation(s)
- Pierre Graff
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse, Toulouse, France.
| | - Daniel Portalez
- Department of Radiology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Amélie Lusque
- Department of Biostatistics, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Thomas Brun
- Department of Biophysics, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Richard Aziza
- Department of Radiology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Jonathan Khalifa
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Mathieu Roumiguié
- Department of Urology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | | | - Thomas Filleron
- Department of Biostatistics, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Jean-Marc Bachaud
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Bernard Malavaud
- Department of Urology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
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16
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Pañella C, Castellví Q, Moll X, Quesada R, Villanueva A, Iglesias M, Naranjo D, Sánchez-Velázquez P, Andaluz A, Grande L, Ivorra A, Burdío F. Focused Transhepatic Electroporation Mediated by Hypersaline Infusion through the Portal Vein in Rat Model. Preliminary Results on Differential Conductivity. Radiol Oncol 2017; 51:415-421. [PMID: 29333120 PMCID: PMC5765318 DOI: 10.1515/raon-2017-0051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 10/22/2017] [Indexed: 12/18/2022] Open
Abstract
Background Spread hepatic tumours are not suitable for treatment either by surgery or conventional ablation methods. The aim of this study was to evaluate feasibility and safety of selectively increasing the healthy hepatic conductivity by the hypersaline infusion (HI) through the portal vein. We hypothesize this will allow simultaneous safe treatment of all nodules by irreversible electroporation (IRE) when applied in a transhepatic fashion. Material and methods Sprague Dawley (Group A, n = 10) and Athymic rats with implanted hepatic tumour (Group B, n = 8) were employed. HI was performed (NaCl 20%, 3.8 mL/Kg) by trans-splenic puncture. Deionized serum (40 mL/Kg) and furosemide (2 mL/Kg) were simultaneously infused through the jugular vein to compensate hypernatremia. Changes in conductivity were monitored in the hepatic and tumour tissue. The period in which hepatic conductivity was higher than tumour conductivity was defined as the therapeutic window (TW). Animals were monitored during 1-month follow-up. The animals were sacrificed and selective samples were used for histological analysis. Results The overall survival rate was 82.4% after the HI protocol. The mean maximum hepatic conductivity after HI was 2.7 and 3.5 times higher than the baseline value, in group A and B, respectively. The mean maximum hepatic conductivity after HI was 1.4 times higher than tumour tissue in group B creating a TW to implement selective IRE. Conclusions HI through the portal vein is safe when the hypersaline overload is compensated with deionized serum and it may provide a TW for focused IRE treatment on tumour nodules.
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Affiliation(s)
- Clara Pañella
- General Surgery Department, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Quim Castellví
- Department of Informatics and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Xavier Moll
- Department of Pathological Anatomy, Hospital del Mar Medical Research Insitute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Rita Quesada
- General Surgery Department, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Alberto Villanueva
- Chemoresistance and Predictive Factors Group, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Mar Iglesias
- Medical and Surgery Animal Department, Faculty of Veterinary, Universitat Autònoma de Barcelona, Cerdanyola del VallèsBarcelona, Spain
| | - Dolores Naranjo
- Medical and Surgery Animal Department, Faculty of Veterinary, Universitat Autònoma de Barcelona, Cerdanyola del VallèsBarcelona, Spain
| | - Patricia Sánchez-Velázquez
- General Surgery Department, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Anna Andaluz
- Department of Pathological Anatomy, Hospital del Mar Medical Research Insitute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Luís Grande
- General Surgery Department, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Antoni Ivorra
- Department of Informatics and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Fernando Burdío
- General Surgery Department, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
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Focal Ablation of Early-Stage Prostate Cancer: Candidate Selection, Treatment Guidance, and Assessment of Outcome. Urol Clin North Am 2017; 44:575-585. [PMID: 29107274 DOI: 10.1016/j.ucl.2017.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Prostate cancer lesions smaller than 0.5 m3, or Gleason pattern 3, are likely clinically insignificant. Clinically significant disease is often limited to a single index lesion. Focal ablation targets this index lesion, maintains oncological control, and minimizes complications by preserving healthy prostate tissue. Template mapping biopsy or multiparametric MRI-targeted biopsies are used to identify appropriate index lesions. Multiple energy modalities have been tested, including high-intensity frequency ultrasound, cryoablation, laser ablation, photodynamic therapy, focal brachytherapy, radiofrequency ablation, irreversible electroporation. Outcome is assessed by biopsy of the target area, triggered by prostate-specific antigen measurements or MRI imaging, or performed per protocol at 12 months.
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18
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Campelo S, Valerio M, Ahmed HU, Hu Y, Arena SL, Neal RE, Emberton M, Arena CB. An evaluation of irreversible electroporation thresholds in human prostate cancer and potential correlations to physiological measurements. APL Bioeng 2017; 1:016101. [PMID: 31069281 PMCID: PMC6481690 DOI: 10.1063/1.5005828] [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: 03/21/2017] [Accepted: 06/26/2017] [Indexed: 12/18/2022] Open
Abstract
Irreversible electroporation (IRE) is an emerging cancer treatment that utilizes non-thermal electric pulses for tumor ablation. The pulses are delivered through minimally invasive needle electrodes inserted into the target tissue and lead to cell death through the creation of nanoscale membrane defects. IRE has been shown to be safe and effective when performed on tumors in the brain, liver, kidneys, pancreas, and prostate that are located near critical blood vessels and nerves. Accurate treatment planning and prediction of the ablation volume require a priori knowledge of the tissue-specific electric field threshold for cell death. This study addresses the challenge of defining an electric field threshold for human prostate cancer tissue. Three-dimensional reconstructions of the ablation volumes were created from one week post-treatment magnetic resonance imaging (MRIs) of ten patients who completed a clinical trial. The ablation volumes were incorporated into a finite element modeling software that was used to simulate patient-specific treatments, and the electric field threshold was calculated by matching the ablation volume to the field contour encompassing the equivalent volume. Solutions were obtained for static tissue electrical properties and dynamic properties that accounted for electroporation. According to the dynamic model, the electric field threshold was 506 ± 66 V/cm. Additionally, a potentially strong correlation (r = −0.624) was discovered between the electric field threshold and pre-treatment prostate-specific antigen levels, which needs to be validated in higher enrollment studies. Taken together, these findings can be used to guide the development of future IRE protocols.
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Affiliation(s)
- Sabrina Campelo
- Laboratory for Therapeutic Directed Energy, Department of Physics, Elon University, Elon, North Carolina 27244, USA
| | | | | | - Yipeng Hu
- Centre for Medical Image Computing, University College London, London WC1E 6BT, United Kingdom
| | | | - Robert E Neal
- AngioDynamics, Marlborough, Massachusetts 01752, USA
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Ouzzane A, Betrouni N, Valerio M, Rastinehad A, Colin P, Ploussard G. Focal therapy as primary treatment for localized prostate cancer: definition, needs and future. Future Oncol 2016; 13:727-741. [PMID: 27882770 DOI: 10.2217/fon-2016-0229] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Focal therapy (FT) may offer a promising treatment option in the field of low to intermediate risk localized prostate cancer. The aim of this concept is to combine minimal morbidity with cancer control as well as maintain the possibility of retreatment. Recent advances in MRI and targeted biopsy has improved the diagnostic pathway of prostate cancer and increased the interest in FT. However, before implementation of FT in routine clinical practice, several challenges are still to overcome including patient selection, treatment planning, post-therapy monitoring and definition of oncologic outcome surrogates. In this article, relevant questions regarding the key steps of FT are critically discussed and the main available energy modalities are analyzed taking into account their advantages and unmet needs.
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Affiliation(s)
- Adil Ouzzane
- Department of Urology, CHRU de Lille, Hôpital Claude Huriez, F-59037 Lille, France.,NSERM, U1189, ONCO-THAI, F-59037 Lille, France
| | | | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Pierre Colin
- Department of Urology, Hôpital Privé de la Louvière, Ramsay Générale de Santé, 59000 Lille, France
| | - Guillaume Ploussard
- Institut universitaire du Cancer de Toulouse - Oncopole, Toulouse, France.,Department of Urology, Saint-Jean Languedoc Hospital, Toulouse, France
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20
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Valerio M, Dickinson L, Ali A, Ramachadran N, Donaldson I, Mccartan N, Freeman A, Ahmed HU, Emberton M. Nanoknife Electroporation Ablation Trial: A Prospective Development Study Investigating Focal Irreversible Electroporation for Localized Prostate Cancer. J Urol 2016; 197:647-654. [PMID: 27697580 DOI: 10.1016/j.juro.2016.09.091] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Irreversible electroporation has attractive attributes for focal ablation, namely nonthermal effect, precise demarcation of treatment and tissue selectivity. We report a prospective development study investigating focal irreversible electroporation. MATERIALS AND METHODS A total of 20 men with certain characteristics were recruited for study, including a visible index lesion on anterior magnetic resonance imaging that was concordant with transperineal targeted and template prostate mapping biopsy, absent clinically significant disease noted elsewhere (University College London definition 2) and prostate specific antigen 15 ng/ml or less. Our primary objective was to determine the side effect profile at 12 months. Secondary objectives included the domain specific toxicity profile using patient reported outcomes and early disease control using magnetic resonance imaging targeted biopsy. RESULTS A total of 19 patients with median age of 60 years (IQR 53-66) and median prostate specific antigen 7.75 ng/ml (IQR 5.5-10.03) were treated. Of the patients 16 were available for estimating the first outcome as 1 was lost to followup and 2 had received another form of treatment by study end. All 16 men had pad-free/leak-free continence at 12 months. The proportion of men with erection sufficient for penetration decreased from 12 of 16 (75%) to 11 of 16 (69%). No serious adverse events were recorded. There was a statistically significant improvement in urinary symptoms according to changes in UCLA-EPIC (UCLA Expanded Prostate Cancer Index Composite) and I-PSS (International Prostate Symptom Score) (p = 0.039 and 0.001, respectively). Erectile function remained stable according to the change in IIEF-15 (15-Item International Index of Erectile Function) (p = 0.572). Median prostate specific antigen significantly decreased to 1.71 ng/ml (p = 0.001). One man refused followup biopsy. No residual disease was found in 11 patients (61.1%). One man (5.6%) harbored clinically insignificant disease and the remaining 6 (33.3%) harbored clinically significant disease. CONCLUSIONS Focal irreversible electroporation has low genitourinary toxicity. Additional studies are needed to optimize patient selection and treatment parameters.
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Affiliation(s)
- Massimo Valerio
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom; Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Louise Dickinson
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Afia Ali
- Department of Mental Health Sciences, University College London, London, United Kingdom
| | - Navin Ramachadran
- Department of Radiology, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Ian Donaldson
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Neil Mccartan
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Alex Freeman
- Department of Histopathology, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Hashim U Ahmed
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
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21
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Perera M, Krishnananthan N, Lindner U, Lawrentschuk N. An update on focal therapy for prostate cancer. Nat Rev Urol 2016; 13:641-653. [DOI: 10.1038/nrurol.2016.177] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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22
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Ultrasound validation of mathematically modeled irreversible electroporation ablation areas. Surgery 2016; 159:1032-40. [DOI: 10.1016/j.surg.2015.10.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/06/2015] [Accepted: 10/28/2015] [Indexed: 12/18/2022]
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23
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Hirst AM, Frame FM, Arya M, Maitland NJ, O'Connell D. Low temperature plasmas as emerging cancer therapeutics: the state of play and thoughts for the future. Tumour Biol 2016; 37:7021-31. [PMID: 26888782 PMCID: PMC4875936 DOI: 10.1007/s13277-016-4911-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 01/22/2016] [Indexed: 12/19/2022] Open
Abstract
The field of plasma medicine has seen substantial advances over the last decade, with applications developed for bacterial sterilisation, wound healing and cancer treatment. Low temperature plasmas (LTPs) are particularly suited for medical purposes since they are operated in the laboratory at atmospheric pressure and room temperature, providing a rich source of reactive oxygen and nitrogen species (RONS). A great deal of research has been conducted into the role of reactive species in both the growth and treatment of cancer, where long-established radio- and chemo-therapies exploit their ability to induce potent cytopathic effects. In addition to producing a plethora of RONS, LTPs can also create strong electroporative fields. From an application perspective, it has been shown that LTPs can be applied precisely to a small target area. On this basis, LTPs have been proposed as a promising future strategy to accurately and effectively control and eradicate tumours. This review aims to evaluate the current state of the literature in the field of plasma oncology and highlight the potential for the use of LTPs in combination therapy. We also present novel data on the effect of LTPs on cancer stem cells, and speculatively outline how LTPs could circumvent treatment resistance encountered with existing therapeutics.
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Affiliation(s)
- Adam M Hirst
- Department of Physics, York Plasma Institute, University of York, Heslington, UK
| | - Fiona M Frame
- YCR Cancer Research Unit, Department of Biology, University of York, Heslington, UK
| | | | - Norman J Maitland
- YCR Cancer Research Unit, Department of Biology, University of York, Heslington, UK
| | - Deborah O'Connell
- Department of Physics, York Plasma Institute, University of York, Heslington, UK.
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Postema AW, De Reijke TM, Ukimura O, Van den Bos W, Azzouzi AR, Barret E, Baumunk D, Blana A, Bossi A, Brausi M, Coleman JA, Crouzet S, Dominguez-Escrig J, Eggener S, Ganzer R, Ghai S, Gill IS, Gupta RT, Henkel TO, Hohenfellner M, Jones JS, Kahmann F, Kastner C, Köhrmann KU, Kovacs G, Miano R, van Moorselaar RJ, Mottet N, Osorio L, Pieters BR, Polascik TJ, Rastinehad AR, Salomon G, Sanchez-Salas R, Schostak M, Sentker L, Tay KJ, Varkarakis IM, Villers A, Walz J, De la Rosette JJ. Standardization of definitions in focal therapy of prostate cancer: report from a Delphi consensus project. World J Urol 2016; 34:1373-82. [PMID: 26892160 PMCID: PMC5026990 DOI: 10.1007/s00345-016-1782-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 02/02/2016] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To reach standardized terminology in focal therapy (FT) for prostate cancer (PCa). METHODS A four-stage modified Delphi consensus project was undertaken among a panel of international experts in the field of FT for PCa. Data on terminology in FT was collected from the panel by three rounds of online questionnaires. During a face-to-face meeting on June 21, 2015, attended by 38 experts, all data from the online rounds were reviewed and recommendations for definitions were formulated. RESULTS Consensus was attained on 23 of 27 topics; Targeted FT was defined as a lesion-based treatment strategy, treating all identified significant cancer foci; FT was generically defined as an anatomy-based (zonal) treatment strategy. Treatment failure due to the ablative energy inadequately destroying treated tissue is defined as ablation failure. In targeting failure the energy is not adequately applied to the tumor spatially and selection failure occurs when a patient was wrongfully selected for FT. No definition of biochemical recurrence can be recommended based on the current data. Important definitions for outcome measures are potency (minimum IIEF-5 score of 21), incontinence (new need for pads or leakage) and deterioration in urinary function (increase in IPSS >5 points). No agreement on the best quality of life tool was established, but UCLA-EPIC and EORTC-QLQ-30 were most commonly supported by the experts. A complete overview of statements is presented in the text. CONCLUSION Focal therapy is an emerging field of PCa therapeutics. Standardization of definitions helps to create comparable research results and facilitate clear communication in clinical practice.
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Affiliation(s)
- A W Postema
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands.
| | - T M De Reijke
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - O Ukimura
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - W Van den Bos
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - A R Azzouzi
- Department of Urology, Angers University Hospital, Angers, France
| | - E Barret
- Department of Urology, Institut Montsouris, Université Paris Descartes, Paris, France
| | - D Baumunk
- Department of Urology, Magdeburg University Medical Center, Magdeburg, Germany
| | - A Blana
- Department of Urology, Fuerth Hospital, Fuerth, Germany
| | - A Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | - M Brausi
- Department of Urology, Ospedale Civile Ramazzini, Carpi, Italy
| | - J A Coleman
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - S Crouzet
- Department of Urology and Transplantation, Edouard Herriot Hospital, Lyon, France
| | - J Dominguez-Escrig
- Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain
| | - S Eggener
- Department of Urology, University of Chicago, Chicago, IL, USA
| | - R Ganzer
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - S Ghai
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
| | - I S Gill
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - R T Gupta
- Departments of Radiology, Duke University Medical Center, Durham, NC, USA
| | - T O Henkel
- Urologische Praxis Dr. Henkel & Dr. Kahmann, Berlin, Germany
| | - M Hohenfellner
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - J S Jones
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - F Kahmann
- Urologische Praxis Dr. Henkel & Dr. Kahmann, Berlin, Germany
| | - C Kastner
- CamPARI Prostate Cancer Clinic, Cancer Directorate, Cambridge University Hospitals Trust, Cambridge, UK
| | - K U Köhrmann
- Department of Urology, Theresien Krankenhaus Mannheim, Mannheim, Germany
| | - G Kovacs
- Interdisciplinary Brachytherapy Unit, University of Lübeck, Lübeck, Germany
| | - R Miano
- Division of Urology, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - R J van Moorselaar
- Department of Urology, Free University Medical Centre, Amsterdam, The Netherlands
| | - N Mottet
- Department of Urology, University Hospital St Etienne, Saint-Étienne, France
| | - L Osorio
- Department of Urology, Porto Hospital Centre, Porto, Portugal
| | - B R Pieters
- Departments of Radiation Oncology, AMC University Hospital, Amsterdam, The Netherlands
| | - T J Polascik
- Departments of Surgery, Duke University Medical Center, Durham, NC, USA
| | - A R Rastinehad
- Department of Urology, Hofstra North Shore-Lij, Hofstra University, Hempstead, NY, USA
| | - G Salomon
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - R Sanchez-Salas
- Department of Urology, Institut Montsouris, Université Paris Descartes, Paris, France
| | - M Schostak
- Department of Urology, Magdeburg University Medical Center, Magdeburg, Germany
| | - L Sentker
- Urologische Gemeinschaftspraxis, Sinsheim, Germany
| | - K J Tay
- Departments of Surgery, Duke University Medical Center, Durham, NC, USA
| | - I M Varkarakis
- 2nd Department of Urology, Athens Medical University, University of Athens, Athens, Greece
| | - A Villers
- Department of Urology, Lille University Medical Center, Lille, France
| | - J Walz
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | - J J De la Rosette
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands
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Wendler JJ, Fischbach K, Ricke J, Jürgens J, Fischbach F, Köllermann J, Porsch M, Baumunk D, Schostak M, Liehr UB, Pech M. Irreversible Electroporation (IRE): Standardization of Terminology and Reporting Criteria for Analysis and Comparison. Pol J Radiol 2016; 81:54-64. [PMID: 26966472 PMCID: PMC4760650 DOI: 10.12659/pjr.896034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 09/22/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Irreversible electroporation (IRE) as newer ablation modality has been introduced and its clinical niche is under investigation. At present just one IRE system has been approved for clinical use and is currently commercially available (NanoKnife® system). In 2014, the International Working Group on Image-Guided Tumor Ablation updated the recommendation about standardization of terms and reporting criteria for image-guided tumor ablation. The IRE method is not covered in detail. But the non-thermal IRE method and the NanoKnife System differ fundamentally from established ablations techniques, especially thermal approaches, e.g. radio frequency ablation (RFA). MATERIAL/METHODS As numerous publications on IRE with varying terminology exist so far - with numbers continuously increasing - standardized terms and reporting criteria of IRE are needed urgently. The use of standardized terminology may then allow for a better inter-study comparison of the methodology applied as well as results achieved. RESULTS Thus, the main objective of this document is to supplement the updated recommendation for image-guided tumor ablation by outlining a standardized set of terminology for the IRE procedure with the NanoKnife Sytem as well as address essential clinical and technical informations that should be provided when reporting on IRE tumor ablation. CONCLUSIONS We emphasize that the usage of all above recommended reporting criteria and terms can make IRE ablation reports comparable and provide treatment transparency to assess the current value of IRE and provide further development.
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Affiliation(s)
- Johann J Wendler
- Department of Urology, University of Magdeburg, Magdeburg, Germany
| | | | - Jens Ricke
- Department of Radiology, University of Magdeburg, Magdeburg, Germany
| | - Julian Jürgens
- Department of Radiology, University of Magdeburg, Magdeburg, Germany
| | - Frank Fischbach
- Department of Radiology, University of Magdeburg, Magdeburg, Germany
| | - Jens Köllermann
- Department of Pathology, Sana Klinikum Offenbach a. M., Offenbach Am Main, Germany
| | - Markus Porsch
- Department of Urology, University of Magdeburg, Magdeburg, Germany
| | - Daniel Baumunk
- Department of Urology, University of Magdeburg, Magdeburg, Germany
| | - Martin Schostak
- Department of Radiology, University of Magdeburg, Magdeburg, Germany
| | - Uwe-Bernd Liehr
- Department of Urology, University of Magdeburg, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology, University of Magdeburg, Magdeburg, Germany
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26
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Abstract
Prostate cancer represents a spectrum ranging from low-grade, localized tumors to devastating metastatic disease. We discuss the general options for treatment and recent developments in the field.
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Affiliation(s)
- Katherine Cotter
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Badrinath Konety
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Maria A Ordonez
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, 55455, USA
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27
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Pennell CP, Hirst AD, Campbell WB, Sood A, Agha RA, Barkun JST, McCulloch P. Practical guide to the Idea, Development and Exploration stages of the IDEAL Framework and Recommendations. Br J Surg 2016; 103:607-15. [PMID: 26865013 DOI: 10.1002/bjs.10115] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/11/2015] [Accepted: 12/21/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Evaluation of new surgical procedures is a complex process challenged by evolution of technique, operator learning curves, the possibility of variable procedural quality, and strong treatment preferences among patients and clinicians. Preliminary studies that address these issues are needed to prepare for a successful randomized trial. The IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up) Framework and Recommendations provide an integrated step-by-step evaluation pathway that can help investigators achieve this. METHODS A practical guide was developed for investigators evaluating new surgical interventions in the earlier phases before a randomized trial (corresponding to stages 1, 2a and 2b of the IDEAL Framework). The examples and practical tips included were chosen and agreed upon by consensus among authors with experience either in designing and conducting IDEAL format studies, or in helping others to design such studies. They address the most common challenges encountered by authors attempting to follow the IDEAL Recommendations. RESULTS A decision aid has been created to help identify the IDEAL stage of an innovation from literature reports, with advice on how to design and report the IDEAL study formats discussed, along with the ethical and scientific rationale for specific recommendations. CONCLUSION The guide helps readers and researchers to understand and implement the IDEAL Framework and Recommendations to improve the quality of evidence supporting surgical innovation.
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Affiliation(s)
- C P Pennell
- Department of Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - A D Hirst
- IDEAL Collaboration, Nuffield Department of Surgical Science, Oxford, UK
| | - W B Campbell
- Interventional Procedures and Medical Technologies Advisory Committees, National Institute for Health and Care Excellence, London, UK
| | - A Sood
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - R A Agha
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J S T Barkun
- Department of Surgery, Division of Hepatobiliary and Transplant Surgery, McGill University Health Centre, Royal Victoria Hospital. Montreal, Quebec, Canada
| | - P McCulloch
- IDEAL Collaboration, Nuffield Department of Surgical Science, Oxford, UK
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28
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Ting F, Tran M, Böhm M, Siriwardana A, Van Leeuwen PJ, Haynes AM, Delprado W, Shnier R, Stricker PD. Focal irreversible electroporation for prostate cancer: functional outcomes and short-term oncological control. Prostate Cancer Prostatic Dis 2015; 19:46-52. [PMID: 26458959 DOI: 10.1038/pcan.2015.47] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 08/25/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Current data on the use of irreversible electroporation (IRE) in the treatment of prostate cancer (PCa) is limited. We aim to evaluate the safety, short-term functional and oncological outcomes of focal IRE in low-intermediate risk PCa. METHODS Between February 2013 and May 2014, 32 consecutive men underwent IRE at a single centre. Patients with low-intermediate risk PCa who had not received previous PCa treatment were included for analysis. The tumour was ablated using 3-6 electrodes, ensuring a minimum 5-mm safety margin around the visible magnetic resonance imaging (MRI) lesion. Follow-up included recording Clavien complications, Expanded Prostate Cancer Index Composite (EPIC) questionnaires (baseline, 1.5, 3, 6 months), 6-month multi-parametric MRI (mp-MRI) and 7-month biopsy. Findings on mp-MRI and biopsy were sub-divided into infield, adjacent or outfield of the treatment zone. RESULTS Twenty-five men were included for final analysis. Safety follow-up revealed one Clavien Grade 3 complication and five Grade 1 complications. Functional follow-up confirmed no significant change in American Urological Association urinary symptom score, sexual or bowel function. Infield, there were no suspicious findings on mp-MRI (n=24) or biopsy (n=21) in all patients. Adjacent to the treatment zone, five (21%) had suspicious findings on mp-MRI with four (19%) proving to be significant on biopsy. Outfield, there were two (8%) with suspicious findings on mp-MRI and one (5%) significant finding on biopsy. For the five patients with significant findings on follow-up biopsy, one is awaiting repeat IRE, one had radical prostatectomy and three remained on active surveillance. CONCLUSIONS In selected patients with low-intermediate risk PCa, focal IRE appears to be safe with minimal morbidity. There were no infield recurrences and 76% of patients were histologically free of significant cancer at 8 months. Almost all recurrences were adjacent to the treatment zone, and this was addressed by widening the treatment margins.
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Affiliation(s)
- F Ting
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - M Tran
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - M Böhm
- Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | - A Siriwardana
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - P J Van Leeuwen
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | - A M Haynes
- Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | - W Delprado
- Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia
| | - R Shnier
- Southern Radiology, Randwick, NSW, Australia
| | - P D Stricker
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, NSW, Australia
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Valerio M, Ahmed HU, Emberton M. Focal Therapy of Prostate Cancer Using Irreversible Electroporation. Tech Vasc Interv Radiol 2015; 18:147-52. [DOI: 10.1053/j.tvir.2015.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Belfiore MP, Ronza FM, Romano F, Ianniello GP, De Lucia G, Gallo C, Marsicano C, Di Gennaro TL, Belfiore G. Percutaneous CT-guided irreversible electroporation followed by chemotherapy as a novel neoadjuvant protocol in locally advanced pancreatic cancer: Our preliminary experience. Int J Surg 2015; 21 Suppl 1:S34-9. [PMID: 26118600 DOI: 10.1016/j.ijsu.2015.06.049] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 03/19/2015] [Accepted: 04/10/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Irreversible electroporation (IRE) is a non-thermal ablation technique recently used in pancreatic cancer. In our prospective study we evaluated safety, feasibility and efficacy of a neoadjuvant protocol based on CT-guided percutaneous IRE followed by chemotherapy in patients with locally advanced pancreatic cancer (LAPC). METHODS We performed CT-guided percutaneous IRE in 20 patients with LAPC, followed by a combination of gemcitabine (1000 mg/mq) and oxaliplatin (100 mg/mq) biweekly. Imaging follow-up was performed by a contrast enhanced CT scan at 1, 3, 6 months and then every 3 months. RESULTS No major complications occurred. Two patients died 3 and 4 months after IRE because of rapidly progressive disease. In the remaining 18 patients 6-month imaging follow-up showed a mean lesions volumetric decrease percentage of 42.89% (95% Confidence Interval: 34.90-54.88%). Thanks to lesions downstaging, three patients underwent R0 resection. At last available follow-up (mean follow-up 91 months; range 6-14), imaging showed no disease progression or post-surgical relapse in all 18 cases. The mean estimated survival was 12,950 months (95% CI: 11,570-14,332). CONCLUSIONS Our preliminary study suggests that IRE followed by chemotherapy is safe, feasible and effective in producing local control of LAPC, with a possible downstaging effect to resectable lesions.
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Affiliation(s)
- Maria Paola Belfiore
- Department of Clinical and Experimental Medicine, "F. Magrassi - A. Lanzara" Second University of Naples, Piazza Miraglia 2, 80131 Naples, Italy.
| | - Francesco Michele Ronza
- Department of Diagnostic Imaging, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy
| | - Francesco Romano
- Department of Informatics, Second University of Naples, Piazza Miraglia 2, 80131 Naples, Italy
| | | | - Guido De Lucia
- Department of Oncology, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy
| | - Concetta Gallo
- Department of Anaesthesiology and Rianimation, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy
| | - Carmela Marsicano
- Department of Anaesthesiology and Rianimation, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy
| | - Teresa Letizia Di Gennaro
- Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Piazza Miraglia 2, 80131 Naples, Italy
| | - Giuseppe Belfiore
- Department of Diagnostic Imaging, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy
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Veereman G, Jonckheer P, Desomer A, Van Brabandt H, D'Hont C, Van Velthoven R, Tombal B. Systematic Review of the Efficacy and Safety of High-intensity Focussed Ultrasound for Localised Prostate Cancer. Eur Urol Focus 2015; 1:158-170. [PMID: 28723429 DOI: 10.1016/j.euf.2015.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/01/2015] [Accepted: 04/25/2015] [Indexed: 11/19/2022]
Abstract
CONTEXT High-intensity focussed ultrasound (HIFU) has been used for 10 yr to treat localised prostate cancer (PCa). OBJECTIVE To evaluate systematically the evidence on the efficacy and side effects of HIFU in the primary treatment of localised PCa. EVIDENCE ACQUISITION We performed a critical review and appraisal of Medline (Ovid), PreMedline, Embase, and Cochrane Database of Systematic Reviews publications on HIFU up to May 2013. One systematic review and 18 primary studies, all case series, were eligible. EVIDENCE SYNTHESIS Outcomes were summarised and evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluation methodology. Low-quality evidence suggests an overall survival rate after Ablatherm HIFU ranging from 80% to 89% for >5 yr. The PCa survival rate ranges from 97% to 99% for >5 yr. Effect of HIFU on quality of life remains undetermined. Erectile dysfunction was the most frequent adverse event reported from zero but up to 74% of patients. Adverse events affecting the urinary tract occurred in 0.7-31% of patients, bladder outlet obstruction in 4-51.5%, and they were more frequent in patients who had transurethral resection of the prostate the same day or within 2 d of HIFU. Outcomes vary for low- and high-risk categories. CONCLUSIONS Good quality evidence on the efficacy of HIFU treatment for localised PCa is lacking. PATIENT SUMMARY We reviewed all the data on treatment with high-intensity focussed ultrasound (HIFU) for localised prostate cancer (PCa). The quality of the evidence is very low because the information is based on a series of patients who received HIFU treatment with no comparison with active surveillance or radical treatment. Case series suggest an overall survival rate up to 89% and a PCa survival rate up to 99% after 5 yr, but these numbers vary according to the patient's risk category. Longer term and effects on quality of life are unknown.
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Affiliation(s)
| | | | - Anja Desomer
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | | | - Chris D'Hont
- Department of Urology, AZ Middelheim, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
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Irreversible electroporation for nonthermal tumor ablation in patients with hepatocellular carcinoma: initial clinical experience in Japan. Jpn J Radiol 2015; 33:424-32. [PMID: 26032929 DOI: 10.1007/s11604-015-0442-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/20/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE This clinical study was conducted to evaluate the safety and short-term outcomes of irreversible electroporation (IRE) for the treatment of patients with hepatocellular carcinoma (HCC) in Japan. MATERIALS AND METHODS The study was designed in a prospective setting. Five patients (3 men and 2 women; mean age, 66.6 ± 5.8 years) with 6 HCCs were enrolled and treated using percutaneous ultrasound (US)-guided IRE. Safety was assessed based on adverse events and laboratory values. Local control was assessed using contrast-enhanced US with a perflubutane microbubble contrast agent, contrast-enhanced multiphase CT, and gadoxetic acid-enhanced MRI (EOB-MRI) at designated points. RESULTS The tumors ranged in diameter from 11 to 28 mm (mean diameter, 17.5 ± 6.3 mm). Five of the 6 tumors (83 %) were successfully treated, with no local recurrence to date (mean follow-up 244 ± 55 days). In 1 lesion located in liver segment 1, residual tumor was diagnosed at 7 days after intervention by follow-up EOB-MRI. No serious complications related to the IRE procedure were observed. CONCLUSION The results of this study suggest that image-guided percutaneous IRE can achieve satisfactory local disease control, particularly for small HCCs, and is well tolerated by patients.
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34
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Affiliation(s)
- Philipp Dahm
- Urology Section, Minneapolis VA Health Care System and Department of Urology, University of Minnesota, Minneapolis, MN, USA
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35
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Wendler JJ, Porsch M, Nitschke S, Köllermann J, Siedentopf S, Pech M, Fischbach F, Ricke J, Schostak M, Liehr UB. A prospective Phase 2a pilot study investigating focal percutaneous irreversible electroporation (IRE) ablation by NanoKnife in patients with localised renal cell carcinoma (RCC) with delayed interval tumour resection (IRENE trial). Contemp Clin Trials 2015; 43:10-9. [PMID: 25962890 DOI: 10.1016/j.cct.2015.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/30/2015] [Accepted: 05/04/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Focal ablation therapy is playing an increasing role in oncology and may reduce the toxicity of current surgical treatments while achieving adequate oncological benefit. Irreversible electroporation (IRE) has been proposed to be tissue-selective with potential advantages compared with current thermal-ablation technologies or radiotherapy. The aim of this pilot trial is to determine the effectiveness and feasibility of focal percutaneous IRE in patients with localised renal cell cancer as a uro-oncological tumour model. METHODS Prospective, monocentric Phase 2a pilot study following current recommendations, including those of the International Working Group on Image-Guided Tumor Ablation. Twenty patients with kidney tumour (T1aN0M0) will be recruited. This sample permits an appropriate evaluation of the feasibility and effectiveness of image-guided percutaneous IRE ablation of locally confined kidney tumours as well as functional outcomes. Percutaneous biopsy for histopathology will be performed before IRE, with magnetic-resonance imaging one day before and 2, 7, 27 and 112 days after IRE; at 28 days after IRE the tumour region will be completely resected and analysed by ultra-thin-layer histology. DISCUSSION The IRENE study will investigate over a short-term observation period (by magnetic-resonance imaging, post-resection histology and assessment of technical feasibility) whether focal IRE, as a new ablation procedure for soft tissue, is feasible as a percutaneous, tissue-sparing method for complete ablation and cure of localised kidney tumours. Results from the kidney-tumour model can provide guidance for designing an effectiveness and feasibility trial to assess this new ablative technology, particularly in uro-oncology.
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Affiliation(s)
- J J Wendler
- Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Germany.
| | - M Porsch
- Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Germany
| | - S Nitschke
- Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Germany
| | - J Köllermann
- Institute of Pathology, Sana Klinikum Offenbach, Offenbach am Main, Germany
| | - S Siedentopf
- Institute of Pathology, University Hospital, Otto von Guericke University of Magdeburg, Germany
| | - M Pech
- Department of Radiology, University Hospital, Otto von Guericke University of Magdeburg, Germany
| | - F Fischbach
- Department of Radiology, University Hospital, Otto von Guericke University of Magdeburg, Germany
| | - J Ricke
- Department of Radiology, University Hospital, Otto von Guericke University of Magdeburg, Germany
| | - M Schostak
- Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Germany
| | - U B Liehr
- Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Germany
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Shah TT, Kasivisvanathan V, Jameson C, Freeman A, Emberton M, Ahmed HU. Histological outcomes after focal high-intensity focused ultrasound and cryotherapy. World J Urol 2015; 33:955-64. [PMID: 25944676 PMCID: PMC4480821 DOI: 10.1007/s00345-015-1561-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/13/2015] [Indexed: 01/28/2023] Open
Abstract
Introduction Focal therapy has increasingly become an accepted treatment option for patients with localised prostate cancer. Most follow-up protocols use a mixture of protocol biopsies or “for cause” biopsies triggered by a rising PSA. In this paper, we discuss the histological outcomes from these biopsies and their use in guiding subsequent management and trial development. Methods We conducted a literature search and reviewed the post-treatment biopsy results from studies on focal HIFU and focal cryotherapy. We subsequently reviewed the results of three recently published consensus statements released discussing many of the issues concerning focal therapy. Results Research suggests that 1 in 5 of all post-treatment biopsies after focal therapy are positive. However, the majority of these seemed to be from the untreated portion of the gland or met criteria for clinically insignificant disease. The histological outcomes from focal therapy are promising and confirm its effectiveness in the short to medium term. Furthermore re-treatment is possible whilst maintaining a low-side-effect profile. Conclusion Debate is ongoing about the clinical significance of various levels of residual disease after focal therapy and the exact threshold at which to call failure within a patient who has had focal therapy.
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Affiliation(s)
- Taimur T Shah
- Division of Surgery and Interventional Science, Urology Research Group, UCL, Room 4.23, 4th Floor, 132 Hampstead Road, London, NW1 2PS, UK,
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Mendez MH, Joh DY, Gupta R, Polascik TJ. Current Trends and New Frontiers in Focal Therapy for Localized Prostate Cancer. Curr Urol Rep 2015; 16:35. [DOI: 10.1007/s11934-015-0513-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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